Lumbar Clinical Presentations pt. 2

Question 1

radicular pain

Answer 1

shooting pain
pain w activities that close neuroforamen - twisting/ext

Question 2

radicular pain + test

Answer 2

SLR
slump test
well leg raise

Question 3

central canal degenerative spinal stenosis

Answer 3

z-jt arthropathy
bulging disc
thickening/ossification of ligamentous structures
spondylolysthesis

Question 4

hx for central canal degenerative spinal stenosis

Answer 4

age >65
chronic LBP

Question 5

symptoms for central canal degenerative spinal stenosis

Answer 5

cauda equina symptoms
UMN/LMN symptoms in lumbosacral
pain standing/walking
pain in legs > low back
bilateral > unilateral

pain relieved with sitting, walking w UE support

Question 6

physical exam for central canal degenerative spinal stenosis

Answer 6

diminished lumbar lordosis
painful/limited ext, lat flex
feels better w flexion
short HS, lengthened hip flexors
hyperreflexia

Question 7

lateral canal degenerative spinal stenosis

Answer 7

spinal nerve in lateral foramen

zjt arthropathy
disc bulging
spondylolythesis

Question 8

what may lateral canal degenerative spinal stenosis cause

Answer 8

radicular symptoms/radiculopathy

Question 9

lateral canal degenerative spinal stenosis symptoms

Answer 9

LMN
pain increase w walking, standing
LBP & LE pain
unilateral (but could be bilateral)

Question 10

lateral canal degenerative spinal stenosis physical exam

Answer 10

decreased lumbar lordosis
painful/limited extension, lat flex
hyporeflexia
zj arthropathy SxS

feels better w flexion

Question 11

z jt degenerative osteoarthropathy

Answer 11

pain in butt & thigh, not reliable - can go below the knee or as far as the foot

Question 12

what is z jt degenerative osteoarthropathy secondary to

Answer 12

Degenerative disc disease
disc spondylosis

Question 13

hx for z jt degenerative osteoarthropathy

Answer 13

prior lumbar injury or idiopathic

Question 14

symptoms for z jt degenerative osteoarthropathy

Answer 14

local/referred
unilateral LBP, butt pain
facet closing motions painful
facet gapping feels better

Question 15

z jt degenerative osteoarthropathy physical exam

Answer 15

PROM/AROM pain lumbar ext, ipsi lat flex, contra rotation, end range flex
muscle guarding
hard to activate multifidi
painful spring test/UPA
hypomobile joint mob testing

Question 16

zjt acute traumatic hx

Answer 16

sudden, hx of trauma
possible acute locked back

Question 17

zjt acute traumatic symptoms

Answer 17

pain w closing jt
pain relief w opening jt

Question 18

zjt acute traumatic physical exam

Answer 18

slouched posture, lateral shift
painful limited ROM
pain spring test
tender muscles

Question 19

potential mechanism of zjt pain

Answer 19

meniscoid entrapment
flaps up btw jt

Question 20

meniscoid entrapment

Answer 20

following trauma, a flap that pinches btw joint during certain motions

can serve as a loose body

Question 21

hx for instability / muscle imbalance

Answer 21

recurrent exacerbations
feelings of instability

Question 22

instability / muscle imbalance symptoms

Answer 22

LBP constant
catching / locking w trunk motion
clicking/clunking/popping
aggravated w prolonged positions, flexion, sudden trunk movements, returning to upright from flexed

Question 23

instability / muscle imbalance physical exam

Answer 23

abnormal trunk motions
painful / limited AROM - flexion
excessive motion
muscles guarded
hypermobile - PPIVM

Question 24

what 2 tests are positive for instability / muscle imbalance

Answer 24

prone instability test
passive lumbar ext test

Question 25

thoracolumbar fascia fat herniation

Answer 25

“back mice”

herniation of fat through posterior layer of thoracolumbar fascia