Lumbar Lecture Flashcards
Spinous processes are located where, relative to the vertebral body?
Same level
Why are the vertebral bodies higher anteriorly?
Maintains lordosis
What is the first ligament to become tender with lumbar postural changes and where is it located (relative to the PSIS)?
Iliolumbar ligament 1 inch superior and lateral to PSIS
Thomas tests examines what muscle dysfunction:
psoas/iliopsoas
Describe the hoover test.
Testing for malingerers
When patient raises one leg, the contralateral side should create pressure on the physician’s hand
No pressure: malingering
If the trendelenburg test is positive on the right (right leg is up), what muscle is weak?
Right gluteus medius
The valsalva maneuver exacerbates pain/symptoms when the patient has what condition?
Disc herniaton
First thing done in diagnosis of lumbar spine
Active range of motion (PROM if AROM limited)
How do you test the piriformis?
Internal rotation of lower extremity
Most common locations (#1 and #2) and direction of herniated discs
Posterolaterally
L5-S1 (#1)
L4-L5 (#2)
Describe some symptoms of a herniated disc.
Sharp low back pain with LE radiculopathy exacerbated by valsalva maneuver
Sensory deficits
Decreased reflexes associated iwth affected nerve root
Discs are named for the vertebrae above or below?
Above
Muscles/sensory of a Disc herniation of L3 and what root affected:
L4 root Patellar reflex Anterior tibialis (inversion, dorsiflexion) Quads (extension) Sensation to medial leg/foot
Muscles/sensory of disc herniation at L4 and what root affected
L5 root
EHL (dorsiflex great toe)
Laterla leg/dorsum of foot sensation
Muscles/sensory of disc herniation at L5 and what root affected
S1 root
Achilles reflex
Peroneus longus, brevis (eversion; plantarflexion)
Lateral foot sensation
Nerve roots exit foramina superior or inferior to correspondering IV disc?
Superior
Iliopsoas innervation
T12-L3
Quadriceps innervation
Femoral nerve L2-L4 ==> extend leg at knee
Adductors innervation
Obturater nerve (L2-L4) Adduct hip
Tibialis anterior innervation
Deep peroneal nerve (L4)
Foot dorsiflexion with inversion
Sx of spinal stenosis
Aching low back pain to lower legs
Worsened by lumbar extension
Relieved by sitting
Sx of psoas syndrome and findings on PE
Aching back pain with possible radiation to groin
Positive thomas test
Flexed/extended L1 or L2
Positive pelvic shift test on the contralateral side
Sacral dysfunction on oblique axis
Contralateral piriformis spasm
Warning signs:
Severe LBP
Sudden onset
No hx of trauma
Dissecting AA
Warning signs:
Claudication sx with LBP
Spinal stenosis
Warning signs:
Pain that wakens pt from sleep
Malignancy
Warning signs:
Rapidly progressing neurological deficits
Epidural abscess/infection
Define spondylosis.
Degenerative changes within IV disc with ankylosing of adjacent vertebral bodies
Defne spondylolysis
Defect/fx of pars interarticularis W/O anterior displacement of vertebral body
Dx: oblique x-ray (fx of collar on scotty dog)
Define spondylolisthesis and where it is usually located on the lumbar spine.
Anterior displacement of one vertebral body in relationship to the one below – primarily the lumbar spine L5 on S1
Difference between spondylolisthesis and spinal stenosis.
Pain aggravated by activity and relieved by rest
stenosis is relieved by SITTING!
Is HVLA indicated or contraindicated in spondylolisthesis?
Seriously?
Contraindicated.
Surgery is indicated in spondylolisthesis when: (3 things)
Grade III-IV
Rapidly progressing sx
Gait abnormalities
