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OMM M1T2E3 > Low Back Pain > Flashcards

Low Back Pain Flashcards

1
Q

What are 5 common causes of low back pain?

A

fracture, strain, disc herniation, infection, referred pain

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2
Q

90% of all back pain will resolve within ___ weeks; 99% in ___ weeks

A

6, 12 weeks

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3
Q

What are 3 goals of LBP treatment?

A

hasten recovery, control pain and facilitate rehabilitation

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4
Q

What are red flags for LBP?

A

bilateral radicular pain, saddle area anesthesia, urinary incontinence, urinary retention, increased urinary frequency or incontinence, night sweats (cancer)

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5
Q

What are the most serious things that red flags could be?

A

Acute Cauda Equina syndrome, massive multi-nerve compression, large central disc herniation, hemorrhage into spinal canal, swelling of tumor

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6
Q

How is Cauda Equina Syndrome treated and in what time frame?

A

Emergency!!! 24 - 48 hours Surgical decompression

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7
Q

What are the risk factors for possible fracture?

A

major trauma, fall from height, female over age 50 or other risk factors for osteoporosis

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8
Q

What are the risk factors for infection?

A 
HIstory-over age 50
-under age 20
-fever or chills
-worse pain supine
-recent UTI
-IV drug abuse
-immune suppression
Physical Exam - temperature, spinous process percussive pain
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9
Q

What are the risk factors for tumors?

A
  • over 50, under 20
  • unexplained weightloss
  • pain worse when supine
  • severe nocturnal pain
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10
Q

During the physical exam, what must be ruled out with fever?

A

infectious etiology of back pain - osteomyelitis, pyelonephritis

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11
Q

During the physical exam, what must be ruled out with weak or rapid pulse or BP?

A

retroperitoneal hemorrhage

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12
Q

What 6 things should be observed on the back?

A

congenital skin lesions, rashes, skin infection, bruising, erythema, scars/lacerations/abrasions

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13
Q

During flexion ROM what 3 additional aspects should be recorded?

A

finger to floor distance, persistence of lordosis and shober test

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14
Q

Describe Shober test.

A

Mark between PSIS, and then 5 cm down and 10 cm up. When flexed marks should increase to 20 cm.

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15
Q

A positive Trendelenberg test indicates weakness of what muscle?

A

gluteus medius muscle

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16
Q

Which nerve innervates the gluteus medius muscle?

A

L5

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17
Q

What is the cause of compromise to L5 nerve?

A

disc herniation, spinal tumor, intraspinal abscess

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18
Q

How would you test for sciatic nerve?

A

Straight leg raising

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19
Q

What muscle tightness can be mistaken for sciatic nerve pain?

A

hamstring muscles

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20
Q

List the two areas of seated percussion and reason.

A

Flank - Lloyd sign, renal pathology

Spinous process - fracture, tumor, infection (osteomyelitis, abcess)

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21
Q

What three things are tested in a neurologic exam?

A

muscle strength, reflexes, sensation

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22
Q

Describe reflex grading.

A 
0 - absent
1 - decresed
2 - normal
3 - increased but normal
4 - clonus (spasm)
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23
Q

What is clonus and what does it indicate?

A

alternating muscle contraction and relaxation in rapid succession; indicates disconnect between UMN and LMN

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24
Q

What nerves are being tested at patellar reflex, Achilles reflex, superficial anal reflex?

A

L4/S1/S2-S4

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25
Q

What does Babinski sign indicate?

A

Disconnect between UMN and LMN; multiple sclerosis, amyotrophic lateral sclerosis; cerebrovascular accident or brain tumor

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26
Q

Describe the grades of muscle strength.

A

0 - flaccid paralysis
1 - palpate muscle contraction but muscle cannot move affected part
2 - can move body part with gravity eliminated
3 - can move body part against gravity
4 - can move body part against gravity with some resistance
5 - full strength an full resistance

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27
Q

Peripheral muscle weakness with LBP indicates ?

A

presence of neural compression if Grade 3-4 (spinal cord, nerve root, peripheral nerve) Grade 0-2(CNS - CVA, Guillain Barre, MS)

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28
Q

If the iliopsoas was weak which levels could be affected?

A

L1-L3

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29
Q

If the quadriceps were weak which levels could be affected?

A

L2-L4

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30
Q

If the hip abductors were weak which levels could be affected?

A

L2 - L4

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31
Q

If the tibialis anterior was weak which levels could be affected?

A

L4

32
Q

If the extensor hallucis longus, extensor digitorum longus/brevis or gluteus medius were weak which levels could be affected?

A

L5

33
Q

If the fibularis longus/brevis or gluteus maximus were weak which levels could be affected?

A

S1

34
Q

If the gastrocnemius or soleus were weak which levels could be affected?

A

S1 & S2

35
Q

What is the most overlooked muscle for the cause of LBP?

