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Manual II > Lumbar Pathology > Flashcards

Lumbar Pathology Flashcards

1
Q

True or false; LBP can’t be relieved by using conservative means alone

A

False

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2
Q

It is estimated that ____% of the population will
experience low back pain at some point in
their lifetime.

A

85%

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3
Q

What are the 3 classic presentations of progressive DJD?

A
  • Fibrilation (roughening)
  • Cartilage ulceration
  • Scleorosis/Osteophytes
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4
Q

What is the capsular pattern of the lumbar spine?

A

SB/Rot>Extension

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5
Q

What are the clinical tests for osteoarthritis of the lumbar spine?

A
  • Compression: ↑ pain
  • Traction: ↓ pain
  • Kemp/Extension-Rotation
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6
Q

What are the 3 classic presentations of RA?

A
  • Synovial Thickening
  • Vascular Granulation
  • Immunochemical (RF)
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7
Q

True or false; only RA has morning stiffness

A

False, all arthritises

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8
Q

True or false; RA can cause instability in the lumbar spine

A

True

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9
Q

Grades __ and ___ for pain

Grade ___ and ___ for stiffness

A

◼ Grades 1 and 2 for pain

◼ Grade 3 and 4 for stiffness

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10
Q

What is the prevalence of spondylosis?

A

◼ 60% >45

◼ Males>Females

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11
Q

Nerve tissue impingement at the cord is a…

A

Myelopathy

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12
Q

Nerve compromise at the nerve root is…

A

Radiculopathy

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13
Q

True or false; spondylosis is non-capsular

A

True

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14
Q

True or false; spondylosis is characterized by osteophyte formation

A

True

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15
Q

For arthritis and spondylosis you should do ___metric exercises first

A

Isometric

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16
Q

What are the 2 types of lumbar sprain ?

A

◼ Traumatic
• Accompanied with Strain ◼ Elongation
• Force dependent

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17
Q

True or false; lumbar sprains are almost always one level

A

FALSE!!!

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18
Q

What are the grades of a sprain?

A
  • Grade 1: Laxity/micro-tear
  • Grade 2: Partial tear
  • Grade 3: Full tear
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19
Q

What type of end feel will a lumbar sprain have?

A

Empty/ abnormal

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20
Q

True or false; the PPIVMs and PAVIMs associated with a lumbar sprain will be restricted

A

False- excessive

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21
Q

After an acute lumbar sprain, teach a patient ___metric exercises, at first

A

Isometric

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22
Q

Which stage of a lumbar sprain is appropriate to begin lumbar stabilization?

A

Sub-acute

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23
Q

What is the CPR for lumbar instability?

A

◼ SLR to tolerance>91°
◼ <40 years old
◼ Aberrant forward bend
◼ Prone Instability Test (+)

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24
Q

True or false; lumbar instability is usually progressive

A

False; traumatic

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25
Q

True or false; lumbar instability can be both unilateral and bilateral

A

True

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26
Q

How do you clinically test a lumbar instability?

A

◼ PPIVM’s/PAIVM’s excessive
◼ Empty/Abnormal end feel
◼ Prone Instability Tests

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27
Q

True or false; forward bending is an appropriate test for spondylolysthesis

A

FALSE

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28
Q

SPONDYLOLISTHESIS usually implies ____ slippage, while specifying ______ implies _______ direction

A

Anterior

Retro= posterior

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29
Q

What are the the causes of a spoldylolysthesis?

A

◼ Congenital Defect
◼ Acute macro-trauma
◼ Chronic micro-trauma

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30
Q

What is a spondylolisis?

A

Fracture

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31
Q

What are the grades of spondylolisthesis?

A

Grade 1 25
Grade 2 25-50
Grade 3 50-75
Grade 4 >75

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32
Q

Which diagnosis would you assess with a palpable step off and a prone instability test?

A

Spondyloisthesis

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33
Q

What are the ways to get a lumbar strain?

A

◼ Traumatic
• Often seen with sprains ◼ Elongation
• Force dependent

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34
Q

True or false; lumbar strains are usually single level.

A

FALSE multi

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35
Q

How do you assess a lumbar strain?

A

Resisted muscle pain

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36
Q

True or false; lumbar strains are a contractile pathology

A

True

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37
Q

True or false; muscle strains can be graded 1-3

A

True

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38
Q

True or false; myofascial pain syndrome may develop as a result of muscle strain

A

True

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39
Q

How do you clinically test a lumbar radiculopathy?

