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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
Q

Which condition?

  • Stress fx/overloading of pars interarticularis
  • Trunk ext/hyperext
  • Trunk ext/rotation
  • Dancers, football
A

Spondylolysis

26
Q

What are the 5 high risk sports for spondylolysis?

A
  1. Classic ballet
  2. Gymnastics
  3. Figure skating
  4. Football linemen
  5. Diving
27
Q

What are the 2 major concerns for Spondylolysis?

A
  1. persistent pain
  2. _Risk of progression to spondylolisthesis*_
28
Q

which condition has a positive spork test?

A

Spondylolysis

29
Q

How do you dx Spondylolysis?

A
  • Positive stork test
  • X-rays
    • AP
    • lateral (most sens for spondylolisthesis)
    • lateral oblique (most specific- scotty dog defect)
      *
30
Q

Dx for Spondylolysis:

What 3 x-ray views do you order and why?

A
  • AP
  • Lateral- most sensitive for spondylolithesis
  • Lateral oblique (scotty dog) - most specific
31
Q

If you see a “scotty dog” defect on lateral oblique x-ray, what condition is this most specific for?

A

Spondylolysis

32
Q

Which condition?

  • Maladaption from repetitive mechanical stress
  • Osteoclast activity > osteoblast
A

Stress rxn

33
Q

What is seen in a Grade I stress rxn?

A

Periosteal edema

34
Q

What is seen in a Grade II-III stress rxn?

A

Varying severity bone marrow edema

35
Q

What is seen in a Grade IV stress rxn?

A

Cortical fracture line

36
Q

What is conservative tx for spondylolysis?

A
  • 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
Q

Although sx for Spondylolisthesis is rarely indicated, when would you do sx?

A

Grade III approaching grade IV

or grade IV spondylolisthesis

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

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