Low Back Pains, Sprains, & Strains Flashcards
1
Q
where does the spinal cord terminate?
A
T12-L2
2
Q
why is radiating pain concerning?
A
could indicate spinal cord/nerve root compression
3
Q
what does localized pain indicate? (4)
A
muscular strain
ligamentous sprain
facet joint injury
fracture
4
Q
pain that persists despite changes in spine position indicates what?
A
inflammation
5
Q
pain that varies depending on spine position and can be relieved/exacerbated indicates what kind of injury?
A
mechanical injury
6
Q
where should the pelvic iliac crest lie?
A
L4-L5 interspace
7
Q
what 3 muscle testing occurs in the neuro levels of L1, L2, and L3?
A
iliopsoas
quadriceps
hip adductor group
8
Q
main flexor of the hip; place hand over distal femur while patient raises thigh against resistance
A
iliopsoas
9
Q
muscle associated with the femoral nerve; patient extends knee/leg against resistance
A
quadriceps
10
Q
muscle associated with obturator nerve; patient adducts legs against resistance
A
hip adductor group
11
Q
dermatomes that cover the anterior thigh between the inguinal ligament and knee joint
A
L1, L2, L3
12
Q
what reflex testing is done for neuro level L4?
A
patellar tendon reflex
13
Q
which muscle testing occurs in the neuro level of L4?
A
tibialis anterior
14
Q
what 2 nerves are associated with the tibialis anterior muscle in the L4?
A
deep peroneal (fibular) nerve
tibial nerve
15
Q
when we place resistance against patient’s dorsiflexion and inversion, what muscle are we testing?
A
tibialis anterior
16
Q
dermatome that covers the medial side of the lower leg
A
L4
17
Q
which muscle testing occurs in the neuro level of L5?
A
extensor hallucis longus
18
Q
what nerve is associated with the extensor hallucis longus?
A
deep peroneal (fibular) nerve
19
Q
dermatome that covers the dorsum of the foot
A
L5
20
Q
what reflex test is done for neuro level S1?
A
achilles tendon reflex
21
Q
what 2 muscle testing occurs in the neuro level of S1?
A
peroneus (fibularis) longus + brevis
grastroc-soleus
22
Q
what nerve is associated with peroneus longus and brevis?
A
superficial peroneal (fibular) nerve
23
Q
what nerve is associated with gastroc-soleus?
A
tibial nerve
24
Q
what 2 ROM test is for peroneus (fibularis) longus and brevis?
A
plantarflexion and eversion of foot
25
what ROM test is for gastroc-soleus?
plantarflexion of foot
26
dermatome that covers the lateral malleolus, and the lateral and plantar surface of the foot
S1
27
what reflex testing is for neuro levels S3 and S4?
superficial anal reflex
28
2 dermatomes that are around the anus
S3 and S4
29
muscle reflex grading associated with 0 muscle strength (no muscle contraction)
absent (0)
30
muscle reflex grading associated with muscle contraction but unable to produce joint motion
diminished reflexes (1)
31
muscle reflex grading associated with 2 muscle strength (muscle contraction with full ROM of joint without force of gravity)
normal (2)
32
muscle reflex grading associated with 3 muscle strength (full ROM against gravity but without resistance)
hyperactive without clonus (3)
33
muscle reflex grading associated with moderate resistance and full resistance
hyperactive with clonus (4)
34
what does an abnormal babinski test indicate?
upper motor neuron lesion
35
what does an positive clonus test indicate?
CNS disease
36
test used to assess sciatic nerve compromise d/t lumbosacral nerve root irritation
Lasegue test (straight leg raise test)
37
during a straight leg raise test (lasegue test), a patient has pain on their posterior thigh. where is the problem?
hamstring
38
during a straight leg raise test (lasegue test), a patient has pain all the way down their leg. where is the problem?
sciatic
39
patient experiences pain along their lower limb in the same distribution of the lower radicular nerve roots (L5 or S1) at an angle of <45 degrees. what test was this?
straight leg raise test (lasegue test)
40
what is the most common cause of a positive straight leg raise test (lasegue test)?
lumbar disc herniation
41
after performing a straight leg raise test (lasegue test), the provider lowers the leg 5-10 degrees and dorsiflexes the foot to reproduce the same pain. what test is this?
bragard sign
42
what should we think about when a patient presents with midline back pain? (3)
musculoligamentous injury
disc herniation
vertebral fracture
43
what should we think about when a patient presents with back pain that is off midline? (3)
sacroiliitis
trochanteric bursitis
hip arthritis
44
occurs from lifting, bending twisting
can radiate to buttocks but NOT legs
restricted ROM
inability to maintain posture d/t pain
muscle spasms with activity or rest
persists for max 10-14 days
sprain/strain
45
a patient presents with paraspinal muscle tenderness, pain with back movement, and loss of normal lumbar curvature. what is their most likely Dx?
lumbar sprain/strain
46
what should NOT be present in a lumbar sprain or strain? (2)
motor/sensory loss
reflex abnormalities
47
what is the first line imaging for lower back pain, but is not necessary if the exam is normal?
plain film xray
48
what should be ordered when we are concerned for nerve pathology, infection or a mass with low back pain?
