Lumbar Flashcards
What are the 10 serious conditions that need to be considered in a lumbar pain presentation?
Myocardial ischaemia Aortic dissection Retroperitoneal haemorrhage Osteomyelitis Tuberculosis Discitis Abscess Neoplasia Fracture Cauda equina
What are the signs and symptoms of cauda equina?
- severe localized central LBP, maybe sharp / stabbing pain in LL
- bladder and bowel incontinence
- sexual dysfunction
- saddle paraesthesia
- motor and sensory deficit LL
What are the signs and symptoms of an aortic dissection?
(must be considered as a DD for lumbar pain in patients with CV risk factors, esp. elderly patients)
- sudden onset severe pain (ripping / stabbing / tearing quality), maybe present in chest / Tx / Lx
- SOB
- difficulty speaking
- loss of vision
- difficulty walking / unilateral paralysis
- mental state change (distress, anxiety, confusion)
- collapse
- pulsatile abdo mass
What are the signs and symptoms of a vertebral compression fracture?
- acute midline back pain (can range from asymptomatic to severe)
- pain agg. by standing / sitting and relieved by lying down
- loss of height
- kyphotic deformity of spine
- maybe radiculopathy / myelopathy
What are the red flags for lumbar pain that indicate a serious cardiovascular condition?
SOB / dyspnoea palpitations pallor sweating mental state changes nausea / vomiting - SSX agg by activity
Which 4 infectious conditions can cause lumbar pain?
Osteomyelitis
Discitis
Abscess
Tuberculosis
What are some PROMs that can be used to measure lumbar pain and function?
ODQ (Oswestry) - best for persistent severe disability
RMQ (Roland-Morris) - best for mild to moderate disability
Describe the condition of lumbar facet syndrome
- lumbar facet joints most common source of mechanical LBP in chronic cases, often contributes to NSLBP
Pathology:
- dysfunction of facet joints that can include irritation / oedema of facet joint and surrounding structures, facet sprain, degeneration, microtrauma, radiculopathy
- most common in L4/5 and L5/S1
- high level of chronicity
Mechanism:
- insidious: degeneration, microtrauma, overuse (esp. repetitive flexion / extension)
Presentation:
- dull aching LBP, sharp w/ agg. movement
Agg by:
- extension, rotation, ipsilateral SB
- returning to standing from a flexed position
- prolonged sitting, standing, walking
Rel by:
- lying supine with bent knees
- contralateral SB
- supported flexion (sitting or standing with weight on hands and elbows
- analgesics / NSAIDs
Findings:
- decreased Lx ROM w pain on movement, pain with local extension, ipsilateral SB, rotation
- decreased pain with contralateral SB, flexion
- pain returning to stand from forward flexion
- pain on palpation / PA springing of affected segment
- increased Lx lordosis (esp. in chronic cases - protective flexion position)
Prognosis: high level of chronicity, need to manage psychosocial factors and pain beliefs, maintain activity
What is the difference between spondylolysis and spondylolisthesis?
Spondylolysis: fracture of pars interarticularis between superior and inferior facets
Spondylolisthesis: anterior slippage of vertebrae (often caused by underlying pars fracture or degeneration of lumbar vertebrae and ligaments)
Describe the condition of SIJ dysfunction
- common presentation, contributes to 15-30% of mechanical LBP cases
Presentation:
- broad area of pain over sacrum and low back, maybe radiating to groin, glutes, greater trochanter, posterior thigh
- dull and aching pain
Classic triad:
- pain over SIJ
- tenderness over sacrospinous and sacrotuberous ligs
- pain reproduction over pubic symphysis
Agg by:
- prolonged sitting
- climbing stairs
- jogging
- lying one one side in bed
- forward flexion
Pathology:
- umbrella term for pathology of SIJ including degeneration of ligaments creating hypermobility instability, hypomobility
Risk factors: age, pregnancy, trauma, hypermobility or hypomobility, mm imbalances around hip, weak trunk and back mm, leg length discrepancies
What are risk factors for SIJ dysfunction?
- pregnancy
- hypermobility
- hypomobility
- leg length discrepancy
- mm imbalance (ext and int hip rotators, hip flexors and extensors, other hip mm)
- asymmetrical biomechanics
- age related degeneration
- trauma
- weak trunk and back mm
What is the classic triad of findings in SIJ dysfunction?
- pain over SIJ
- pain reproduced on springing of pubic symphysis
- tenderness over sacrospinous and sacrotuberous ligaments
In a presentation of lumbar facet sprain or facet syndrome, which movements aggravate and which movements relieve pain?
Agg by:
- extension
- rotation
- ipsilateral SB
- returning to stand from forward flexion
Rel by:
- forward flexion
- contralateral SB
What are risk factors for lumbar disc herniation?
- age related degeneration
- lumbar trauma
- obesity / pregnancy
- prolonged Lx flexion (desk work, driving, manual labour)
- typical mechanism of injury flexion with rotation
What are typical findings in a lumbar disc herniation?
Pain (can be asymptomatic):
- typically dull and diffuse with sharp aggravations
- may have radicular pain in LL and particularly sciatic nerve
Agg by:
- flexion
- prolonged sitting, standing
Findings:
- single level motor / sensory disturbance
- diminished Achilles or patellar reflex
- positive SLR
- positive Slump test
- pain on Lx flexion
Prognosis:
- SSX reduction 4-6/52
- resolution 3-6/12
- if radiculopathy: resolution 3-6/12
