Lumbar Content Flashcards
How many IVD are there?
23
There are no disks between C0-C1 or C1-C2
How are disks named?
Named for the 2 vertebrae they are between
L4-L5 IVD
What are the functions for IVD?
- Increase total ROM available
- Absorb longitudinal & rotational stresses
What is the anatomy of a IVD?
Consists of…
- Annulus Fibrosus (outer) richly innervated by sensory nerves
- Nucleus Pulposus (inner)
What are the characteristics of Annulus Fibrosus?
- Tough, dense outer layer
- Multilayered fibers
- Thinner posteriorly
What are the characteristics of Pulposus?
- Flexible inner layer
- 60-70% water
- dehydration/rehydration occurs - Highly elastic, semigelatinous
Articulations and Ligamentous Anatomy:
Which ligament limits EXTENSION?
Anterior longitudinal ligament (ALL)
Articulations and Ligamentous Anatomy:
Which ligament limits FLEXION?
- Posterior longitudinal ligament (PLL)
- Supraspinous ligament
- Interspinous ligament
- Ligamentum Flavum
Note: dural sheath is flexion
Pathologies: IVD Lesions
Classifications of IVD lesions - 4 types
- Protrusion
- Prolapse
- Extrusion
- Sequestration
Pathologies: IVD Lesions
Protrusion
Annular bulge
Pathologies: IVD Lesions
Prolapse
Herniation
nucleus contained by outermost annular fibers
Pathologies: IVD Lesions
Extrusion
Herniation
nucleus contained by PLL, breaks through annular fibers
Pathologies: IVD Lesions
Sequestration
Herniation
nuclear material free in neural cannal
Pathologies: IVD Lesions
What are some common evaluation findings?
Typically insidious-onset
Constant vs intermittent s/s
Localized paraspinal spasm
Flexion vs extension
Pathologies: IVD Lesions
What is the pain progression
Posterior, central pain
Posterior, lateral pain
Radiating pain
Sensory/motor loss
Exam Findings: Disc Pathology
Joint play
Possibly increased P-A mobility initially
Later: decreased joint play
Exam Findings: Disc Pathology
Special Tests
Valsalva Test SLR Test Well SLR Test Milgram Test Hoover Test
Exam Findings: Disc Pathology
Dermatomes/Myotomes/reflexes
CHECK EM
Exam Findings: Disc Pathology
Definitive Dx
MRI (high sensitivity) + Hx + clinical findings
GOLD STANDARD: Discography
Exam Findings: Disc Pathology
Treatment
Movements to localize pain (centralization) - extension
Core stability & pelvic stabilization exercises
Exam Findings: Facet Dysfunction
What is the onset?
What are the causes?
What motions can cause it?
- Can be Acute or Insidious
- Repetitive stress to joint through movement & loading
- Extension, hyperextension, rotation, ipsilateral sidebending
Exam Findings: Facet Dysfunction
What are the pain characteristics?
- Localized pain over involved facet(s)
- Decrease in s/s w/ increase in activity
Exam Findings: Facet Dysfunction
When inspecting, what are you looking for?
Pt assumes posture that lessens pressure on affected facets (flexion, contralateral sidebending)
Exam Findings: Facet Dysfunction
What to look for when palpating?
Possible local spasm of paravertebral muscles
Exam Findings: Facet Dysfunction
What should one be looking for when examining joint & muscle function during A/PROM?
Increased pain w/ extension and rotation
Pain will decrease with flexion
Exam Findings: Facet Dysfunction
How would you test joint play?
Spring Test (pain, decreased motion)
Exam Findings: Facet Dysfunction
Special tests that rule in Facet Joint Dysfunction
(+) Quadrant Test
(-) Tests for IVD Lesion
Exam Findings: Spondylopathies
What is it?
Its a defect in the Pars Interarticularis & is most common at the L5 level
Exam Findings: Spondylopathies
What is the MOI?
Repetitive force Hyperextension
Exam Findings: Spondylopathies
What are some common sports that cause facet dysfunction?
Football Lineman, gymnastics, cheerleaders
Exam Findings: Spondylopathies
How would you diagnosis it?
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
Exam Findings: Spondylopathies
Describe Spondylolysis
- Defect in the pars interarticularis
- “Collard Scotty Dog”
- Localized LBP restricts extension
Exam Findings: Spondylopathies
Describe Spondylolisthesis
- 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”
Exam Findings: Spondylopathies
What are the pain Characteristics?
- Pain in Lumbar spine
- Intensity of pain increases as condition worsens
- Possible radiating pain into butt, upper portions of posterolateral thighs
Exam Findings: Spondylopathies
What to look for during Inspection?
Hyperlordosis of lumbar spine & Gait: short stride, stiff-legged
Exam Findings: Spondylopathies
What should one palpate for?
Spasm of paraspinal muscles & Spondylolisthesis: “step-off” deformity at involved level
Exam Findings: Spondylopathies
What should be noticed/observed during joint & muscle function
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
Exam Findings: Spondylopathies
JP
Pain and/or hypermobility
Exam Findings: Spondylopathies
What Special Tests will give us the best diagnosis?
(+) SLS Test (Stork Stance)
Possible (+) SLR Test
