Lumbar Flashcards
Lbp radiating below knee means:
More in the butt?
Disc injury
Disc herniation
Common Medical Dx for LBP
Fx Neoplasm Cauda equina Ankylosing spondylitis Spinal infection
Risk factor for neoplasm
Sign/symptom
Cancer
>50
Unexplained weight loss
Constant pain
No relief
Night pain
Saddle anesthesia
Bladder dysfunction
Progrssive LE symptoms?
Cauda Equina
Characteristics of Ankylosing Spondylitis
Male <35 Night pain Stiff Symptoms reduce with activity
History of spinal infection?
Characteristics?
Recent spine surgery/infection
IV drug abuse
Immunosuppresion
Fever
Deep pain/rigidity
Bony landmarks
Iliac crest
ASIS
PSIS
Fib heads
Tightness where contributes to back pain>?
Gastrcos Quads Hammys Hip flexors Glute max Hip add Rotators
Where does most motion in forward bending come from?
L4/5
L5/S1
5 cm is norm.
Less than 3 indicates pathology
Weakness where contributes to back pain?
Quads Glutes Hip abd Back extensors Abs
L5 nerve root affected by
S1?
L4/L5 disc
L5/S1 disc
ST of lumbar?
SLR Slump Crossed Leg test Neural Tension Test Flip test (sitting ROOT Test) Valsalva Maneuver Piriformis test Prone instability test .
Clinical Dx involving Low back?
Herniated disc/radiculopathy Ligament sprain (facet) Muscle strain Spondylolisis/lysthesis Spondylosis (OA or stenosis) Fx Post surgical SIJD
Etiology of lumbar radiculopathy?
Prognosis?
<55
Good but longer than nonspecific
Signs of radiculopathy
Pain below knee and worse at butt than back
Nerve root signs
Pain worse at sitting
+ SLR at 40 deg
Iv for radiculopathy?
Extension exercises
Force lordosis?
Presence of Fx in pars intraarticularis
Presence of vertebra that has slipped forward due to bilateral Fx?
Spondylolysis
Spondyloslisthesis
What to look for for Spondylolysis and listhesis?
Pain worth with extension movement (slips ant)
Better with flexion posture
SCotty dog collar on Xray
Slippage grades for spodylolysis/listhesis
I: 1/4 slipped forward
II:1/2
III:3/4
IV: most slipped.
How is Spondylosis Dx Tx?
Xray/MRI
Stablility exercise/ maintain neutral
Hip mobs
Caused by bone encroachment into spinal canal or intervertebral foramen 2ndary to degenerative changes
Stenosis
Spinal canal (central)
Intervertebral lateral stenosis
Increase with ext decrease with flexion
How to differentiate between claudication and Stenosis?
Stationary bike makes it worse for claudication
+ Dx for stenosis?
4 out of 5
Bilateral Leg pain > back Pain with walk/stand Decrease pain in sitting >48
Ossification of SPinal ligaments and jt capsule?
Tx?
Ankylosing Spondylitis
Mobility decrease over time
Maintain extension/lordosis ROM
Should traction be used?
Not really?
