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OCS Cards > Lumbar > Flashcards

Lumbar Flashcards

1
Q

How long do acute instances take to recover for LBP?

A

6-8 weeks

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2
Q

Does acute LBP have flare ups?

A

Yes - has flare ups, but quick recovery - pain does not mean failure of tx

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3
Q

What are previously thought risk factors for LBP?

A

Prolong sitting, lifting, sports - study found no associated factors associated & should not be avoided w/o rationale

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4
Q

Hancock CPR - recovery time: what results in quick recovery?

A

1) Lower initial pain 2)shorter duration sxs 3)fewer previous episodes - conversely; 1) high deg of disability 2)previous hx of loss of work -> much less likely to recover (overall strength is weak to moderate)

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5
Q

What 3 areas of body do pain modulators affect?

A

1) spinal cord 2) brain stem 3)higher brain centers

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6
Q

Chronic spinal pain results in firing of what fibers

A

C-fibers / A-delta fibers; analgesia results in blocking these fibers - sensitization results in lower threshold in these fibers

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7
Q

What area of the brain stem is stimulated for inhibition?

A

DPag (dorsal periacqueductal grey)

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8
Q

What disease processes affect the heterogeneity of LBP?

A

1) reduced physical activity 2)inc sitting 3)inc use of computers 4)obesity with chronic inflammation (theoretical)

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9
Q

Should pts be encouraged to initiate early treatment or bed rest?

A

Early treatment - improves LT outcomes; rapid transition from passive to active treatment

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10
Q

Is a single red flag item predictive of serious disease?

A

No - need constellation of sxs

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11
Q

What are signs/sxs consistent with metastatic cancer?

A

1) hx of cancer 2) night pain/pain at rest 3) unexplained weight loss 4) age >50 / <17 5) failure to improve with predicted time frame

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12
Q

What are signs/sxs consistent with infection with disc/vertebrae?

A

1) immunosuppression 2) prolong fever (100.4) 3)hx of intravenous drug use 4) hx of UTI, cellulitis, pneumonia

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13
Q

What are signs/sxs consistent with AAA?

A

1) pulsating mass in abdomen 2) hx of atherosclerotic vascular dx 3) throbbing, pulsating back pain at rest 4) age >60 years

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14
Q

What is the CPR by Henscke for vertebral fractures?

A

1) age > 70 2)female 3) significant trauma 4) prolong use of steroids - 3 or more +LR of 52%

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15
Q

What two MRI findings, according to Hancock systematic review, were meaningful in disc pathology?

A

1) high intensity zone (associated with annular tear) +LR 1.5 to 5.9 - 2) Modic sign = end plate changes which result in impaired diffusion between subchondral bone/disc - LR 0.21

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16
Q

What positive eval/exam finding is consistent with disc pathology?

A

Centralization - +LR 2.8

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17
Q

Definition and example yellow flags -

A

Definition: pt’s personal mistaken beliefs about pain/injury - example = pain catastrophizing, hypervigiliance,

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18
Q

Definition of blue flag

A

Related to injured worker; describe pt’s perception of work and work conditions that may impair return to work

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19
Q

Definition of black flag

A

Social & financial issues related to care - ie: unhelpful reimbursement incentive to remain disabled

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20
Q

What are established predictors of chronicity of pain?

A

1) imaging findings of multi-level DDD 2)strenuous/stressful job 3) leg pain 4) low education background 5) fear avoidance beliefs

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21
Q

Roland Morris Disability Questionnaire - important clinical change?

A

5 points

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22
Q

Oswestry Disability Index - important clinical change?

A

10 points

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23
Q

Manual therapy effect on outcomes?

A

Early use with transition to more active approach - generally thought to have small, moderate effect with potential meaningful

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24
Q

Childs CPR for LBP - 5 factors

A

1) no sxs distal to knee 2)at least 1 hip > 35 IR 3) FABQ-W <19 4) at least 1 hypomobile L/S segment 5) acute onset <16 days

25
Q

Define graded exposure:

A

General hierarchy of feared activities and then gradually progress through these in attempt to reduce activity related anxiety

26
Q

Define graded activity:

A

Operant condition to reinforce healthy behavior & progress through different levels of functional activity

27
Q

What is the research regarding progressive endurance / fitness exercise for LBP?

A

Aerobic fitness programs reduce inc awareness (hypervigiliance) of neural stimulus // Weight training reduces frequency of acute episodes

28
Q

According to the LBP CPG: 3 areas for pt education/ counseling:

A

1) avoid bedrest - stay active 2) cognitive behavioral therapy / graded inc in activity 3) physiology of pain (neuroplasticity, central sensitization - sxs don’t represent serious pathology/disease)

29
Q

Trigger points, taut bands, in muscles are:

A

Local areas of congestion, inc concentration of cytokines (hyperalgesia), with sustained muscle contraction & alteration in chemical environment = end plate noise

30
Q

What theory does trigger point dry needling operate on use?

