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AT 2501 > Lumbar Content > Flashcards

Lumbar Content Flashcards

1
Q

How many IVD are there?

A

23

There are no disks between C0-C1 or C1-C2

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2
Q

How are disks named?

A

Named for the 2 vertebrae they are between

L4-L5 IVD

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3
Q

What are the functions for IVD?

A
  • Increase total ROM available

- Absorb longitudinal & rotational stresses

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4
Q

What is the anatomy of a IVD?

A

Consists of…

  • Annulus Fibrosus (outer) richly innervated by sensory nerves
  • Nucleus Pulposus (inner)
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5
Q

What are the characteristics of Annulus Fibrosus?

A
  1. Tough, dense outer layer
  2. Multilayered fibers
  3. Thinner posteriorly
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6
Q

What are the characteristics of Pulposus?

A
  1. Flexible inner layer
  2. 60-70% water
    - dehydration/rehydration occurs
  3. Highly elastic, semigelatinous
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7
Q

Articulations and Ligamentous Anatomy:

Which ligament limits EXTENSION?

A

Anterior longitudinal ligament (ALL)

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8
Q

Articulations and Ligamentous Anatomy:

Which ligament limits FLEXION?

A
  1. Posterior longitudinal ligament (PLL)
  2. Supraspinous ligament
  3. Interspinous ligament
  4. Ligamentum Flavum
    Note: dural sheath is flexion
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9
Q

Pathologies: IVD Lesions

Classifications of IVD lesions - 4 types

A
  1. Protrusion
  2. Prolapse
  3. Extrusion
  4. Sequestration
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10
Q

Pathologies: IVD Lesions

Protrusion

A

Annular bulge

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11
Q

Pathologies: IVD Lesions

Prolapse

A

Herniation

nucleus contained by outermost annular fibers

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12
Q

Pathologies: IVD Lesions

Extrusion

A

Herniation

nucleus contained by PLL, breaks through annular fibers

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13
Q

Pathologies: IVD Lesions

Sequestration

A

Herniation

nuclear material free in neural cannal

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14
Q

Pathologies: IVD Lesions

What are some common evaluation findings?

A

Typically insidious-onset
Constant vs intermittent s/s
Localized paraspinal spasm
Flexion vs extension

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15
Q

Pathologies: IVD Lesions

What is the pain progression

A

Posterior, central pain
Posterior, lateral pain
Radiating pain
Sensory/motor loss

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16
Q

Exam Findings: Disc Pathology

Joint play

A

Possibly increased P-A mobility initially

Later: decreased joint play

17
Q

Exam Findings: Disc Pathology

Special Tests

A 
Valsalva Test
SLR Test
Well SLR Test
Milgram Test
Hoover Test
18
Q

Exam Findings: Disc Pathology

Dermatomes/Myotomes/reflexes

A

CHECK EM

19
Q

Exam Findings: Disc Pathology

Definitive Dx

A

MRI (high sensitivity) + Hx + clinical findings

GOLD STANDARD: Discography

20
Q

Exam Findings: Disc Pathology

Treatment

A

Movements to localize pain (centralization) - extension

Core stability & pelvic stabilization exercises

21
Q

Exam Findings: Facet Dysfunction
What is the onset?
What are the causes?
What motions can cause it?

A
  • Can be Acute or Insidious
  • Repetitive stress to joint through movement & loading
  • Extension, hyperextension, rotation, ipsilateral sidebending
22
Q

Exam Findings: Facet Dysfunction

What are the pain characteristics?

A
  • Localized pain over involved facet(s)

- Decrease in s/s w/ increase in activity

23
Q

Exam Findings: Facet Dysfunction

When inspecting, what are you looking for?

A

Pt assumes posture that lessens pressure on affected facets (flexion, contralateral sidebending)

24
Q

Exam Findings: Facet Dysfunction

What to look for when palpating?

A

Possible local spasm of paravertebral muscles

25
Q

Exam Findings: Facet Dysfunction

What should one be looking for when examining joint & muscle function during A/PROM?

A

Increased pain w/ extension and rotation

Pain will decrease with flexion

26
Q

Exam Findings: Facet Dysfunction

How would you test joint play?

A

Spring Test (pain, decreased motion)

27
Q

Exam Findings: Facet Dysfunction

Special tests that rule in Facet Joint Dysfunction

A

(+) Quadrant Test

(-) Tests for IVD Lesion

28
Q

Exam Findings: Spondylopathies

What is it?

A

Its a defect in the Pars Interarticularis & is most common at the L5 level

29
Q

Exam Findings: Spondylopathies

What is the MOI?

A

Repetitive force Hyperextension

30
Q

Exam Findings: Spondylopathies

What are some common sports that cause facet dysfunction?

A

Football Lineman, gymnastics, cheerleaders

31
Q

Exam Findings: Spondylopathies

How would you diagnosis it?

A

Radiographs - may show flattening of inferior facet on superior vertebra of affected side (may result in false positive)
CT determines whether fx site is metabolically active

32
Q

Exam Findings: Spondylopathies

Describe Spondylolysis

A
  • Defect in the pars interarticularis
  • “Collard Scotty Dog”
  • Localized LBP restricts extension
33
Q

Exam Findings: Spondylopathies

Describe Spondylolisthesis

A
  • Can be a progression of spondylolysis
    • Bilateral defects in pars
    • SP separates from vertebral body
  • Spinal instability
    • Superior vertebra slides anteriorly & possibly inferiorly
  • “Decapitated Scotty Dog”
34
Q

Exam Findings: Spondylopathies

What are the pain Characteristics?

A
  1. Pain in Lumbar spine
    • Intensity of pain increases as condition worsens
  2. Possible radiating pain into butt, upper portions of posterolateral thighs
35
Q

Exam Findings: Spondylopathies

What to look for during Inspection?

A

Hyperlordosis of lumbar spine & Gait: short stride, stiff-legged

36
Q

Exam Findings: Spondylopathies

What should one palpate for?

A

Spasm of paraspinal muscles & Spondylolisthesis: “step-off” deformity at involved level

37
Q

Exam Findings: Spondylopathies

What should be noticed/observed during joint & muscle function

A

AROM:
- Trunk flex restricted (but pain free)
- PAIN, describes a “catch” when returning to upright & durning active extension
- PAIN during lumbar rotation
PROM:
- Hip flexion reveals tightness of HS Muscles
MMT: Weakness of erector spinae muscles

38
Q

Exam Findings: Spondylopathies

JP

A

Pain and/or hypermobility

39
Q

Exam Findings: Spondylopathies

What Special Tests will give us the best diagnosis?

A

(+) SLS Test (Stork Stance)

Possible (+) SLR Test

AT 2501 (3 decks)

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