lower extremity spine Flashcards
what history ? is especially important for
LBP?
numbness + tingling b/c could be serious or permanent
what muscles contribute to muscle tone of spine
paraspinals
what may cause scoliosis
neuromuscular dysfunction, congenital, idiopathic
kyphosis def
posterior curve
kyphosis causes
congenital, muscle imbalance, osteoporosis
lordosis def
excessive anterior curve
lordosis causes
congenital factors, muscle imbalance
cafe au lait macules def
spots or darkened area of skin pigmentation, may be collagen disease
faun’s beard def
tuft of hair that indicates spina bifida
what does congenital malformation of faun’s beard result in
incomplete closure of spinal vertebrae
how many lumbar vertebrae are there
5
lumbarization def
first sacral verebrae doesn’t unite w/ sacrum, leads to L6
sacralization def
when 5th lumbar vertebra becomes fused to sacrum and appears to be only 4 lumbar vertebrae
when someone says they threw their back out what does that usually mean
sprain a ligament of the back
intervertebral disc outer potion
annulus fibrosis
intervertebral disc inner portion
nucleus pulposus
annulus fibrosis composition
multilayered, thin posteriorly
nucleus pulposus composition
mostly made of water, very elastic
how many intervertebral discs are there
23
muscles involved with flexion of spine
rectus abdominis, external oblique, internal oblique
muscles involved with extension of spine
illiocostals, longissimus, spinalis, quadratus lumborum, semispinalis, rotatores, multifidi, interspinalis
which side of the muscles are involved with flexion and extension to that side
the same side ex) lateral flexion to right side uses right side of muscles
which side of muscles are used for rotation to the right
right side of muscles with the exception of left internal oblique
which side of muscles are used for rotation to the left
left side of muscles with the exception of right internal oblique
T12-L5 innervates what muscles
LUMBAR: anterior and medial muscles of thigh, medial leg, foot
L2-L4 posterior branches form what nerve
femoral nerve
L2-L4 anterior branches form what nerve
obturator
sacral plexus innervates what muscles
buttocks, posterior femur, lower leg
why are lumbar region reflexes so important
check bilaterally b/c a nerve could be compressed and cause major problems
what indicates scoliosis during a test
asymmetrical hump observed along the lateral aspect of the thoracolumbar spine and rib cage
should patient be sitting or standing for scoliosis test
standing and bend forward
valsalva maneuver test set up
patient seated, hold deep breath while bearing down to increase intrathecal pressure
+ valsalva maneuver test
increased spinal or radicular pain
what does + valsalva maneuver test indicate
herniated disc or other space occupying lesion
hoover test set up
patient supine, AT cup the heels of patient as their legs are extended
hoover test perform
straight leg raise as AT cups heels
hoover test +
lack of downward pressure felt in the opposite hand during the SLR
hoover test indicates
malingering patient
SLR set up
supine, one hand under the heel when the other is on the anterior knee to ensure full extension
+ SLR test
radiating pain in the involved leg
when are findings of SLR test highly significant
if elicited less than 30 deg hip flexion
what does + SLR test indicate
sciatic nerve compression/irritation
well SLR indicates
pain experienced on opposite side being raised= herniated disc or space occupying lesion
brudzinskis test set up
supine, SLR with cervical flexion
+ brudzinskis test
pain or radicular symptoms relieved w/ knee flexion
+ brudzinskis test indicates
disc herniation
milgram test set up
supine, perform bilateral SLR 2-6 inches above table and hold for 30 sec
+ milgram test
can’t hold position or experiences pain
why is milgram test bad
could mean disc herniation or could just mean weak core muscles
slump test set up
pt end of table and slumps forward will keeping spine neutral, knees extended and ankle dorsiflexed
+ slump test
sciatic pain or reproduction of neurological symptoms
tension sign test set up
supine with hip and knee flexed 90 deg
+ tension sign test
tender with possible sciatic symptoms
+ tension sign test indicates
sciatic nerve irritation
quadrant test set up
