Lumbar Clinical Presentations Flashcards
prognostic indicators for development of recurrent LBP
hx previous episodes
excessive spine mobility
excessive mobility in other joints
prognostic indicators for development of chronic LBP
presence of symptoms below the knee
psychosocial distress or depression
fear of pain, movement, re-injury or low expectations of recovery
pain of high intensity
passive coping style
lumbar spine pain
T12-S1
sacral spine pain
area of PSISs through S1 and sacrococcygeal joints
neoplasms common site for metastasis
prostate
breast
kidney
thyroid
lung
what kind of pain complaints do u see with neoplasms
persistent
not alleviated with bed rest
worse at night
neurologic symptoms
physical exam w neoplasms
non-mechanical presentation
age >50
anemia
neurologic signs
lab tests for confirmation
vertebral osteomyelitis
misdiagnosed alot
infxn in vertebraes
epidural abscess
haematogenous spread of bacteria into epidural space
what is epidural abscess associated with
DM, chronic renal failure, IV drug misues, alcoholism, cancer
if vertebral osteomyelitis what is seen w prior hx
traced to other source of infxn - bladder, dental, pneumonia
increased risk for vertebral osteomyelitis
immunocompromised pt
DM
SxS with vertebral osteomyelitis
wt loss
fatigue
fever
neurologic symptoms
local back pain
worse w mechanical loading
progression of epidural abscess
local, back pain
radicular SxS
paralysis
vertebral fx red flags
old age
significant trauma
corticosteroid use
contusion/abrasion
vertebral fx red flags cluster from Roman and Henschke
age >70
significant trauma
prolonged corticosteroid use
sensory alterations from trunk down
vertebral fx red flags cluster from Roman and Cook - QUADAS
age >52
no presence of leg pain
BMI less than or equal to 22
does not exercise
female
spondylolysis
fatigue fx of pars interarticularis
acquired spondylolysis
repetitive microtrauma with extension/extension with side bending activities
flail segment
bilateral pars defect with attached multifidi
spondylolysthesis
anterior slip of vertebra after bilateral spondylolysis
symptoms of spondylolysis & spondylolysthesis
localized LBP worse w extension
physical exam for spondylolysis & spondylolysthesis
neuro test
excessive lumbar lordosis
step off deformity
pain w ext & rotation
HS tightness
+ instability & spring testing
what is latrogenic discitis
infxn of the disc due to another medical procedure
latrogenic discitis
bacterial infxn from needle during discography
painful
internal disc disruption
disc degrades within can get schmorl’s nodes
blood extruded from intraosseous veins in marrow spaces
IDD occurs from what
following rotary injury or end plate injury
what grade do you start to feel pain with IDD
grade 3 due to annulus being innervated
what does IDD lead to
nucleus less able to bind water
disc loses height
excessive loading on facet joints
disc pathology is what
bulging disc
herniating disc
what % of the disc must be compromised to have pathology
more than 50%
bulging disc
involves 50-100% of circumference and can be symmetrical or asymmetrical
disc is just kinda squished
herniated disc
disc has hole and can leak out fluid
herniated disc types
broad based
focal
extrusion
sequestered
broad based herniation
25-50% protrusion
90-180 degree angle
focal herniation
<25% protrusion
<90 degrees
sequestered extrusion
goes back into the disc and some outside the disc
foraminal herniation zone
herniation occurs in the foramen
central herniation zone
occurs in central aspect, posterior cord or caude equina
symptoms of disc pathology
sudden or gradual onset
recurrent episodes, worse w each episode
dull, constant, aching
multi-directional trunk motions painful - worse at end range - compression loading painful
two important signs of disc patholgy
pain/stiffness worse when first getting up - improves with activity
worsens over the day
physical exam with disc pathology
lateral shift / postural abnormalities
multi-directional PROM/AROM limitations
spring testing painful
radicular signs (LMN)
+ SLR test
