Lumbar Pathologies (PPT 5) Flashcards
What happens to the nucleus in intra-spongy nuclear herniation
-nucleus displaced in vertebral body thru cartilaginous endplate
What is a cause of ISNH
mod to severe flexion trauma
What are the four grades of ISNH
1: subchondral fx in vertebral body
2: small cracks in endplates
3: crack and bone shifted
4: crack, bone shift, and disc leaks
What happens to the nucleus in HNP protrusion w/o n root involvement
discrete bulge in outer annulus
Where is HNP protrusion w/o n root involvement commonly found at
L4-L5 and L5-S1
What movement causes HNP protrusion w/o n root involvement
cumulative forward bending and lifting
-sitting slumped in bent posture
Characteristics of HNP protrusion w/o n root involvement pt
30-50, male
What are relieving and agg factors of HNP protrusion w/o n root involvement
relief: standing and walking
agg: sitting
Pt presentation of HNP protrusion w/o n root involvement
-pain greater on one side
-refer pain in leg usually unilat (dermatomal pattern)
-gradual onset
-norm neuro
-involved seg tender
-lat shift and flat lordosis
EXT limited
Describe the nucleus for HNP protrusion w/ n root involvement
-nucleus bulges but still contained within annulus and PLL
-bulge intrudes into spinal canal and/or vertebral foramen
Which nerve root does a HNP protrusion w/ n root involvement impinge
segment level BELOW bulge
Findings for HNP protrusion w/ n root involvement
-pain greater on one side
-refer pain in leg usually unilat (dermatomal pattern)
-gradual onset
-norm neuro
-involved seg tender
-lat shift and flat lordosis
EXT limited
AND positive neuro s/s
What neuro s/s would you find in HNP protrusion w/ n root involvement
-decreased myotome strength
-decreased DTR
-loss sensation
- (+) SLR
Describe how the pt will shift with a lateral or medial n root involvement for HNP protrusion
-HNP lateral, pt shifts opp
-HNP medial, pt shifts toward
What needs to be corrected first before McKenzie in HNP protrusion w/ n root involvement
protective scoliosis
What happens to nucleus in HNP extrusion
nuclear material escapes into spinal canal
What color is white and black in MRI
white = healthy
black = disc desiccation
What are the findings for HNP sequestration
-peripheral s/s likely greater than spinal s/s
-pain from disc bugle gone
Pathophysiology of DDD (4)
-dehydrated NP
-narrow intervertebral space
-weakening of degen. annular rings
-facets approximate
DDD findings (3)
-tender at segmental levels
-early stage (A/PROM restricted)
-advanced stage (pain w/ any movement, hypermob)
MOI of facet impingement
SUDDEN unguarded movement w/ ext, SB and/or rot
-little to no trauma
Clinical findings of facet impingement (6)
-ease = rest
-agg = movement
-intermittently LOCKED protective posture
-AROM decreased in 3/6 ranges, w/ end range pain
-single seg involvement
-TTP
Which directions would be agg/limited for facet impingement
ipsilat SB and contralat rot
What is key to identify facet sprain
pt’s hx
How does a facet sprain occur
progression of repetitive facet impinge
S/S of clinical instability
-recurrent BP
-constant when exacerbated, catch/lock
-unprovoked repeated episodes
-minor ache AFTER sensation of giving way
-consistent click/clunk
-protracted pain w/ FULL ROM
-excessive AROM
Agg postures and movements for instability
-sustained sit, prolong stand, semi flexed pos
-forward bend, sudden movement, return upright from bending, lift/sneeze
4 examples of DJD
-calcific deposits in and around jt periphery
-wearing away of hyaline cartilage
-thickening of synovial jt and jt capsule
-thickening of subchondral bone
4 signs of DDD
-dehydrated NP
-narrowing intervertebral space
-weaking and degen. annular rings
-approx facets
What is spondylolysis
defect of pars interarticularis
Findings of spondylolysis
-STEP OFF of SP can be felt
-hyperlordosis
-pain prolong stand
-relief w/ sit
-original onset from vig act or athletics when younger
What is spondylolisthesis
-forward displacement
-common L5-S1
Describe the grades of spondylolisthesis
G1: 1-25%
G2: 26-50%
G3: 51-75%
G4: 76-100%
G3 and 4 cause cauda equina symps
What is n root compression? Describe the pain
-impinged/irritated n root
-causes true neuro s/s
-deep and superficial burning of one n root
N root swelling and inflammation findings
true neuro signs
How does nerve root swelling and inflam occur
-insidious onset
-accompany mus and jt inflam
-following severe injury within a few day s
nerve root adhesion findings
marked absence of STANDING flexion
-little to no restriction in sit or supine
-disc protrusion signs NOT present
What is ankylosing spondylitis
-systemic inflam process
-progressive jt sclerosis and lig ossification
ankylosing spondylitis pt characteristics
20-35 yo male
Findings of ankylosing spondylitis
-chronic
-initially vague LBP and stiff
-worse waking and eased with light exercise
-onset insidious, no MOI
-flat of lumbar lordosis and increased t/s rounding
UMN or LMN for cauda equina
young: UMN
adult: LMN
Clinical prediction rule for lumbar stability tx
-SLR > 91 degrees
+ prone instab test
+ aberrant movements
age < 40 yo
Manip. successful intervention
< 19 on FAB-Q
symps 15/16 days or less
no symps distal to knee
l/s hypomobility any level
hip w/ >35 degree IR
