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MSK 3 > Lumbar Clinical Presentations > Flashcards

Lumbar Clinical Presentations Flashcards

1
Q

prognostic indicators for development of recurrent LBP

A

hx previous episodes
excessive spine mobility
excessive mobility in other joints

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2
Q

prognostic indicators for development of chronic LBP

A

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

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3
Q

lumbar spine pain

A

T12-S1

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4
Q

sacral spine pain

A

area of PSISs through S1 and sacrococcygeal joints

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5
Q

neoplasms common site for metastasis

A

prostate
breast
kidney
thyroid
lung

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6
Q

what kind of pain complaints do u see with neoplasms

A

persistent
not alleviated with bed rest
worse at night
neurologic symptoms

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7
Q

physical exam w neoplasms

A

non-mechanical presentation
age >50
anemia
neurologic signs
lab tests for confirmation

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8
Q

vertebral osteomyelitis

A

misdiagnosed alot
infxn in vertebraes

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9
Q

epidural abscess

A

haematogenous spread of bacteria into epidural space

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10
Q

what is epidural abscess associated with

A

DM, chronic renal failure, IV drug misues, alcoholism, cancer

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11
Q

if vertebral osteomyelitis what is seen w prior hx

A

traced to other source of infxn - bladder, dental, pneumonia

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12
Q

increased risk for vertebral osteomyelitis

A

immunocompromised pt
DM

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13
Q

SxS with vertebral osteomyelitis

A

wt loss
fatigue
fever
neurologic symptoms
local back pain
worse w mechanical loading

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14
Q

progression of epidural abscess

A

local, back pain
radicular SxS
paralysis

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15
Q

vertebral fx red flags

A

old age
significant trauma
corticosteroid use
contusion/abrasion

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16
Q

vertebral fx red flags cluster from Roman and Henschke

A

age >70
significant trauma
prolonged corticosteroid use
sensory alterations from trunk down

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17
Q

vertebral fx red flags cluster from Roman and Cook - QUADAS

A

age >52
no presence of leg pain
BMI less than or equal to 22
does not exercise
female

18
Q

spondylolysis

A

fatigue fx of pars interarticularis

19
Q

acquired spondylolysis

A

repetitive microtrauma with extension/extension with side bending activities

20
Q

flail segment

A

bilateral pars defect with attached multifidi

21
Q

spondylolysthesis

A

anterior slip of vertebra after bilateral spondylolysis

22
Q

symptoms of spondylolysis & spondylolysthesis

A

localized LBP worse w extension

23
Q

physical exam for spondylolysis & spondylolysthesis

A

neuro test
excessive lumbar lordosis
step off deformity
pain w ext & rotation
HS tightness
+ instability & spring testing

24
Q

what is latrogenic discitis

A

infxn of the disc due to another medical procedure

25
Q

latrogenic discitis

A

bacterial infxn from needle during discography
painful

26
Q

internal disc disruption

A

disc degrades within can get schmorl’s nodes

blood extruded from intraosseous veins in marrow spaces

27
Q

IDD occurs from what

A

following rotary injury or end plate injury

28
Q

what grade do you start to feel pain with IDD

A

grade 3 due to annulus being innervated

29
Q

what does IDD lead to

A

nucleus less able to bind water
disc loses height
excessive loading on facet joints

30
Q

disc pathology is what

A

bulging disc
herniating disc

31
Q

what % of the disc must be compromised to have pathology

A

more than 50%

32
Q

bulging disc

A

involves 50-100% of circumference and can be symmetrical or asymmetrical

disc is just kinda squished

33
Q

herniated disc

A

disc has hole and can leak out fluid

34
Q

herniated disc types

A

broad based
focal

extrusion
sequestered

35
Q

broad based herniation

A

25-50% protrusion
90-180 degree angle

36
Q

focal herniation

A

<25% protrusion
<90 degrees

37
Q

sequestered extrusion

A

goes back into the disc and some outside the disc

38
Q

foraminal herniation zone

A

herniation occurs in the foramen

39
Q

central herniation zone

A

occurs in central aspect, posterior cord or caude equina

40
Q

symptoms of disc pathology

A

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

41
Q

two important signs of disc patholgy

A

pain/stiffness worse when first getting up - improves with activity

worsens over the day

42
Q

physical exam with disc pathology

A

lateral shift / postural abnormalities
multi-directional PROM/AROM limitations
spring testing painful
radicular signs (LMN)
+ SLR test

MSK 3 (12 decks)

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