Lumbar

Question 1

Lumbar stats

Answer 1

• 8 of 10 Americans will experience a back problem at some point during their lifetime
• The number of Americans with back pain is on the rise, especially > 65
• Back problems are more common in adult women than men
• The CDC’s research shows nearly 1/3 o f suffer from back problems compared to ¼ of men

Approximately ½ of all pregnant women will suffer from back pain

•39% of adults say back pain impacts everyday activities including sleep

•54% of Americans with back pain have desk jobs

•2-5% of doctor visits are for back pain

9 out of 10 people who seek medical treatment for low back pain do find out the primary cause (non specific low back pain)

•Only 5% of Pts with back pain have back surgery

Question 2

BULGE

Answer 2

ANY ABNORMALITY OF ANNULAR FIBERS; APPARENT IN 30% OF POULATION; 3 OR MORE; AYSMPTOMATIC

Question 3

PROTRUSION

Answer 3

•NUCLEUS HAS SLIPPED THROUGH TEARS IN ANNULUS; THERE IS PRESSURE ON THECAL SAC AND/OR NERVE ROOT; NUCLEUS IS CONTIGUOUS

Question 4

PROLAPSE

Answer 4

•NUCLEUS IS NOT CONTIGUOUS; MOTHER AND DAUGHTER NUCLEUS; PRESSURE ON THECAL SAC AND/OR NERVE ROOT

Question 5

SEQUESTATION

Answer 5

•NUCLEUS HELD IN PLACE ONLY BY POSTERIOR LONGITUDINAL LIGAMENT; PRESSURE ON THECAL SAC AND/OR NERVE ROOT

Question 6

LUMBAR DISC HERNIATION

Answer 6

•3 OF 4 MUST BE PRESENT

1. PRIMARY COMPLAINT IS LEG PAIN (MAY HAVE BACK PAIN)
2. PAIN FOLLOWS A SPECIFIC DERMATOMAL PATTERN
3. NEURAL STRETCH TESTS ARE POSITIVE
4. 2 OF 4 NEURO POSITIVE

Question 7

•SCIATICA:

Answer 7

•A feeling in the lower extremity of numbness, tingling, pins & needles, a feeling like it’s “falling asleep” or any combination of these

Question 8

LUMBAR DISC HERNIATION
•WHAT IS OUR SEQUENCE FOR EXAMINING A PATIENT?

Answer 8

• Hx
• Inspection
• Palpation
• Percussion
• Instrumentation
• ****X-RAY???
• ROM
• Orthopedic Evaluation
• Neurological Evaluation
• Examination of Related Areas

Question 9

LUMBAR DISC HERNIATION

•ROM:

Answer 9

decrease in ALL planes

Question 10

NEURO EVAL

Answer 10

• DTR’S
• DERMATOMES
• MYO STRENGTH
• GIRTH

Question 11

EXAMINATION OF RELATED AREAS

Answer 11

• Abdomen
• Hip
• Knee

Question 12

TREATMENT OF DISC HERNIATION

•CONSIDER:

Answer 12

•Function of motor unit

•INFLAMMATION

• Myo spasm
• Support
• ADL’s
• Work preclusions
• Home care

Question 13

OSTEOARTHRITIS (AND OTHER ARTHRITIDES)

CDC:

Answer 13

• Risk of arthritis increases with age
• More common among women
• 2015 – 54.4 M US adults (22.7% of population) had Doctor-Dx of arthritis
• Most common is OA then RA then gout
• By 2040, 78 M (26%) projected to have doctor-diagnosed arthritis
• Adults with arthritis are 2.5X more likely to fall and suffer further injury
• 2011 - $62.1 B

Question 14

OSTEOARTHRITIS (AND OTHER ARTHRITIDES)

•ETIOLOGY:

Answer 14

• Aging
• Trauma/joint injury
• Congenital anomaly
• Stresses on joints from certain jobs or sports

Question 15

OSTEOARTHRITIS (AND OTHER ARTHRITIDES)

symptoms

Answer 15

• LB pain
• Worse in AM or after sleep/rest
• Worse after getting up after no movement (gelling phenomenon)
• Better after movement
• Periodic swelling/redness

Question 16

OSTEOARTHRITIS (AND OTHER ARTHRITIDES)

ROM

Answer 16

decrease in all planes

Question 17

OSTEOARTHRITIS (AND OTHER ARTHRITIDES)

•NEURO EXAM:

Answer 17

• MYO strength
• Reflexes
• Dermatomes
• Girth

Question 18

OSTEOARTHRITIS (AND OTHER ARTHRITIDES)

•EXAMINE RELATED AREAS:

Answer 18

• Abdomen
• Funduscopic
• HIP
• KNEE

Question 19

OSTEOARTHRITIS

•X-RAY IS DIAGNOSTIC

Answer 19

asymmetrical loss of joint space, subchondral sclerosis, osteophyte formation

Question 20

•MANAGEMENT OF THE ARTHRITIDES:

Answer 20

• Reduce pain
• Maintain or improve ROM
• Improve ADL’s

Question 21

Malingering

Answer 21

•to pretend illness or injury especially in order to shirk one’s work duty or for monetary gain

Question 22

MALINGERING findings

Answer 22

•THE SUBJECTIVE COMPLAINTS AND OBJECTIVE FINDINGS DO NOT MATCH THE PATIENT’S COMPLAINTS