Lumbar Pathology Flashcards
1
Q
True or false; LBP can’t be relieved by using conservative means alone
A
False
2
Q
It is estimated that ____% of the population will
experience low back pain at some point in
their lifetime.
A
85%
3
Q
What are the 3 classic presentations of progressive DJD?
A
- Fibrilation (roughening)
- Cartilage ulceration
- Scleorosis/Osteophytes
4
Q
What is the capsular pattern of the lumbar spine?
A
SB/Rot>Extension
5
Q
What are the clinical tests for osteoarthritis of the lumbar spine?
A
- Compression: ↑ pain
- Traction: ↓ pain
- Kemp/Extension-Rotation
6
Q
What are the 3 classic presentations of RA?
A
- Synovial Thickening
- Vascular Granulation
- Immunochemical (RF)
7
Q
True or false; only RA has morning stiffness
A
False, all arthritises
8
Q
True or false; RA can cause instability in the lumbar spine
A
True
9
Q
Grades __ and ___ for pain
Grade ___ and ___ for stiffness
A
◼ Grades 1 and 2 for pain
◼ Grade 3 and 4 for stiffness
10
Q
What is the prevalence of spondylosis?
A
◼ 60% >45
◼ Males>Females
11
Q
Nerve tissue impingement at the cord is a…
A
Myelopathy
12
Q
Nerve compromise at the nerve root is…
A
Radiculopathy
13
Q
True or false; spondylosis is non-capsular
A
True
14
Q
True or false; spondylosis is characterized by osteophyte formation
A
True
15
Q
For arthritis and spondylosis you should do ___metric exercises first
A
Isometric
16
Q
What are the 2 types of lumbar sprain ?
A
◼ Traumatic
• Accompanied with Strain ◼ Elongation
• Force dependent
17
Q
True or false; lumbar sprains are almost always one level
A
FALSE!!!
18
Q
What are the grades of a sprain?
A
- Grade 1: Laxity/micro-tear
- Grade 2: Partial tear
- Grade 3: Full tear
19
Q
What type of end feel will a lumbar sprain have?
A
Empty/ abnormal
20
Q
True or false; the PPIVMs and PAVIMs associated with a lumbar sprain will be restricted
A
False- excessive
21
Q
After an acute lumbar sprain, teach a patient ___metric exercises, at first
A
Isometric
22
Q
Which stage of a lumbar sprain is appropriate to begin lumbar stabilization?
A
Sub-acute
23
Q
What is the CPR for lumbar instability?
A
◼ SLR to tolerance>91°
◼ <40 years old
◼ Aberrant forward bend
◼ Prone Instability Test (+)
24
Q
True or false; lumbar instability is usually progressive
A
False; traumatic
25
True or false; lumbar instability can be both unilateral and bilateral
True
26
How do you clinically test a lumbar instability?
◼ PPIVM’s/PAIVM’s excessive
◼ Empty/Abnormal end feel
◼ Prone Instability Tests
27
True or false; forward bending is an appropriate test for spondylolysthesis
FALSE
28
SPONDYLOLISTHESIS usually implies ____ slippage, while specifying ______ implies _______ direction
Anterior
Retro= posterior
29
What are the the causes of a spoldylolysthesis?
◼ Congenital Defect
◼ Acute macro-trauma
◼ Chronic micro-trauma
30
What is a spondylolisis?
Fracture
31
What are the grades of spondylolisthesis?
Grade 1 25
Grade 2 25-50
Grade 3 50-75
Grade 4 >75
32
Which diagnosis would you assess with a palpable step off and a prone instability test?
Spondyloisthesis
33
What are the ways to get a lumbar strain?
◼ Traumatic
• Often seen with sprains ◼ Elongation
• Force dependent
34
True or false; lumbar strains are usually single level.
FALSE multi
35
How do you assess a lumbar strain?
Resisted muscle pain
36
True or false; lumbar strains are a contractile pathology
True
37
True or false; muscle strains can be graded 1-3
True
38
True or false; myofascial pain syndrome may develop as a result of muscle strain
True
39
How do you clinically test a lumbar radiculopathy?
◼ Kemp/Quadrant Test, SLR
| ◼ Myotomes/Dermatomes/Reflexes
40
Herniated nucleus pulposis, according to McKenzie, would be which syndrome?
Derangement
41
Radiculopathies are usually (unilateral/bilateral)
Unilateral
42
Radiculopathies may be associated with spondylosis and DDD because of
Osteophytes
43
LUMBAR LAMINOFORAMINOTOMIES are performed using a _______ approach
Posterior
44
What are the types of lumbar fractures?
```
⦿ Compression
⦿ Wedge
⦿ Flexion-Distraction
⦿ Spondylolysis
◼ Pars Inter-articularis
```
45
What is fractured with a diagnosis of Spondylolysis?
Pars Inter-articularis
46
True or false; lumbar laminoforaminotomies have a relatively slow recovery
False; quicker recovery than other methods
47
Average healing time for bone is approximately ____________.
10 weeks
48
What is a lumbarization?
Congenital separation
| of S1
49
What is a sacralization?
Congenital fusion or
| hemi-fusion of L5
50
What are McKenzie's 3 syndromes?
⦿ Postural Syndrome
⦿ Dysfunction Syndrome
⦿ Derangement Syndrome
51
What are the 4 aspects of McKenzie's treatment philosophy?
◼ ↑ Centralization
◼ ↓ Peripheralization
◼ Repeated movements
◼ Self treatment
52
With new stability, you may find the segments above and below may become...
Unstable
53
What is postural syndrome?
Pain caused by mechanical
deformation of soft tissue
from prolonged positioning
54
True or false; postural syndrome has no underlying pathology
True
55
Which McKenzie syndrome is least frequently seen in clinic?