feet shoulder width apart, patient extends spine and side bends and rotates to the affected side
+ quadrant test
reproduction of symptoms
radicular symptoms after quadrant test indicate
nerve root compression, facet joint pathology, SI joint dysfunction
single leg stance test/standing stork test set up
patient standing, instruct patient to lift one leg and hyperextended the trunk
+ single leg stance test
pain in lumbar spine or SI area
+ single leg stance test indicates
a spondy
bilateral pars fractures result in pain when either leg is lifted for which special test
single leg stance
long sit/supine sit test set up
supine, grasp malleoli and ask patient to perform glute bridge
long sit/supine test +
involved leg goes from longer/shorter when supine to shorter/longer when sitting after glute bridge
+ long sit/supine test indicates
SI joint dysfunction
FABER test set up
patient supine with foot of involved side crossed over opposite thigh, place one hand on ASIS and the other on medial aspect of the flexed knee
+ FABER test
reproduction of symptoms in SI joint
gaenslen test set up
patient lying close to side of table and instruct to pull knee to chest, AT applies pressure near leg forcing the hip into extension
gaenslen test +
pain in SI region
SI joint compression test
patient side lying w/ painful side up, repeat on other side too, place hands on lateral aspect of pelvis and apply downward force
SI joint distraction test
place one hand on iliac crest, apply pressure through anterior portion of ilium spreading anterior portions of SI joints
sacral thrust test set up
prone, hands on top of each other over sacrum, apply anterior force through the sacrum
spring test set up
prone, hyopthernar eminence of one hand over spinous process to be tested, apply anterior force feeling for vertebral translation
+ spring test
vertebra does not spring or move excessively
+ spring test indicates
lumbar segmental hypomobility or hypermobility
lumbar contusion s/s
decreased ROM, spasm, stiffness, swelling
what is important to rule out for lumbar contusion
trauma to kidney and other organs
MOI lumbar sprains
direct trauma, sudden loading, rotational movement, extension and rotation, poor lifting mechanics
risk factor for lumbar sprains
weak abs
lumbar strain MOI
sudden contraction or stretching of musculature, poor lifting mechanics
tx lumbar strain
RICE, pain free strengthening, improve mechanics and muscular endurance
spinal stenosis
narrowing of spinal canal or intervertebral foramen, collapse of disc space
when is spinal stenosis common
50-60 years old
MOI spinal stenosis
degenerative
s/s spinal stenosis
pain w/ walking, absence of pain when seated, N+T, radiating pain
disc herniation def
extrusion of nucleus pulposus through annulus fibrosis
lumbar disc pathology MOI
repetitive loading, poor mechanics, posture, weak musculature
lumbar disc pathology special tests
SLR, Milgram, Slump, valsalva, kernig, brudzinski
what part of lumbar disc pathology eval requires immediate referall
cauda equina syndrome
facet joint dysfunction def
dislocation, subluxation, degeneration of facet
MOI facet joint dysfunction
gradual or acute, extension, rotation, lateral bending of vertebrae
+ test for facet joint dysfunction
quadrant test
tx facet joint dysfunction
williams flexion exercises, steroid injection, MRI
facet joint dysfunction s/s
localized pain over facet, muscle spasm, pain w/ extension
spondylalgia def
pain arising from vertebrae
spondylitis
inflammation of vertebrae
spondylolisthesis
forward slipping of vertebrae onto the one below it
spondylolysis
degeneration of vertebral structures
spondylopathy
disorder of vertebrae
spondylosis
arthritis or osteoarthritis of vertebrae placed on vertebral nerve roots
spondlylosis vs spondyloisthesis
pars interarticularis, collared scotty dog, localized pain
progression of ^, separation of vertebra, decapitated scotty dog
MOI spondylopathies
repeated extension
risk factor spondylopathies
adolescence, gymnast, weightlifters
s/s spondylopathies
pain, radiating, tender, spasm
+ test for spondlypathies
spring, standing stork
mobility of ___ mm or less indiciates SI dysfunction
2 mm
MOI SI dysfunction
fall on butt, stp into hole, gradual
risk factor women SI joint dysfunction
hormonal changes
