Lumbar I Flashcards
Disc vs stenosis sx
Extension vs flx
Neural tensions
Dermatomal patterns
Worse in AM
Disc is better with extension / stenosis is better with flexion
Neural tension with disc
Dermatomal pattern with disc
Disc worse in AM
Nerve root irritation vs compression
Pain
DTRs
Tension tests
Motor sx
Sensation sx
Pain high with irritation, low with compression
DTRs reduced with compression
+tension tests with both
Motor/sensation reduced with compression, normal with irritation
Test for short abdominals
Arms overhead, full inhalation and exhalation - use tape measure under nipple line to measure difference between the two, normal is 2.5-3 inches
Iliopsoas MMT
Patient supine, if testing left left put left leg into flexion/external rotation/abduction and stabilize right side pelvis with other hand, push in extension and slight abduction direction
Patient seated, passively put into full flexion and apply downward force
In supine the hip should be able to flex how much before low back begins to flex
100-120 degrees
For hip and low back disassociation, you should not see what?
More than 1cm movement in first 50% of motion
Glute Med MMT
Sidelying, place top leg into flexion, abduction and external rotation.
Test over if they cannot hold ER, if they can, push in anterior and inferior direction
Ober Test
Sidelying, top leg put into 20 degrees knee flexion, abduction, extension, ER and dropped below horizontal. Normal is 10 degrees below horizontal
Meniscoid intra articular structure purpose
Meniscoid provided lubrication to cartilage and moves with the facet. Can cause pain coming up from flexion as it is not re-entering properly
Spinal nerve inside foramen named for # above or below of vertebrae?
Below
Ex. L4 nerve at L4/L5 facet
What happens to each with age
- disc and body
- what causes narrowing
- proteoglycans
- nucleus
Disc increases in size and body decreases in height
Nucleus degradation
Less proteoglycans leading to less water which increases rigidity
Increased pressure on annulus as nucleus is less able to exert fluid pressure
What is a cardinal symptom of spondylosis on radiograph?
Osteophytes
A decrease in spinal motion with age mainly due to?
Dehydration and aging of discs
List ligaments of discs post to ant
Supraspinous
Interspinous
Yellow lig / lig flavum
Facet jt capsule
Intertransverse lig
PLL
Annulus
ALL
Psoas major
- attachments
- function
- compressive loads
T12-L5 TPs to lesser trochanter of femur
Hip flexion
Lumbar discs
QL
- attachment
- action
12th rib to iliac crest
Fixates rib during inspiration
Controls buckling
Side bending lumbar spine
TFL
- attachment
- action
Femur flexion, abduction, internal rotation
Intertransversarii Lateralis
Proprioceptive transducers
Multifidus (deep and superficial fibers)
Deep: run 2 levels, help prevent meniscoid displacement
Superficial: run 3-5 levels, extension due to longer lever arm and mainly counteracts abdominal flexion with rotation
Erector spinae
- longissimus thoracis: unilateral SB and B/L ext
- iliocoatalis lumborum: unilateral SB and B/L ext/rot
Thoracolumbar fascia
Lateral raphe of 3 layers
Prevents dorsal displacement of back muscles and stability for low back
LAROM values
Flx: 40-50
Ext: 15-20
Rot: 5-10
SB: 20
IV foramen opens how much with flx and closes how much with ext
Opens 19%
Close 11%
SB and rotation couple how in lumbar spine?
Opposite
Right rotation in lumbar spine arthros
R rot= R goes down and back and opens, L goes up and forward but closes
L3 radic sx
Pain where
Reflex
Muscle
Pain at GT, distal ant thigh, medial knee (nothing past knee)
Reflex patellar
Muscle: quad
LQ sensation points
L3: medial knee
L4: medial ankle
L5: web space between 1st and 2nd toe
S1: lateral foot over met heads
S2: popliteal fossa
L4 radic sx
Pain
Reflex
Muscle
Lateral knee, upper lat glute, ant leg, medial foot
(Medial foot/ankle)
None
Tibialis ant
L5 radic Sx
Pain
Reflex
Muscle
Pain lat glute though, posterior lat thigh, lateral leg, ant foot and 1st toe
(1st toe and ant foot)
No reflex
EHL
S1 radic sx
Lat glute, post thigh, post lat leg, heel, lat foot, 3-5 toes (lateral foot, 3-5 toes)
Achilles
Peronei/gastroc