Postural
56
How many reps are performed for McKenzie ?
10
57
What do you assess in a Mckenzie eval?
ROM
Pain intensity
Pain distribution
58
True or false; postural syndrome can be associated with both anterior pelvic tilt AND posterior pelvic tilt
True
59
What are the force loads of the lumbar spine
◼ Body weight
◼ Ligamentous tension
• Flexion relaxation phenom ◼ Muscle tension
60
What is flexion relaxation phenomenon?
Getting past a certain point where ligament tension kicks in and muscles do less.
61
What forces are going through the spine as we bend forward?
Torque
62
For every foot you lean forward, you increase ___lbs on the spine
10
63
In lower cross syndrome, whats tight and whats loose?
Weak abs
weak Glute Max
Tight thoracolumbar extensors
Tight hip flexors
64
How do you dose repeated postural correction exercises?
10-15 reps; 3x/day
65
What is dysfunction syndrome?
Pain caused by mechanical
deformation of soft tissue
due to structural impairment
66
What causes dysfunction syndrome?
◼ Prior injury, inflammation, or
current degenerative process
◼ Tissue shortening/adaptation
• Facet Syndrome/FRS/ERS
67
Which is the second most common McKenzie syndrome?
Dysfunction syndrome
68
Where is the pain associated with dysfunction syndrome?
Toward available end range
69
What is the clinical prediction rule for LBP likely to benefit from spinal manipulation ?
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
What is the dosage for repeated movement correction for dysfunction syndrome?
2x10 reps; 3-8x/day
71
What is derangement syndrome?
Pain caused by internal
| intervertebral disc displacement
72
Which McKenzie syndrome has constant pain?
Derangement
73
Which Mckenzie syndrome may include deformity?
Derangement
74
Which McKenzie syndrome is associate with pain influenced by loading?
Derangement
75
Which McKenzie syndrome is associated with neutral ingrowth with chronicity?
Derangement
76
Which category is a type 1 derangement syndrome?
Type 1: Central across L4-L5; no butt/thigh pain; no deformity
77
Which category is a type 2 derangement syndrome?
Type 2: Central across L4-L5; possible butt/thigh pain with L-kyphosis
78
Which category is a type 3 derangement syndrome?
Type 3: Unilateral across L4-L5; possible butt/thigh pain; no deformity
79
Which category is a type 4 derangement syndrome?
Type 4: Unilateral across L4-L5; possible butt/thigh pain with lat. shift
80
Which category is a type 5 derangement syndrome?
Type 5: Unilateral across L4-L5; possible butt/thigh pain; pain below
knee; no deformity
81
Which category is a type 6 derangement syndrome?
Type 6: Unilateral across L4-L5; possible butt/thigh pain; pain below
knee with lateral trunk shift
82
Which category is a type 7 derangement syndrome?
Type 7: Symmetric/Asymmetric across L4-L5; possible butt/thigh pain
with accentuated lumbar lordosis
83
True or false; derangement syndrome may involve deformity
True
84
What's the cut off point for when a derangement becomes NOT OKAY and needs to be corrected with manual therapy?
If they can't get to midline
85
Which derangement syndrome categories are central?
1 &2
86
Which derangement syndrome categories are unilateral ?
3,4,5&6
87
Which derangement syndrome categories are accompanied by deformity?
Even numbers (2,4&6)
88
Which direction has the disc herniated for a derangement syndrome category 7 patient?
Anterior
89
Which herniation are reducible and benefit from McKenzie intervention?
Degeneration and prolapse
90
True or false; if a disc is extruded or sequestered, you can't treat
False- McKenzie might not be great, but we can do a lot
91
What is stenosis?
Inward canal closure secondary to spondylosis
92
What are the signs and symptoms of a lumbar myelopathy?
◼ Usually over age of 50
◼ Hunched posture
◼ Decreased coordination/balance
◼ Bilateral numbness/tingling
93
True or false; a myelopathy will have a positive babinski
True
94
What are the signs and symptoms of cauda equina syndrome?
```
◼ Bowel/bladder dysfunction
◼ LE pain, numbness, weakness
◼ Hyporeflexive
◼ Saddle area pain/numbness
◼ Unsteady gait
```
95
What is cauda equina syndrome and what may cause it?
Distal cord compression
◼ Disc derangement
◼ Tumor
◼ Infection
◼ Stenosis
96
True or false; we may treat cauda equina syndrome
False, medical referral
97
What are the signs and symptoms of an abdominal aortic aneurysm?
◼ Lower back/flank pain
◼ Abdominal pain
◼ Pulsation near navel
98
Belly exam reveals strong,
| abnormal pulse 2” from midline. What is it?
Abdominal aortic aneurysm
99
My patient walks around leaning on her cart, why might this be?
Lumbar myelopathy to unweight the compression
100
```
My patient has...
◼ Males > 50
◼ Painful, difficult urination
◼ Blood in urine/semen
◼ Constipation/incontinence
◼ LBP/hip-upper thigh pain
```
What am I thinking?
Prostate
101
My patient has...
```
◼ Females > 60
◼ Vaginal bleeding
◼ LBP/abdominal-pelvic pain
◼ Urination urgency/bloating
◼ Constipation/diarrhea
```
What am I thinking?
Ovarian cancer
102
My patient has...
```
◼ > 50 years of age
◼ Diarrhea/constipation
◼ Rectal bleeds/blood in stool
◼ Painful bowel movement
◼ LBP/abdominal discomfort
```
What am I thinking?
Colon cancer
103
True or false; cauda equina syndrome is unilateral
False
104
The spinal cord becomes the cauda equina around...
L2
105
True or false; more women than men have colon cancer
False
Males>Females (1 in 20)
106
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?
Uterine fibrosids
