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Musculoskeletal II > Lumbar Part 2 > Flashcards

Lumbar Part 2 Flashcards

1
Q

Disc Lesion with

Radiculopathy

A

Patient complains of LBP and leg pain below knee….may be sudden onset after bending and/or twisting
previous hx of LBP that resolved
changes in reflexes, muscle weakness, sensation
numbness, tingling in specific dermatome
Special tests such as SLR, WLR and Braggard’s positive

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2
Q

Crossed Femoral

Stretching Test

A

Performed like FNTT except that symptoms occur in contralateral limb that is being tested

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3
Q

Positive Crossed Femoral

Stretching Test

A

Pain in groin and hip that radiate along anterior medial thigh (L3 nerve root) and pain extending to to mid-tibia (L4) indicate positive test for mid-lumbar nerve root tension

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4
Q

Favorable prognostic factors of positive outcome with conservative intervention with lumbar disk herniation

A

absence of crossed SLR
spinal motion in extension that does not reproduce leg pain
relief or 50% reduction in leg pain within first 6 wks of onset
self employed
educational level greater than 12 yrs
absence of spinal stenosis
limited psychosocial issue
progressive return of neurological deficit with 12 wks

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5
Q

Unfavorable prognostic factors of positive outcome with conservative intervention with lumbar disk herniation

A 
positive crossed SLR
leg pain produced with spinal extension
lack of 50% reduction in leg pain within first 6 wks of onset
overbearing psychosocial issues
worker's comp
educational level less than 12 years
concomitant spinal stenosis
cauda equina
progressive neurological deficit
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6
Q

Neutral prognostic factors of positive outcome with conservative intervention with lumbar disk herniation

A 
degree of SLR
response to bed rest
response to passive care
gender
age
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7
Q

Questionable prognostic factors of positive outcome with conservative intervention with lumbar disk herniation

A

actual size of lumbar disc herniation
canal position of lumbar disk herniation
spinal level of lumbar disk herniation
lumbar disk herniation material

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8
Q

Painful arc for disk herniation:

A

30-60 degrees

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9
Q

PT management of disk herniation:

A

Management with McKenzie method and lumbar stabilization program along with HEP

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10
Q

Medical management of disk herniation:

A

medications and/or surgery such as discectomy, laminectomy, decompression, fusion, and lumbar artificial disc replacement

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11
Q

Facet Syndrome or

Z-Joint Dysfunction

A

well-localized LBP with some hip/buttock or leg pain above knee
Onset after simple misjudged movement or arising from flexed position
Absence of neurological deficits and nerve root tension signs/tests
AROM provokes pain (flexion/extension)
Hypomobility with PPIVM and/or PPAIVM (spring testing)

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12
Q

Facet Syndrome or

Z-Joint Dysfunction Management:

A 
Mobilizations and/or SMT
Postural education
Correction of muscle imbalances
Core stabilization exercises
Medical approach may include injections
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13
Q

Primary spinal stenosis:

A

congenital narrowing

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14
Q

Secondary or acquired spinal stenosis:

A 
Degenerative (hypertrophy of articular process, disc degeneration, ligamentum flavum hypertrophy, spondylolisthesis)
Fracture/trauma
Post-operative (post-laminectomy)
Ankylosing spondylitis
Tumors
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15
Q

Who is spinal stenosis most common in?

A

65 years or older

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16
Q

Diagnostic Utility of Patient History for Identifying Lumbar Spinal Stenosis

A 
age over 65
pain below knees
pain below buttocks
no pain when seated
sever LE pain
symptoms improved when seated
worse when walking
numbness
poor balance
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17
Q

Spinal stenosis signs and symptoms:

A

Often over age 50 years complaining of leg and back pain
Pain may be unilateral (lateral canal stenosis) or bilateral (central canal stenosis) and often diffuse
May complain of onset of leg pain with walking and relief after resting 20 minutes or by maintaining a flexed posture

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18
Q

CPR Diagnosis of

Lumbar Spinal Stenosis (LSS)

A

age 60-70 (2 points
age over 70 (3)
symptoms over 6 months (1)
symptoms improve when bending forward (2)
symptoms improve when bending backwards (-2)
symptoms exacerbated while standing up (2)
intermittent claudication (1)
urinary incontinence (1)

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19
Q

Diagnosis of LSS if:

A

Seven or higher on scoring system

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20
Q

LSS likely NOT present if:

A

Two or lower on scoring system

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21
Q

Neurological signs and symptoms of spinal stenosis:

A

Neurological deficits may be apparent yet cross-dermatomal and other nerve root boundaries
Normal peripheral pulses
Positive Romberg test and possible urine incontinence
↓ lumbar extension and difficulty standing or lying in erect position

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22
Q

Spinal Stenosis

Neurological Testing

A 
Vibration
pin prick
weakness
absent reflexes
Rhomberg
thigh pain with 30 seconds of extension
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23
Q

Spinal stenosis management:

A

Management with therapeutic exercise including postural education, stretching, core stabilization, and aerobic conditioning
Medical approach may involve medications, injections and/or surgery

24
Q

What percentage of spinal stenosis patients have resolution without treatment

A

30%

25
Q

Type I Spondylolisthesis (dysplastic):