A

quadratus lumborum

36
Q

List OMT treatments for LBP.

A

counterstrain for tenderpoints; ME/HVLA restrictions

37
Q

What is the quality of the pain in somatic dysfunction of LBP?

A

achy, muscle spasm

38
Q

LBP may be acute, chronic or both?

A

both

39
Q

Where does most back pain problem occur?

A

Multifidus triangle

40
Q

Exacerbation of LBP during iliopsoas strength testing often indicates the presence of what type of pain?

A

discogenic

41
Q

A patient comes in with flexed contraction of the iliopsoas and a positive Thomas test. What is dx?

A

psoas syndrome

42
Q

What are the 5 organic etiologies of psoas syndrome?

A

appendicitis, sigmoid colon dysfunction, uretal caclculi or dysfunction, prostate CA mets, salpingitis

43
Q

What are treatment options for psoas syndrome?

A

Acute: ice
OMT: indirect followed by direct (counterstrain then ME/HVLA)
Chronic: stretching

44
Q

How would you test iliopsoas muscle (L1-L3)?

A

pt. seated, have pt lift bent leg and physician pushed down at knee

45
Q

How would you test quadriceps (L2-L4)?

A

pt. seated, leg extended; physician pushes down on leg

46
Q

How would you test hip adductors (L2-L4)?

A

pt is supine; physician pulls legs out while patient pushes in

47
Q

How would you test tibialis anterior (L4)?

A

Have pt. supinate foot (motor), patellar reflex and sensation on medial malleolus

48
Q

How would you test extensor hallucis longus (L5)?

A

Extend halluces longus (motor), no reflex, sensation on top of foot

49
Q

How would you test gluteus medius (L5)?

A

pt on side and have them lift leg while physician pushes down

50
Q

How would you test fibularis longus and brevis (S1)?

A

pronate foot (motor), Achilles tendon reflex, and sensation on outer part of foot

51
Q

How would you test gluteus maximus (S1)?

A

pt is pronate with leg bent at knee. Have patient lift thigh while physician presses down

52
Q

How would you test the gastrocnemius & soleus (S1 & S2)?

A

Have pt hop

53
Q

Where would you test sensation for L1-L3?

A

anterior thigh

54
Q

Where would you test L4?

A

medial side of foot

55
Q

Where would you test L5?

A

web space between great toe and second toe

56
Q

Where would you test S1?

A

lateral side of foot

57
Q

Where would you test S2-S5?

A

perianal skin

58
Q

What are three modalities for sensation testing?

A

pain (pin prick), light touch (wisp of gauze), vibration (tuning fork)

59
Q

LBP may be referred pain from abdomen. What three things would you palpate for in the abdomen?

A

guarding response; masses; abdominal aneurysm (auscultate for bruits)

60
Q

How would you produce the valsalva test?

A

Patient is supine. place hand on midabdominal area and increase pressure while patient pushes back. Patient’s face should turn red/purple. Positive test is reproduction of pain.

61
Q

The valsalva test will exacerbate symptoms in any space occupying ______ in the _____ _____.

A

lesion, spinal canal

62
Q

During the Naffziger test the physician compresses which veins?

A

jugular veins

63
Q

Describe Soto Hall test.

A

Patient is supine. Restrain the sternum and flex the neck. Pain is elicited at site of spinal disorder.

64
Q

What three tests are available to diagnose sacroiliac joint pain?

A

pelvic rock test, Gaenslen test, Patrick test

65
Q

What three things can the Patrick test identify?

A

sacroilitis, hip joint disease, pain reproduction test

66
Q

How is the Patrick test abbreviated?

A

FABERE (flexion, abduction, external rotation, extension)

67
Q

What does the Nachalas test indicate?

A

pain radiating down the anterior thigh implies femoral nerve entrapment

68
Q

For how many seconds should a patient be able to hold raised shoulders or legs for normal truncal strength testing?

A

10 seconds

69
Q

What degenerative changes happen in spinal stenosis?

A

hypertrophy of facet joints, Ca2+ deposits in ligamentum flavum/posterior longitudinal ligament and loss of intervertebral disc height

70
Q

What treatments are available for spinal stenosis?

A

OMT, PT, NSAIDs, epidural steroid injection, surgical laminectomy

71
Q

What is the quality of pain in a herniated nucleus propulsus?

A

numbness, tingling, sharp burning, shooting pain worsens with flexion

72
Q

What is the quality of pain in spinal stenosis?

A

achy, shooting pain, paresthesis, worsened by extension

73
Q

What tests would be used to diagnose herniated nucleus propulsus?

A

decreased reflexes, sensory deficit, positive straight leg test, MRI (Gold standard)

74
Q

What OMT technique is generally contraindicated in herniated nucleus propulsus?

A

HVLA

75
Q

What type of supportive care can be offered with LBP?

A

medical management of pain control, therapeutic exercise, OMT

OMM M1T2E3 (9 decks)

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