MRI
49
what is the treatment for acute, mechanical low back pain? (3)
NSAIDs
rest
physical therapy
*+/- PO steroids*
*+/- IM steroid injection*
50
what does an increased lordotic curve the cervical spine indicate? (2)
poor posture
muscular weakness/imbalance
51
what does a decreased lordotic curve the cervical spine indicate? (2)
muscular spasm/guarding
nerve root impingement
52
what does tenderness to C7 indicate?
stretched nucal ligament d/t neck flexion injury (whiplash)
53
where does flexion and extension of the neck occur?
occiput and C1
54
where does rotation of the neck occur?
C1 and C2
55
where do cervical nerves 1-7 exit?
above the cervical vertebra
56
where does cervical nerve 8 exit?
below C7 and above T1
57
what are the 5 peripheral nerves of the brachial plexus?
musculocutaneous nerve (forearm)
axillary nerve
radial nerve (dorsum of hand)
median nerve
ulnar nerve
58
what 2 muscles are associated with neuro level C5? and what nerve are they associated with?
deltoid - axillary n
biceps - musculocutaneous n
59
what reflex can be performed at the neuro level of C5?
biceps reflex
60
dermatome that covers the lateral side of the arm
C5
61
what nerve does sensory testing of the C5 neuro level test?
axillary nerve
62
what 2 muscles are associated with neuro level C6? and what nerve are they associated with?
wrist extension - radial n
biceps - musculocutaneous n
63
what reflex test can be performed at the C6 neuro level?
brachioradialis reflex
64
what nerve does sensory testing of the C6 neuro level test?
musculocutaneous n
65
dermatome that convers the lateral forearm, thumb and index finger
C6
66
what 3 muscles are associated with neuro level C7? and what nerve are they associated with?
triceps - radial n
wrist flexion - median/ulnar n
finger extension - radial n
67
what reflex test can be performed at the C7 neuro level?
triceps reflex
68
dermatome that covers the middle finger
C7
69
what 2 muscles are associated with neuro level C8? and what nerve are they associated with?
finger flexors - median/ulnar n
interossei muscle - median/ulnar n
70
dermatome that covers the little finger, ring finger, and medial forearm
C8
71
what is a cervical sprain/strain commonly called?
whiplash
72
a patient presents with neck pain, stiff neck, headache, dizziness, and pain in the shoulder/between shoulder blades. Dx?
cervical sprain/strain
73
what is the treatment for a cervical sprain/strain? (2)
NSAIDs
physical therapy
*+/- muscle relaxants*
74
what imaging should be done for a cervical sprain/strain?
xrays
75
what are the 2 most common causes of cervical trauma?
MVA
fall from height
76
what should be done with a patient with cervical trauma? (6)
assess ACBD
avoid head tilt-chin lift
cervical collar
eval LOC
neuro exam
rectal exam
77
what should be done for a patient who presents with cervical trauma from MVC, fall, assault, or sports injury?
immobilize with C collar
78
what imaging should be done for cervical trauma?
xray
79
what imaging should be done for cervical trauma if we are concerned about a neuro deficit?
CT/MRI
80
cervical nerve root compression leads to what?
cervical radiculopathy
81
a patient presents with neck pain, sharp burning or tingling pain down one or both arms. Dx?
cervical radiculopathy
82
what commonly causes cervical radiculopathy? (2)
arthritis
herniated cervical disc
83
patient lies supine, clinician stabilizes head at chin and occiput, passive traction force straight up off cervical spine relieves symptoms
distraction test
84
patient lies supine, clinician applies axial traction on top of patient's head and increases the pain
axial cervical compression test
85
extension of neck, rotating of head with axial downward pressure with increased pressure on side that is rotated
spurling's test
86
what is the first line imaging for cervical radiculopathy?
xrays
87
what tests nerve root function and is helpful if symptoms are believed to be from peripheral nerve compression?
EMG/NCV
88
what is the main goal in cervical radiculopathy?
determine root cause and refer
89
cervical cord compression
cervical myelopathy
90
a patient presents with neck pain with bilateral weakness and paresthesias in both upper and lower extremities. Dx?
cervical myelopathy
91
what is the most common cause of cervical myelopathy?
large disc herniation
92
neck flexion that causes worsened symptoms
Lhermitte's sign
93
flicking the nail of the middle finger causes reflexes in the index finger and thumb; used for cervical myelopathy
hoffman's test
94
series of quick alternating movements of flexion and extension of the wrist; used for cervical myelopathy
wrist clonus
95
what is needed if there is a positive hoffman's sign or wrist clonus?
MRI
96
compression of the subclavian artery / brachial plexus between the clavicle and 1st rib or tightened anterior and middle scalene muscles
thoracic outlet syndrome
97
a patient presents with muscle fatigue, ischemic pain, discoloration, parasthesias, weakness, and muscle wasting. Dx?
thoracic outlet syndrome
98
patient seated, arms at sides, radial pulse palpated; have patient rotate their head to side being tested and extend the neck; abduct and externally rotate the arm and have pt take deep breath and hold - a positive test results in diminished radial pulse, numbness, and tingling. what test is this and what is it used for?
adson's test
thoracic outlet syndrome
99
what should all patients with thoracic outlet syndrome receive?
vascular + neuro referral
100
what is the management for thoracic outlet syndrome? (3)
physical therapy
weight loss
NSAIDs
101
painfully twisted and tilted neck that usually resolves in several days to a couple of weeks
torticollis (wry neck)
102
what is the treatment for torticollis (wry neck)? (4)
physical therapy
stretching
NSAIDs
muscle relaxants
103
what is the treatment for chronic spasms of torticollis (wry neck)?
botox injections