A

Congenital abnormality in upper sacrum or neural arch of L5, allowing displacement

26
Q

Type II Spondylolisthesis (isthmic):

A

A lytic or fatigue fracture of pars, or elongated but intact pars, or acute fracture of pars

27
Q

Type III Spondylolisthesis (degenerative):

A

Secondary to degenerative arthrosis of z-joints or discovertebral articulation

28
Q

Type IV Spondylolisthesis (traumatic):

A

Secondary to fractures in area of neural arch other than pars

29
Q

Type V Spondylolisthesis (pathologic):

A

In conjunction with bone disease (e.g. Paget’s disease, osteoporosis)

30
Q

Type VI Spondylolisthesis (iatrogenic):

A

Occurs above or below a spinal fusion

31
Q

Epidemiology of Spondylolisthesis

A

Two most common types are isthmic, occurring in younger patients and degenerative, occurring in older patients

32
Q

When is the incidence of onset of type II spondylolisthesis?

A

adolescence, figure skaters, high jumpers

33
Q

Grade 0 Spondylolisthesis

A

normal

34
Q

Grade 1 Spondylolisthesis

A

1-25%

35
Q

Grade 2 Spondylolisthesis

A

26-50%

36
Q

Grade 3 Spondylolisthesis

A

51-75%

37
Q

Grade 4 Spondylolisthesis

A

76-100%

38
Q

Symptoms and Signs

Spondylolisthesis

A

asymptomatic or LBP worse with extension

pain worsened w/activity, relieved with rest

39
Q

Subtle signs of Spondylolisthesis:

A

hamstring tightness, hyperlordosis, and palpable step defect of SP

40
Q

What do patients with a grade 3 or greater spondylolisthesis have:

A

symmetric transverse skin furrow and hyperlordosis along with anterior pelvic tilt

41
Q

Intervention for spondylolisthesis depends on:

A

presenting symptoms

42
Q

Interventions for spondylolisthesis

A

pelvic positioning initially to provide symptomatic relief, followed by an active lumbar stabilization program and stretching (rectus femoris and iliopsoas muscles) to decrease anterior pelvic tilting

43
Q

Surgical referrals for what grades?

A

III and IV

44
Q

Who is pirifomis most common amoung?

A

active (athletes, runners, etc) and those who sit a great deal

45
Q

Signs and symptoms of piriformis syndrome?

A

unilateral buttock and posterior leg pain and paresthesia
Resisted external rotation of hip or passive internal rotation of hip may increase pain
Palpation of piriformis muscle may cause referred pattern down back of leg
Neurological symptoms uncommon

46
Q

Six cardinal features of Piriformis Syndrome:

A

(1) History of trauma to sacroiliac and gluteal regions
(2) Pain in region of SIJ, greater sciatic notch, and piriformis muscle, extending down lower limb and causing difficulty in walking
(3) Acute exacerbation of symptoms by lifting or stooping
(4) Palpable, sausage-shaped mass over piriformis muscle, during exacerbation of symptoms, which is markedly tender to pressure (this feature pathognomonic)
(5) Positive SLR test
(6) Gluteal atrophy (depending on duration of symptoms)

47
Q

When is aggressive stretch and massage of piriformis indicated?

A

If muscular spasm and tightness suspected etiology

48
Q

Diagnostic Utility of History for Identifying Ankylosing Spondylitis

A 
Pain not relieved by lying down
Back pain at night
Morning stiffness greater than 30 mins
Pain or stiffness relieved by exercise
age onset 40 years or less
49
Q

Ankylosing

Spondylitis Signs and Symptoms:

A

young male, CLBP and stiffness w/occasional radiation
Stiffness upon rising with some relief of complaints with mild to moderate activity
Global decrease in lumbopelvic ROM with gradual stiffening
Gradual loss of lumbar lordosis, increase thoracic kyphosis and decrease in chest expansion

50
Q

Ankylosing

Spondylitis Management:

A

Gentle mobilization/manipulation, stretching, and postural and breathing exercises
Monitor cardiac and pulmonary function

51
Q

Multiple Myeloma Signs and Symptoms:

A

Usually older patient (over 50 years age) with complaints of persistent LBP unrelieved by rest
Pain worse at night and may be associated with rib pain

52
Q

Metastatic Carcinoma Signs and Symptoms

A

Patient is usually >50 years with insidious onset of pain that is persistent, worse at night and not mechanically affected
Often an Hx of previous cancer, weight loss and fatigue
Unresponsiveness to conservative care after one month highly suggestive of cancer, especially in patients >50 years

53
Q

Where are METS most commonly from in metastatic carcinoma?

A

breast, lung and kidney

54
Q

Infectious Spondylitis Symptoms and Signs:

A

deep back pain made worse with pressure or percussion of SP’s, fever, and difficulty sleeping d/t pain; may present with antalgia
History of recent respiratory or UTI, or IV drug use or diabetes
Infection involving both disc and vertebral body
Involved organisms include Staph, Strept and TB

55
Q

What size is considered aneurysm?

A

greater than 3.8 cm

56
Q

What does urine test reveal in patients with multiple myeloma?

A

Bence-Jones proteins

57
Q

Where is AAA usually?

A

b/w L2 and L4

Musculoskeletal II (14 decks)

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