A

◼ Kemp/Quadrant Test, SLR

◼ Myotomes/Dermatomes/Reflexes

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40
Q

Herniated nucleus pulposis, according to McKenzie, would be which syndrome?

A

Derangement

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41
Q

Radiculopathies are usually (unilateral/bilateral)

A

Unilateral

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42
Q

Radiculopathies may be associated with spondylosis and DDD because of

A

Osteophytes

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43
Q

LUMBAR LAMINOFORAMINOTOMIES are performed using a _______ approach

A

Posterior

44
Q

What are the types of lumbar fractures?

A 
⦿ Compression 
⦿ Wedge 
⦿ Flexion-Distraction 
⦿ Spondylolysis
◼ Pars Inter-articularis
45
Q

What is fractured with a diagnosis of Spondylolysis?

A

Pars Inter-articularis

46
Q

True or false; lumbar laminoforaminotomies have a relatively slow recovery

A

False; quicker recovery than other methods

47
Q

Average healing time for bone is approximately ____________.

A

10 weeks

48
Q

What is a lumbarization?

A

Congenital separation

of S1

49
Q

What is a sacralization?

A

Congenital fusion or

hemi-fusion of L5

50
Q

What are McKenzie’s 3 syndromes?

A

⦿ Postural Syndrome
⦿ Dysfunction Syndrome
⦿ Derangement Syndrome

51
Q

What are the 4 aspects of McKenzie’s treatment philosophy?

A

◼ ↑ Centralization
◼ ↓ Peripheralization
◼ Repeated movements
◼ Self treatment

52
Q

With new stability, you may find the segments above and below may become…

A

Unstable

53
Q

What is postural syndrome?

A

Pain caused by mechanical
deformation of soft tissue
from prolonged positioning

54
Q

True or false; postural syndrome has no underlying pathology

A

True

55
Q

Which McKenzie syndrome is least frequently seen in clinic?

A

Postural

56
Q

How many reps are performed for McKenzie ?

A

10

57
Q

What do you assess in a Mckenzie eval?

A

ROM
Pain intensity
Pain distribution

58
Q

True or false; postural syndrome can be associated with both anterior pelvic tilt AND posterior pelvic tilt

A

True

59
Q

What are the force loads of the lumbar spine

A

◼ Body weight
◼ Ligamentous tension
• Flexion relaxation phenom ◼ Muscle tension

60
Q

What is flexion relaxation phenomenon?

A

Getting past a certain point where ligament tension kicks in and muscles do less.

61
Q

What forces are going through the spine as we bend forward?

A

Torque

62
Q

For every foot you lean forward, you increase ___lbs on the spine

A

10

63
Q

In lower cross syndrome, whats tight and whats loose?

A

Weak abs
weak Glute Max
Tight thoracolumbar extensors
Tight hip flexors

64
Q

How do you dose repeated postural correction exercises?

A

10-15 reps; 3x/day

65
Q

What is dysfunction syndrome?

A

Pain caused by mechanical
deformation of soft tissue
due to structural impairment

66
Q

What causes dysfunction syndrome?

A

◼ Prior injury, inflammation, or
current degenerative process
◼ Tissue shortening/adaptation
• Facet Syndrome/FRS/ERS

67
Q

Which is the second most common McKenzie syndrome?

A

Dysfunction syndrome

68
Q

Where is the pain associated with dysfunction syndrome?

A

Toward available end range

69
Q

What is the clinical prediction rule for LBP likely to benefit from spinal manipulation ?

A
  1. LBP < 16 days
  2. No symptoms below knee
  3. FABQ work subscale score < 19 points
  4. One or more lumbar segments are hypo-mobile
  5. One or both hips have > 35° of IR
70
Q

What is the dosage for repeated movement correction for dysfunction syndrome?

A

2x10 reps; 3-8x/day

71
Q

What is derangement syndrome?

A

Pain caused by internal

intervertebral disc displacement

72
Q

Which McKenzie syndrome has constant pain?

A

Derangement

73
Q

Which Mckenzie syndrome may include deformity?

A

Derangement

74
Q

Which McKenzie syndrome is associate with pain influenced by loading?

A

Derangement

75
Q

Which McKenzie syndrome is associated with neutral ingrowth with chronicity?

A

Derangement

76
Q

Which category is a type 1 derangement syndrome?

