lumbar back - 1 intro and red flags Flashcards
what are broad clinical concerns at we have
weight loss
fever, chill, sweat
fatigue
unexplained nausease and vomiting
night pain
inability to increase or decrease symptoms
pathological fractures - what pop
older
female > male
pathological fractures - other factors
prolonged corticosteriod use
mild trauma or sudden pain without reason
history of osteoporosis
pt- position of comfort it supine - this is getting pressure off of the area
sacral stress fracture
athletic female
increased level of vigor/rep atheltic activity
pain in the butt
pain reproduced with athletic activity
nonreponsive to previous treatment
what is the sign of the buttock used for
To determine the possibility of non-musculoskeletal causes for the patient’s symptoms
what is included in the sign of the buttock
limited trunk flexion - standing
supine SLR limited and painful
hio flexion and knee flexion is limited painful - greater then SLR
hip rot is painful - in a non-capsular pattern
empty end feel on hip flexion
spondy - presentation
young individual
sudden bilat sciatica - with athletic activity
rep hyper ext injury
pain with ext
no urinary bowel incontinience
what is happening with spondy
fracture insufficiency with the pars interarticularis
this allows for unresrticted ant motion of the vert
what are some cardiovascular symptoms - AAA
pain at rest or night
pulsing abdomen
throbbing type of pain
family history of cardiovascular disease
symptoms cannot be provoked with mechanical manipulation of the lower spine
what are signs of vascular claudication
older individual
pain in the calf with activity that is relieved with rest
family history of cardio disease
one foot is colder then the other
sym cannot be provoked with mechanical manipulation
what are the signs of a DVT
throbbing pain in one leg (nor normally bilat)
swelling in one leg
warm skin around the painful area
red or darkened skin
what do we use to classify a DVT
wells criteria
what is a DVT
occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs
what is cauda equina - presentation
saddle parathesia
bilateral serve pain in the LE
urinary and bowel incontinence (S4) is not effected
is cauda equina an emergency
yes
this is a timely medical emergency
what is normally the cause of CES
atraumatic midline post disc herniation at L3 - S1 levels
what is anklosing spondyitis
middle age individual
pain on and off regardless of exertion
progressive loss of ROM
stiffness in the morning that decreases throughout the day
alternating pain between the the SI joints
no parathesia
pain goes in the vertical direction - does not go into the lower extremilties
have mechanical pain but this is because of their inflammation
cancer
night pain
previous history of cancer
weight loss
fatigue
patient over 50 with new onset of back pain
sign of the buttock
no response to conservative management
infection
fever
night pain
worsening pain
immunocompomised status
recent bacterial infection
recent lumbar spine surgery
no response to consrvative treatment
kidney stones
sudden sharp pain - in back under ribs next to the spine
pain can reach the testicles or labium
same pain with fever
symptoms cannot be reproduced with mechanical examination of the back
how does radiculopathy present (due to disc herniation) - history of pain
acute or reccurrent
how does radiculopathy present (due to disc herniation) - pain pattern
pain or numbness radiating down to one LE below the knee
normally increases with lumbar flexion
how does radiculopathy present (due to disc herniation) - neuro exam
motor and sensory changes
dimished or absent DTR
spinal stenosis - age
> 60
spinal stenosis - history
insidious onset of progressive chronic LBP
more recent onset of LE symptoms
spinal stenosis - neuro exam
sensory and motor changes
spinal stenosis - ROM
painful and limited in flexion
do people with CES have a postive SLR
yes
lumbar radicolpathy - history
presence of sciatica
LE pain greater then back pain
dermatonal distribution of pain
can you use SLR for radiculopathy
yes
.91 sensitivity
SLR neural tension
40-deg
crossed SLR
UMN sign
hypertonicity - spascity
hypereflexia
altered motor activity
LMN sign
hypotonicity
hyporeflexia
flaccid paralysis
muscle fassiculation
hip vs the lumbar spine
hip: L3 and L4 –> groin, anterior thigh, anterior leg, ankle
back: lateral thigh, buttock, iliac crest
how to decribe visceral pain
dull, diffused, poorly localized
does not change in position and posture
discogenic LBP
acute LBP - someone who injuries themselve’s by bending lifting and twisting
sever onset of backpain that become back pain
neurological back pain
spinal stenosis
radiculopathy
UMN
segmental back pain
L4 and above
unilateral back pain
mechanical may have a movement pattern
