Lumbar Flashcards
Lumbar stats
- 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
BULGE
ANY ABNORMALITY OF ANNULAR FIBERS; APPARENT IN 30% OF POULATION; 3 OR MORE; AYSMPTOMATIC
PROTRUSION
•NUCLEUS HAS SLIPPED THROUGH TEARS IN ANNULUS; THERE IS PRESSURE ON THECAL SAC AND/OR NERVE ROOT; NUCLEUS IS CONTIGUOUS
PROLAPSE
•NUCLEUS IS NOT CONTIGUOUS; MOTHER AND DAUGHTER NUCLEUS; PRESSURE ON THECAL SAC AND/OR NERVE ROOT
SEQUESTATION
•NUCLEUS HELD IN PLACE ONLY BY POSTERIOR LONGITUDINAL LIGAMENT; PRESSURE ON THECAL SAC AND/OR NERVE ROOT
LUMBAR DISC HERNIATION
•3 OF 4 MUST BE PRESENT
- PRIMARY COMPLAINT IS LEG PAIN (MAY HAVE BACK PAIN)
- PAIN FOLLOWS A SPECIFIC DERMATOMAL PATTERN
- NEURAL STRETCH TESTS ARE POSITIVE
- 2 OF 4 NEURO POSITIVE
•SCIATICA:
•A feeling in the lower extremity of numbness, tingling, pins & needles, a feeling like it’s “falling asleep” or any combination of these
LUMBAR DISC HERNIATION
•WHAT IS OUR SEQUENCE FOR EXAMINING A PATIENT?
- Hx
- Inspection
- Palpation
- Percussion
- Instrumentation
- ****X-RAY???
- ROM
- Orthopedic Evaluation
- Neurological Evaluation
- Examination of Related Areas
LUMBAR DISC HERNIATION
•ROM:
decrease in ALL planes
NEURO EVAL
- DTR’S
- DERMATOMES
- MYO STRENGTH
- GIRTH
EXAMINATION OF RELATED AREAS
- Abdomen
- Hip
- Knee
TREATMENT OF DISC HERNIATION
•CONSIDER:
•Function of motor unit
•INFLAMMATION
- Myo spasm
- Support
- ADL’s
- Work preclusions
- Home care
OSTEOARTHRITIS (AND OTHER ARTHRITIDES)
CDC:
- 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
OSTEOARTHRITIS (AND OTHER ARTHRITIDES)
•ETIOLOGY:
- Aging
- Trauma/joint injury
- Congenital anomaly
- Stresses on joints from certain jobs or sports
OSTEOARTHRITIS (AND OTHER ARTHRITIDES)
symptoms
- LB pain
- Worse in AM or after sleep/rest
- Worse after getting up after no movement (gelling phenomenon)
- Better after movement
- Periodic swelling/redness
OSTEOARTHRITIS (AND OTHER ARTHRITIDES)
ROM
decrease in all planes
OSTEOARTHRITIS (AND OTHER ARTHRITIDES)
•NEURO EXAM:
- MYO strength
- Reflexes
- Dermatomes
- Girth
OSTEOARTHRITIS (AND OTHER ARTHRITIDES)
•EXAMINE RELATED AREAS:
- Abdomen
- Funduscopic
- HIP
- KNEE
OSTEOARTHRITIS
•X-RAY IS DIAGNOSTIC
asymmetrical loss of joint space, subchondral sclerosis, osteophyte formation
•MANAGEMENT OF THE ARTHRITIDES:
- Reduce pain
- Maintain or improve ROM
- Improve ADL’s
Malingering
•to pretend illness or injury especially in order to shirk one’s work duty or for monetary gain
MALINGERING findings
•THE SUBJECTIVE COMPLAINTS AND OBJECTIVE FINDINGS DO NOT MATCH THE PATIENT’S COMPLAINTS
