lumbar conditions Flashcards
strain
damage to muscle, muscle tendon; typically has faster healing than sprain due to vascularization
sprain
damage to ligament or the stabilizing components of a joint; typically slower healing time due to no vascularity
grade I sprain/strain
mild swelling and point tenderness over ligament, no bruising, <10% fiber damage, mild stretch, no instability; recovery 2-14 days
grade II sprain/strain
mild to moderate swelling, large spectrum of injury that can include partial tearing, 11-90% fiber damage; recovery in 14 days-2 months
grade III sprain/strain
severe deep bruising and swelling, complete tear of multiple ligaments, muscles, and joint capsules; recovery in 1-3 months
clinical presentation of lumbar sprain/strain
low back pain, stiffness, or muscle spasms, prior history of back injury, limited ROM, pain is better with rest, heat, and non-weight bearing, pain aggravated by activity and lifting
clinical presentation of lumbar facet syndrome
dull achy low back pain with sharp, acute episodes, insidious onset with degenerative changes and sudden onset in cases of trauma; pain worse with prolonged standing and lumbar extension, pain relieved when lying supine, sitting, or lumbar flexion
clinical presentation myofascial pain syndrome
deep, aching pain in a muscle, pain that persists or worsens, a tender knot in a muscle, difficulty sleeping due to pain
primary sciatica
direct involvement of the sciatic nerve as a result of underlying neurologic changes such as diabetes, alcoholism, pernicious anemia, B12 deficiency, heavy metal toxicity
secondary sciatica
direct irritation of the sciatic nerve or its nerve roots
clinical presentation of sciatica
ongoing buttock and leg complaints which are self described as sciatica
clinical presentation of piriformis syndrome
chronic pain in buttock that may radiate down into the leg, pain is worse with walking, squatting, or hip internal rotation or adduction, low tolerance for sitting
clinical presentation of degenerative joint and disc disease
dull, achy pain following joint pain, morning stiffness, better with mild activity and rest, worse with excessive activity, prior history of trauma or injury
primary DJD (idiopathic)
abnormal biomechanics or posture, genetic predisposition, metabolic causes
secondary DJD (trauma)
equal gender distribution, childhood anatomic abnormalities, joint trauma or fracture, obesity, repetitive action or joint motion
phase I of degeneration: dysfunctional phase
circumferential tears in the outer annulus, nucleus pulposus loses water and proteoglycan content
phase II degeneration: unstable phase
loss of mechanical integrity, internal disc disruption, resorption and loss of disc height, leading to segmental instability
phase III degeneration: stabilization
further disc resorption, disc space narrowing, endplate destruction, osteophyte formation, possible discogenic pain results
central canal stenosis
may be associated with bulging of the ligamentum flavum or posterior body spurs as well as bulging of the annulus fibrosis
lateral canal stenosis
compression of exiting nerve roots from the lateral recess through the foramen to the extra foraminal zone
most common level of lumbar spinal stenosis
L5/S1
clinical presentation of lumbar spinal stenosis
typically seen in elderly patients who is undergoing extensive degenerative changes, localized dull achy pain that is worse with extension and exercise and better with rest and flexion
lumbar instability
loss of normal biomechanical function between 2 adjacent vertebrae resulting in increased or abnormal motion or static malposition
generalized instability
may be genetic, affects multiple joints
segmental instability
reversible, hypomobile segments respond well to manipulation
functional instability
chronic, muscle imbalance may require conditioning and proprioceptive retraining
structural instability
difficult to reverse, unstable end range motion
surgical instability
very unstable
compressive lesions
related to a volume occupying space lesion where nerves are present
inflammatory lesions
create a reaction that leads to sensitivity of the nerve root
central canal
compresses the cord in the cervical and thoracic regions, compresses the cauda equina in the lumbar region (myelopathy)
central lesion of central canal
compresses structures that transverse over the disc
paracentral lesion of central canal
compresses structures in the midline
lateral lesion of central canal
compresses lateral structures
IVF
compresses the nerve root as it exits the vertebrae (radiculopathy)
medial lesion of IVF
compresses structure that are on the medial side of the nerve root
lateral lesion of IVF
compresses structures that are on the lateral side of the nerve root
clinical presentation of lumbar disc herniation
sudden onset of LBP and potential leg pain past the knee, frequent episodes of LBP, may follow lifting, twisting, or straining episode or repetitive stress; pain is sharp, shooting in dermatomal pattern and increased with changes in intradiscal pressure
clinical presentation of lumbar myelopathy
leg or lower back pain, tingling, weakness, or numbness, increased reflexes in the extremities, difficulty walking, loss of urinary or bowel control, issues with balance and coordination
cauda equina syndrome
acute neurocompressive disorder of lumbar spine where cauda equina of the spinal cord becomes compressed resulting in serious neurologic symptoms below the level of the lesion
clinical presentation of cauda equina syndrome
rapid progression of neurologic signs in patient with known disc herniation, severe bilateral leg pain, saddle anesthesia, bowel or bladder incontinence
most common segment involved in spondylolisthesis
L5
type I spondylolisthesis: dysplastic
congenital defect in neural arch or sacrum
type II spondylolisthesis: isthmic
lytic: stress fracture in pars
acute: fracture of the pars
type III spondylolisthesis: degenerative
degenerative arthrosis of regional lumbar anatomy
type IV spondylolisthesis: traumatic
fracture of neural arch
clinical presentation of spondylolisthesis
may be asymptomatic; low back, thigh, and leg pain that radiates into the buttock, increased pain with weight bearing extension
coccygeal disorders
group of disorders and/or syndromes that involve the coccyx region
coccyx anatomy
made up of 4 tiny fused vertebrae, it is connected to the inferior end of the sacrum and is solid; there is no spinal canal in the coccyx
clinical presentation of coccygeal disorders
pain around the sacrococcygeal articulation, may be acute or chronic recurrent episodes, may have a history of a sit down fall, pain with sitting and transitioning from sitting to standing, pain is relieved by walking, pain with palpation and ROM
