lumbar back - 1 intro and red flags

Question 1

what are broad clinical concerns at we have

Answer 1

weight loss

fever, chill, sweat

fatigue

unexplained nausease and vomiting

night pain

inability to increase or decrease symptoms

Question 2

pathological fractures - what pop

Answer 2

older

female > male

Question 3

pathological fractures - other factors

Answer 3

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

Question 4

sacral stress fracture

Answer 4

athletic female

increased level of vigor/rep atheltic activity

pain in the butt

pain reproduced with athletic activity

nonreponsive to previous treatment

Question 5

what is the sign of the buttock used for

Answer 5

To determine the possibility of non-musculoskeletal causes for the patient’s symptoms

Question 6

what is included in the sign of the buttock

Answer 6

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

Question 7

spondy - presentation

Answer 7

young individual

sudden bilat sciatica - with athletic activity

rep hyper ext injury

pain with ext

no urinary bowel incontinience

Question 8

what is happening with spondy

Answer 8

fracture insufficiency with the pars interarticularis

this allows for unresrticted ant motion of the vert

Question 9

what are some cardiovascular symptoms - AAA

Answer 9

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

Question 10

what are signs of vascular claudication

Answer 10

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

Question 11

what are the signs of a DVT

Answer 11

throbbing pain in one leg (nor normally bilat)

swelling in one leg

warm skin around the painful area

red or darkened skin

Question 12

what do we use to classify a DVT

Answer 12

wells criteria

Question 13

what is a DVT

Answer 13

occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs

Question 14

what is cauda equina - presentation

Answer 14

saddle parathesia

bilateral serve pain in the LE

urinary and bowel incontinence (S4) is not effected

Question 15

is cauda equina an emergency

Answer 15

yes

this is a timely medical emergency

Question 16

what is normally the cause of CES

Answer 16

atraumatic midline post disc herniation at L3 - S1 levels

Question 17

what is anklosing spondyitis

Answer 17

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

Question 18

cancer

Answer 18

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

Question 19

infection

Answer 19

fever

night pain

worsening pain

immunocompomised status

recent bacterial infection

recent lumbar spine surgery

no response to consrvative treatment

Question 20

kidney stones

Answer 20

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

Question 21

how does radiculopathy present (due to disc herniation) - history of pain

Answer 21

acute or reccurrent

Question 22

how does radiculopathy present (due to disc herniation) - pain pattern

Answer 22

pain or numbness radiating down to one LE below the knee

normally increases with lumbar flexion

Question 23

how does radiculopathy present (due to disc herniation) - neuro exam

Answer 23

motor and sensory changes

dimished or absent DTR

Question 24

spinal stenosis - age

Answer 24

> 60

Question 25

spinal stenosis - history

Answer 25

insidious onset of progressive chronic LBP

more recent onset of LE symptoms

Question 26

spinal stenosis - neuro exam

Answer 26

sensory and motor changes

Question 27

spinal stenosis - ROM

Answer 27

painful and limited in flexion

Question 28

do people with CES have a postive SLR

Answer 28

yes

Question 29

lumbar radicolpathy - history

Answer 29

presence of sciatica

LE pain greater then back pain

dermatonal distribution of pain

Question 30

can you use SLR for radiculopathy

Answer 30

yes

.91 sensitivity

Question 31

SLR neural tension

Answer 31

40-deg

crossed SLR

Question 32

UMN sign

Answer 32

hypertonicity - spascity

hypereflexia

altered motor activity

Question 33

LMN sign

Answer 33

hypotonicity

hyporeflexia

flaccid paralysis

muscle fassiculation

Question 34

hip vs the lumbar spine

Answer 34

hip: L3 and L4 –> groin, anterior thigh, anterior leg, ankle

back: lateral thigh, buttock, iliac crest

Question 35

how to decribe visceral pain

Answer 35

dull, diffused, poorly localized

does not change in position and posture

Question 36

discogenic LBP

Answer 36

acute LBP - someone who injuries themselve’s by bending lifting and twisting

sever onset of backpain that become back pain

Question 37

neurological back pain

Answer 37

spinal stenosis

radiculopathy

UMN

Question 38

segmental back pain

Answer 38

L4 and above

unilateral back pain

mechanical may have a movement pattern