A

Type 1: Central across L4-L5; no butt/thigh pain; no deformity

77
Q

Which category is a type 2 derangement syndrome?

A

Type 2: Central across L4-L5; possible butt/thigh pain with L-kyphosis

78
Q

Which category is a type 3 derangement syndrome?

A

Type 3: Unilateral across L4-L5; possible butt/thigh pain; no deformity

79
Q

Which category is a type 4 derangement syndrome?

A

Type 4: Unilateral across L4-L5; possible butt/thigh pain with lat. shift

80
Q

Which category is a type 5 derangement syndrome?

A

Type 5: Unilateral across L4-L5; possible butt/thigh pain; pain below
knee; no deformity

81
Q

Which category is a type 6 derangement syndrome?

A

Type 6: Unilateral across L4-L5; possible butt/thigh pain; pain below
knee with lateral trunk shift

82
Q

Which category is a type 7 derangement syndrome?

A

Type 7: Symmetric/Asymmetric across L4-L5; possible butt/thigh pain
with accentuated lumbar lordosis

83
Q

True or false; derangement syndrome may involve deformity

A

True

84
Q

What’s the cut off point for when a derangement becomes NOT OKAY and needs to be corrected with manual therapy?

A

If they can’t get to midline

85
Q

Which derangement syndrome categories are central?

A

1 &2

86
Q

Which derangement syndrome categories are unilateral ?

A

3,4,5&6

87
Q

Which derangement syndrome categories are accompanied by deformity?

A

Even numbers (2,4&6)

88
Q

Which direction has the disc herniated for a derangement syndrome category 7 patient?

A

Anterior

89
Q

Which herniation are reducible and benefit from McKenzie intervention?

A

Degeneration and prolapse

90
Q

True or false; if a disc is extruded or sequestered, you can’t treat

A

False- McKenzie might not be great, but we can do a lot

91
Q

What is stenosis?

A

Inward canal closure secondary to spondylosis

92
Q

What are the signs and symptoms of a lumbar myelopathy?

A

◼ Usually over age of 50
◼ Hunched posture
◼ Decreased coordination/balance
◼ Bilateral numbness/tingling

93
Q

True or false; a myelopathy will have a positive babinski

A

True

94
Q

What are the signs and symptoms of cauda equina syndrome?

A 
◼ Bowel/bladder dysfunction
◼ LE pain, numbness, weakness
◼ Hyporeflexive
◼ Saddle area pain/numbness
◼ Unsteady gait
95
Q

What is cauda equina syndrome and what may cause it?

A

Distal cord compression

◼ Disc derangement
◼ Tumor
◼ Infection
◼ Stenosis

96
Q

True or false; we may treat cauda equina syndrome

A

False, medical referral

97
Q

What are the signs and symptoms of an abdominal aortic aneurysm?

A

◼ Lower back/flank pain
◼ Abdominal pain
◼ Pulsation near navel

98
Q

Belly exam reveals strong,

abnormal pulse 2” from midline. What is it?

A

Abdominal aortic aneurysm

99
Q

My patient walks around leaning on her cart, why might this be?

A

Lumbar myelopathy to unweight the compression

100
Q 
My patient has...
◼ Males > 50
◼ Painful, difficult urination
◼ Blood in urine/semen
◼ Constipation/incontinence
◼ LBP/hip-upper thigh pain

What am I thinking?

A

Prostate

101
Q

My patient has…

◼ Females > 60
◼ Vaginal bleeding
◼ LBP/abdominal-pelvic pain
◼ Urination urgency/bloating
◼ Constipation/diarrhea

What am I thinking?

A

Ovarian cancer

102
Q

My patient has…

◼ > 50 years of age 
◼ Diarrhea/constipation 
◼ Rectal bleeds/blood in stool 
◼ Painful bowel movement 
◼ LBP/abdominal discomfort

What am I thinking?

A

Colon cancer

103
Q

True or false; cauda equina syndrome is unilateral

A

False

104
Q

The spinal cord becomes the cauda equina around…

A

L2

105
Q

True or false; more women than men have colon cancer

A

False

Males>Females (1 in 20)

106
Q

My patient has…

◼ Non-cancerous fibroid
◼ Heavy menstrual bleeding
◼ Pelvic pain/pressure
◼ LBP/abdominal-pelvic pain
◼ ↑ Urination frequency
◼ Constipation/urinary retention

What am I thinking?

A

Uterine fibrosids

Manual II (11 decks)

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