lumbar conditions

Question 1

strain

Answer 1

damage to muscle, muscle tendon; typically has faster healing than sprain due to vascularization

Question 2

sprain

Answer 2

damage to ligament or the stabilizing components of a joint; typically slower healing time due to no vascularity

Question 3

grade I sprain/strain

Answer 3

mild swelling and point tenderness over ligament, no bruising, <10% fiber damage, mild stretch, no instability; recovery 2-14 days

Question 4

grade II sprain/strain

Answer 4

mild to moderate swelling, large spectrum of injury that can include partial tearing, 11-90% fiber damage; recovery in 14 days-2 months

Question 5

grade III sprain/strain

Answer 5

severe deep bruising and swelling, complete tear of multiple ligaments, muscles, and joint capsules; recovery in 1-3 months

Question 6

clinical presentation of lumbar sprain/strain

Answer 6

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

Question 7

clinical presentation of lumbar facet syndrome

Answer 7

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

Question 8

clinical presentation myofascial pain syndrome

Answer 8

deep, aching pain in a muscle, pain that persists or worsens, a tender knot in a muscle, difficulty sleeping due to pain

Question 9

primary sciatica

Answer 9

direct involvement of the sciatic nerve as a result of underlying neurologic changes such as diabetes, alcoholism, pernicious anemia, B12 deficiency, heavy metal toxicity

Question 10

secondary sciatica

Answer 10

direct irritation of the sciatic nerve or its nerve roots

Question 11

clinical presentation of sciatica

Answer 11

ongoing buttock and leg complaints which are self described as sciatica

Question 12

clinical presentation of piriformis syndrome

Answer 12

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

Question 13

clinical presentation of degenerative joint and disc disease

Answer 13

dull, achy pain following joint pain, morning stiffness, better with mild activity and rest, worse with excessive activity, prior history of trauma or injury

Question 14

primary DJD (idiopathic)

Answer 14

abnormal biomechanics or posture, genetic predisposition, metabolic causes

Question 15

secondary DJD (trauma)

Answer 15

equal gender distribution, childhood anatomic abnormalities, joint trauma or fracture, obesity, repetitive action or joint motion

Question 16

phase I of degeneration: dysfunctional phase

Answer 16

circumferential tears in the outer annulus, nucleus pulposus loses water and proteoglycan content

Question 17

phase II degeneration: unstable phase

Answer 17

loss of mechanical integrity, internal disc disruption, resorption and loss of disc height, leading to segmental instability

Question 18

phase III degeneration: stabilization

Answer 18

further disc resorption, disc space narrowing, endplate destruction, osteophyte formation, possible discogenic pain results

Question 19

central canal stenosis

Answer 19

may be associated with bulging of the ligamentum flavum or posterior body spurs as well as bulging of the annulus fibrosis

Question 20

lateral canal stenosis

Answer 20

compression of exiting nerve roots from the lateral recess through the foramen to the extra foraminal zone

Question 21

most common level of lumbar spinal stenosis

Answer 21

L5/S1

Question 22

clinical presentation of lumbar spinal stenosis

Answer 22

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

Question 23

lumbar instability

Answer 23

loss of normal biomechanical function between 2 adjacent vertebrae resulting in increased or abnormal motion or static malposition

Question 24

generalized instability

Answer 24

may be genetic, affects multiple joints

Question 25

segmental instability

Answer 25

reversible, hypomobile segments respond well to manipulation

Question 26

functional instability

Answer 26

chronic, muscle imbalance may require conditioning and proprioceptive retraining

Question 27

structural instability

Answer 27

difficult to reverse, unstable end range motion

Question 28

surgical instability

Answer 28

very unstable

Question 29

compressive lesions

Answer 29

related to a volume occupying space lesion where nerves are present

Question 30

inflammatory lesions

Answer 30

create a reaction that leads to sensitivity of the nerve root

Question 31

central canal

Answer 31

compresses the cord in the cervical and thoracic regions, compresses the cauda equina in the lumbar region (myelopathy)

Question 32

central lesion of central canal

Answer 32

compresses structures that transverse over the disc

Question 33

paracentral lesion of central canal

Answer 33

compresses structures in the midline

Question 34

lateral lesion of central canal

Answer 34

compresses lateral structures

Question 35

IVF

Answer 35

compresses the nerve root as it exits the vertebrae (radiculopathy)

Question 36

medial lesion of IVF

Answer 36

compresses structure that are on the medial side of the nerve root

Question 37

lateral lesion of IVF

Answer 37

compresses structures that are on the lateral side of the nerve root

Question 38

clinical presentation of lumbar disc herniation

Answer 38

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

Question 39

clinical presentation of lumbar myelopathy

Answer 39

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

Question 40

cauda equina syndrome

Answer 40

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

Question 41

clinical presentation of cauda equina syndrome

Answer 41

rapid progression of neurologic signs in patient with known disc herniation, severe bilateral leg pain, saddle anesthesia, bowel or bladder incontinence

Question 42

most common segment involved in spondylolisthesis

Answer 42

L5

Question 43

type I spondylolisthesis: dysplastic

Answer 43

congenital defect in neural arch or sacrum

Question 44

type II spondylolisthesis: isthmic

Answer 44

lytic: stress fracture in pars
acute: fracture of the pars

Question 45

type III spondylolisthesis: degenerative

Answer 45

degenerative arthrosis of regional lumbar anatomy

Question 46

type IV spondylolisthesis: traumatic

Answer 46

fracture of neural arch

Question 47

clinical presentation of spondylolisthesis

Answer 47

may be asymptomatic; low back, thigh, and leg pain that radiates into the buttock, increased pain with weight bearing extension

Question 48

coccygeal disorders

Answer 48

group of disorders and/or syndromes that involve the coccyx region

Question 49

coccyx anatomy

Answer 49

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

Question 50

clinical presentation of coccygeal disorders

Answer 50

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