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MSK 3 > Lumbar Common Presentations > Flashcards

Lumbar Common Presentations Flashcards

1
Q

Hx of neoplasms findings

A
  • PMH includes cancer
  • fatigue
  • weight loss
  • smoking
  • pain complaints - persistent, not alleviated with bed rest, worse at night, neuro symptoms
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2
Q

physical exam findings of neoplasms

A
  • non-mechanical presentation
  • age > 50 years
  • anemia
  • neuro signs
  • lab tests for confirmation
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3
Q

What is an epidural abscess associated with?

A
  • DM
  • chronic renal failure
  • IV drug misuse
  • alcoholism
  • cancer
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4
Q

Hx of vertebral osteomyelitis

A
  • traced with other sources of infection (bladder infection most common)
  • weight loss
  • fatigue
  • fever
  • neuro symptoms
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5
Q

pain complaints of vertebral osteomyelitis

A
  • local, focal back pain
  • worse with mechanical loading, improves with recumbent positions
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6
Q

physical exam findings of vertebral osteomyelitis

A
  • fever
  • local tenderness
  • aggravated with local percussion
  • neuro signs
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7
Q

red flag cluster findings for vertebral fractures

A
  • age > 70
  • significant trauma
  • prolonged corticoid steroid use
  • sensory alterations from the trunk down
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8
Q

cluster findings for identifying the presence of osteoporotic vertebral compression fracture

A
  • age > 52 years old
  • no presence of leg pain
  • BMI </= 22
  • does not exercise regularly
  • female
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9
Q

What is a fatigue fx of pars interarticularis?

A

spondylolysis

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10
Q

What is a flail segment?

A

bilateral pars defect with attached multifidi

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11
Q

What is spondylolysthesis?

A

anterior slip of the vertebra following bilateral spondylolysis

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12
Q

At what age does the greatest slippage occur?

A

10-15 y/o

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13
Q

What sign on imagining indicates spondylolisthesis?

A

scotty dog with a collar

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14
Q

symptoms of spondylolisthesis

A

localized LBP
- worsened with extension activities

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15
Q

physical exam findings of spondylolisthesis

A
  • excessive lumbar lordosis
  • possible step-off deformity
  • pain with lumbar extension, rotation
  • hamstring tightness
    • instability testing and spring testing at involved segment
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16
Q

What can occur with torsion/rotary injury?

A

discogenic pain - extremely painful

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17
Q

What part of the disc is innervated? What level of disc injury would cause pain?

A
  • outer 1/3 of the disc is innervated
  • grade 3 or higher will cause pain
18
Q

What is considered a focal herniation?

A

< 25% herniation or < 90 deg

19
Q

What is considered a broad based herniation

A

25-50% herniation or > 90 deg

20
Q

What type of impingement is more likely to have impingement on the spine? Impingement on the lateral foramen?

A

spine - central impingment

lateral foramen - foraminal

21
Q

symptoms of disc pathology

A
  • gradual/progressive onset
  • dull, constant, aching pain
  • pain with mulit-directional trunk motions, worse at end range and activities that compress disc (coughing, straining, sitting)
  • pain/stiffness worsens when first getting up after recumbency
22
Q

physical exam findings of disc pathology

A
  • high prevalence rates in asymptomatic populations
  • postural abnormalities/lateral shift
  • multi-directional P/AROM pain
  • pain with spring testing
  • radicular symptoms
    • SLR test
23
Q

Hx of radicular pain

A
  • actue = trauma (twisting/lifting injury common)
  • insidious = progressively more distal as health condition progresses
24
Q

symptoms of radicular pain

A
  • shooting pain along nerve root
  • “band-like”
  • pain w/ activities that close foramen (twisting/extension)
25
Q

physical exam of radicular pain

A
  • lateral shift possible
  • painful/limited ROM that compress foramen
  • potentially slump test +, SLR test +, well leg raise test +
  • tenderness/turgor with guarding paraspinals
26
Q

Hx of degenerative spinal stenosis

A
  • age > 65 years
  • chronic LBP
27
Q

central canal degenerative spinal stenosis symptoms

A
  • UMN or LMN symptoms
  • pain increases with walking/standing (prolonged)
  • pain relieved with sitting, or walking with support
  • bilateral pain in legs > lower back
28
Q

physical exam of central canal degenerative spinal stenosis

A
  • diminished lumbar lordosis
  • painful/limited extension and lateral flexion P/AROM
  • pain improves with flexion
  • shortened hamstrings, lengthened hip flexors
  • neuro signs = hyperreflexia
29
Q

lateral canal degenerative spinal stenosis symptoms

A
  • LMN symptoms
  • pain increases with walking/standing (prolonged)
  • pain relieved with sitting, walking with support
  • LBP and LE pain unilateral
30
Q

lateral canal degenerative spinal stenosis physical exam

A
  • diminished lumbar lordosis
  • painful/limited extension and lateral flexion P/AROM
  • pain improves with flexion
  • neuro signs = hyporeflexia
31
Q

symptoms of degenerative osteoarthropathy at z joint

A
  • local/referred, unilateral pain
  • facet closing motion causes pain
  • facet opening motion relieves pain
32
Q

physical exam findings of degenerative osteoarthropathy at z joint

A
  • P/AROM pain/limitations
  • muscle guarding - erector spinae, multifidi
  • painful spring testing/UPA
  • hypomobility with joint testing
33
Q

What is the diagnosis if a patient is stuck in a flexed position and can’t stand up?

A

acute traumatic z joint
- acute locked back

34
Q

during lumbar flexion, the meniscoid does what in the joint?

A

drawn out of the joint

35
Q

during lumbar extension, the meniscoid does what in the joint?

A

buckles and occupies space

36
Q

What 3 things are required for a trigger point?

A
  • palpable band
  • local and referred tenderness
  • local twitch response
37
Q
  • Radiofrequency ablation of medial branch of dorsal rami
  • Indicated for pain relief to address z-joint pain
  • relief is temporary
A

medial branch neurotomy

38
Q

Tissues in neuroforamen compressing nerve tissue removed (lamina, disc, hypertrophied ligaments, etc.)

A

laminoforaminotomy

39
Q

Removal of the lamina

A

laminectomy

40
Q

Reconstruction of posterior ring at lamina
- increases space for cord

A

laminoplasty

41
Q

Aspiration of nucleus via probe – take out (suck out) some of the disc to make it smaller

A

percutaneous discectomy

42
Q

Removal of disc that is compressing/ irritating the nerve root

A

microdiscectomy

MSK 3 (13 decks)

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