Low back pain quiz 3 Flashcards
Most episodes of low back pain include all the following except
- older age
- carpal tunnel syndrome
- scoliosis
- spinal stenosis
carpal tunnel syndrome
With the straight leg raising test the NP is evaluating tension on which nerve
- L1L2
- L3L4
- L5S1
- S2S3
L5 S1
Sciatica is
Sciatica:“associatedpain*syndrome”
Sciatic produces paresthesias where
paresthesias extending down the leg in a dermatomal pattern (nerve roots L4, L5, S1, S2, S3
Spondylolisthesis
forward displacement of vertebrae
Spondylosis
stress fracture forward onto next vertebral body
-seen in hyperextension sports (diving, gymnastics, wt. lifting, +FH)
Scotty Dog sign:
break in the “dog collar” corresponds to a fx in the region of the pars interarticularis – specific sign for spondylosis
Risk Factors for LBP
Overweight
Mechanical disorders (scoliosis, kyphosis)
Non-mechanical disorders (prostate CA, pelvis & renal disease)
Occupational strain
Leg length differences (measure)
Poor posture – don’t slouch
Poor body mechanics
what is the most comfortable position for someone with LBP
lying down
Cauda Equina syndrome
anal laxity, bladder dysfunction , lower extremity weakness
perianal and perineal weakness
Knee extension with weaknesses and foot drop
Herniated Disc
Radicular pain – shooting, electric to below the knee. Goes down the center of the butt/thigh
and around the leg.
Herniated Disc pain is worsen with
Valsalva maneuvers
Herniated disc can not
walk on heels and tiptoes
Unable to walk on toes is
S1
Unable to walk on heels
L4 and L5
L4-5 nerve root dysfunction
weakness in dorsiflexion of ankle or great toe
Perform straight leg raise sitting & lying is
Gold standard
L3 – L4 Disc prolapse will produce
Pain in front of thigh
Wasting of quadriceps muscles may be present
Diminished sensation on the front of the thigh and medial lower lag
Reduced knee jerk (mostly L4)
L4 – L5 Disc prolapse
Pain along posterior or posteriolateral thigh w/ radiation to the top of foot
Weakness on dorsiflexion of the great toe and foot
Paresthesia and numbness of foot and great toe
No reflex changes noted
L5 – S1 Disc prolapse
pain along posterior thigh w/ radiation to the heel
Weakness on plantar flexion – may be absent
Sensory loss in the lateral foot
Absent ankle jerk reflex (mostly S1)
positive waddell sign
3out of 5 present Distraction:inconsistentpainresponseafterdistraction
• Overreaction to slight touch
• Regionalization: pain that radiates to an anatomically incorrect region
• Simulation:axial loading and rotation
•Tenderness:superficial and diffuse tenderness and/or non anatomictenderness
Low back pain red flags
Possible fracture with MVA , trauma, fall >50 <20 H/o cancer pain worsens when supine severe night time pain fever chills wt. loss infection, IVDA, immunosuppression
DTR @ S1
ankle
DTR @ S4
Knee
Diagnostic test for LBP
Nojustificafionforimagingstudiesw/infirst30daysof complaintwhenallotherthingsareexcluded*
Backpainpersists>4weeks what diagnostic test should be performed?
cbc,ESR,X-ray,bonescan*
Suspected stenosis diagnostic test
MRI, CT
suspected sciatica
Surgeon, MRI, CT, EMG
absent or decreased ankle jerk suggest
S1
diminished knee jerk is suggestive of
L34 herniation
Pain below the knee at less than 70 degrees of elevation that is aggravated by dorsiflexion of the ankle or hip rotation is a sign of
L5-S1 nerve root tension
sprain is
injury to a ligament
Strain is
trama to muscle or muscular skeletal unit
fracture
loss of continuity of the bone
s/s of a lumbar sacral strain
minimal pain at event but increases w/stiffness 12-36 hours later as soft tissue swells
pain with a Lumbar sacral strain is located where
back can radiate to the buttocks
Pain is increased w/movement or standing and relieved with rest is consistent with a
Lumbar scacral strain
Herniated disk pain is
radicular pain shooting electric pain to below the knee
worsened with valsalva maneuver
Herniated disc
Herniated disk creates numbness where
along the nerve root
L5S1 pain is located
posterior or posteriolateral thigh w/ radiation to the top of foot
L5 S1 Weakness
on plantar flexion
L5 S1 can see sensory loss
in the lateral foot
L5 S1 absent
ankle jerk
Most common complaint for runners
Patellofemerolpainsyndrome(PFPS)
ACl you will see
Pop =joint effusion, w+ anterior drawer test
Knee X-ray indications after acute knee injury:
aged 55 years or over
tenderness at the head of the fibula
isolated tenderness of the patella
inability to flex knee to 90 degrees
inability to bear weight (defined as an inability to take four steps, ie. two steps on each leg, regardless of limping) immediately and at presentation
is the Ottawa Knee rule
