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MJ- F3 E2: MSK/Rheum > Lumbar > Flashcards

Lumbar Flashcards

1
Q

Acute low back pain= New onset LBP < ___ weeks duration

A

Acute low back pain= New onset LBP < 12 weeks duration

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2
Q

What 3 structures are involved in LBP and which is MC?

A
  1. Facet joints (MC)
  2. Ligamentous structure
  3. Paravertebral spinal muscle
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3
Q

What are the 4 common mechanisms of injury of LBP?

A
  1. Poor Lifting technique
  2. Carrying excessive load
  3. Making a sudden movement
  4. Falls
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4
Q

Acute LBP typically follows pattern of what?

A

irritated facet joint

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5
Q

Which condition?

  • TTP over involved facet joint
  • Pain w/ extension and rotation–> facet joint compression
  • Tightness/pain w/ forward flexion
  • Difficulty arising from seated position
  • Nml neuro (negative straight leg raise)
A

Acute LBP

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6
Q

What What are the 7 components of Acute LBP management?

A
  1. Avoid complete bedrest
  2. Ice/heat
  3. Stretching (hamstring & hip flexors)
  4. NSAIDs (Ketorolac) or short course of prednisone
  5. Acetaminophen
  6. Muscle Relaxers (Cyclobenzaprine, Metaxalone, Carisporodol)
  7. PT
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7
Q

How long does Acute LBP usually last?

A

Most cases self limited

Several days to 4 weeks

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8
Q

What 4 sxs does Lumbar Radiculopathy cause?

A
  1. Pain
  2. Sensory impairment
  3. Weakness
  4. Diminished DTRs

(distribution key to determining involved nerve root)

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9
Q

What special test would be positive in a lumbar radiculopathy?

A

Straight leg raise

(seated straight leg raise would also be positive)

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10
Q

What does straight leg raise evaluate for?

A

Sciatic nerve irritation

Lumbar nerve root irritation

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11
Q

Supine leg raise:

Radicular pain brought on w/ testing of the contralateral leg is highly specific for what?

A

Lumbar nerve root entrapment/irritation

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12
Q

What imaging is used to evalulate Lumbar radiculopathy?

A
  • 1st: X-ray
  • If neg, try conservative tx
  • if doesn’t get better- consider MRI
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13
Q

How do you tx Lumbar radiculopathy (5)

A
  1. 1st line: NSAIDs, PT
  2. Prednisone
  3. Injections
  4. Epidural (max 3)
  5. Sx?
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14
Q

What condition?

  • Bilateral sciatica (pain radiating down legs)
  • Bilateral LE weakness
  • Saddle anesthesia
  • Sphincter dysfunction (DRE)
  • Bowel/bladder dysfunction
    *
A

Cauda Equina Syndrome

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15
Q

How do you treat cauda equina syndrome?

A

Emergent Neurosurgery consult

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16
Q

What condition?

  • Disc degeneration
  • arthritic changes involving lumbar vertebrae and facet joints
  • Thickening of ligamentum flavum
  • Bone spurs
  • Narrowing of spinal canal and nerve root canal
A

Lumbar Spinal stenosis

17
Q

Clinical presentation of what condition?

  • >50y/o
  • Insidious onset
  • Start w/ LBP and morning stiffness
  • Pain expands to buttocks and LE
  • Neurogenic claudication
  • _Shopping cart sign**_
  • WEAKNESS NOT COMMON
  • Nml neuro
A

Lumbar SPinal stenosis

18
Q

Which condition has the shopping cart sign?

A

Lumbar Spinal Stenosis

(b/c leaning forward relieves pressure, lessening sxs)

19
Q

Lumbar spinal stenosis:

  • Weakness not common, but if it is present you may see what 2 things
A
  • Partial foot drop
  • Plantar flexion weakness w/ prolonged walking
20
Q

What 3 diagnostic studies are used to evaluate lumbar spinal stenosis?

A
  • X-rays
  • MRI
  • arterial US to r/o vascular claudication
21
Q

What is Spondylolistheis?

A
  • Forward translation of one vertebra on another
  • often occurs during growth spurt
22
Q

What are grades 1-4 for Spondylolisthesis?

A

Grade 1- < 25% translation

Grade 2- < 50% translation

Grade 3- < 75% translation

Grade 4- < 100% translation

23
Q

How do you tx Lumbar spinal stenosis? (9)

A
  • NSAIDs/Acetaminophen
  • Duloxetine
  • Amitryptiline (for sleep)
  • Gabapentin
  • _Weight loss***_
  • PT/OT
  • epidural injections
  • Radiofrequency ablation
  • Sx- spinal cord stimulator, fusion
24
Q

What condition?

  • Defect/ stress fx in pars interarticularis of the lumbar vertebra
  • NO neuro sxs or radiculopathy
  • MC women
A

Spondylolysis

25
Which condition? * Stress fx/overloading of pars interarticularis * Trunk ext/hyperext * Trunk ext/rotation * Dancers, football
Spondylolysis
26
What are the 5 high risk sports for spondylo**_lysis_**?
1. Classic ballet 2. Gymnastics 3. Figure skating 4. Football linemen 5. Diving
27
What are the 2 major concerns for **Spondylo**_lysis_**?**
1. persistent pain 2. _**Risk of progression to spondylolisthesis\***_
28
which condition has a **positive spork test**?
Spondylolysis
29
How do you dx Spondylo**_lysis_**?
* **Positive stork** test * X-rays * AP * **lateral** (most sens for **spondylolisthesis**) * **lateral oblique** (most specific- **scotty dog** defect) *
30
Dx for Spondylolysis: What 3 x-ray views do you order and why?
* AP * Lateral- most sensitive for spondylolithesis * Lateral oblique (scotty dog) - most specific
31
If you see a "**scotty dog**" defect on lateral oblique x-ray, what condition is this most specific for?
Spondylolysis
32
Which condition? * Maladaption from repetitive mechanical stress * Osteoclast activity \> osteoblast
Stress rxn
33
What is seen in a **Grade I** stress rxn?
Periosteal edema
34
What is seen in a **Grade II-III** stress rxn?
Varying severity bone marrow edema
35
What is seen in a **Grade IV** stress rxn?
Cortical fracture line
36
What is conservative tx for spondylolysis?
* **Activity restriction** weeks 1-4 * **PT** weeks 5-12 (LE flexibility, core strength) * **Gradual activity progression** weeks 9-12 * **Full return to activity** * **_Brace_** consideration
37
Although sx for Spondylolisthesis is rarely indicated, when would you do sx?
Grade III approaching grade IV or grade IV spondylolisthesis

MJ- F3 E2: MSK/Rheum (7 decks)

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