A

Gate control effect; activating alpha-delta nerves stimulating dorsal horn interneurons to create opiate like pain reduction

31
Q

Peripheral manual therapy for LBP results in what changes in the disc?

A

Diffusion rates of fluid movement in muscles/joints - > changes in disc fluids

32
Q

What central hormone is found affected with manual therapy?

A

Cortisol

33
Q

IVD consists of what 4 layers:

A

1) nucleus 2) transitional zone 3)inner annulus 4) outer annulus

34
Q

What are the main features and roles for the IVD?

A

Support, mobility, maintain stability under loading, permits multi directional & intersegmental motion - maintains vertical distance between vertebrae for tension on ligaments, alignment of facets

35
Q

Where are nearly ALL the neurovascular structures of the IVD found?

A

Outer annulus - sensory & nerve fibers as well as blood vessels (depth of 3.5 mm)

36
Q

What are the two routes of sensory travel for the IVD in lowback pain?

A

1) segmentally (posterior dorsal root) 2)extra-segmentally thru paravertebral chain sympathetic == vague & diffuse pain

37
Q

What area of IVD is only area with blood supply and can entertain O2 / nutrient exchange?

A

Outer annulus - rest of disc relies on osmosis

38
Q

What is the diurnal variation for the IVD like before and after 35?

A

< 35- greater water content in AM (after recumbency) loss of 0.9 mm of disc
>35 - decreased ability to perform fluid exchange; DDD

39
Q

What three tissues are disc pathology associated with?

A

Nucleus, annulus or subchondral bone/endplate

40
Q

What force does the annulus abnormally resist with a decreased water content?

A

Compression - acts as solid restraint vs. flexible interspace

41
Q

What decade of life is DDD usually present by - and what decade is it universally present by?

A

Third decade usually

Universally by 7-8th decade

42
Q

By what decade are the blood vessels gone from the endplate of the IVD?

A

2nd decade - > Modic sign; changes in endplate intensity on MRI

43
Q

Define Schmorl Node:

A

Cartilage protruding into adjacent vertebral body

44
Q

Where does the annulus typically rupture?

A

Lower lumbar segments

45
Q

Where in the IVD annulus do sxs generate due to injury?

A

Peripheral rim lesions - outer most 3.5 mm

46
Q

What loss in disc height results in overloading facet joints?

A

1-3 mm - noticeably reduces foraminal space / loads longitudinal ligaments -> stimulates osetophyte formation (spondylosis)

47
Q

What is the capacity for healing for the IVD?

A

Annulus: limited; poorly remodeled scar

Middle/inner: filled granulation tissue - lack of tensile strength

48
Q

What do the tissue changes of remodeled annulus/middle & inner discs result in for metabolism of the cell?

A

Decreased diffusion of O2/nutrients - lower O2 = lower pH = higher lactic acid; inactive cells -> cell death

49
Q

What are the implications for late stage DDD? (disk height, microtrauma, prolong exposure to compressive loads)

A

1) Microtrauma causes pain next day - delayed onset
2) Avoid lifting first two hours awake
3) Avoid long exposure of compressive load (prolong sitting, lumbar flexion)

50
Q

What is the biggest predictor of patient satisfaction in clinical interaction?

A

Therapist interaction with patient - likely results in better clinical outcome

51
Q

What are signs/sxs for cauda equina?

A

50-55 y.o., bowel/bladder changes, saddle parestheisa, LE weakness - exacerbated by standing/walking - eased by flexion

52
Q

Grades for spondylolisthesis:

A

Grade 1 <25%
Grade 2 25-50%
Grade 3 50-75%
Grade 4 >75%

53
Q

CPR for return to work with acute LBP: non-recovery at 3 months (negative factors)

A

1) age > 45 years
2) smoking
3) 2 or more neurologic findings
4) >90 score on psychosocial screen = high distress

54
Q

Motion in the SIJ: (mm & deg)

A

1.6 mm - - 4 deg rotation

55
Q

Laslett special test cluster for SIJ: (5 tests)

A

1) SIJ compression
2) SIJ distraction
3) thigh thrust
4) sacral thrust
5) gaenslen’s

56
Q

Van der Wurff special test cluster of SIJ (5 tests)

A

1) FABERs
2) ASIS distraction
3) thigh thrust
4) ASIS compression
5) gaenslen’s
3 or more tests = Sn 0.85 // Sp 0.79 with +LR 4, -LR 0.19

57
Q

Where is McBurney’s point?

A

Line between naval & ASIS; halfway between - positive test = rebound pain

58
Q

What is the Psoas sign?

A

Bring the hip passively into extension and adduction which reproduces pain in the abdomen = can be consistent with inflamed appendix

59
Q

What is the Obturator sign?

A

Passively flex hip to 90 and IR hip which reproduces pain in the abdomen = cam be consistent with inflamed appendix

OCS Cards (23 decks)

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