Lumbar, Pelvic, Hip

Question 1

Serious pathologies of LBP?

Answer 1

• Trauma
• Metastasise to the spine (neoplasia)
• Primary Ca
• Osteoporosis
• Ankylosing spondylitis
• Cauda equina
• Infection (osteomyelitis)
• Visceral (kidneys, AAA, repro)

Question 2

Red flags for LBP?

Answer 2

• History of Ca
• Systemic illness (fever, nauseated, vommiting)
• Severe pain
• Unexplained weightloss
• Significant trauma
• Neurological deficits
• Drug/alcohol abuse
• Anticoagulants
• Long hx of corticosteroid use
• No improvement
• Ssx of Cauda equina

Question 3

How to screen for red flags for LBP?

Answer 3

1. Fracture (trauma, osteoporosis, steroids)
2. Malignancy (unexplained WL, Hx of Ca, night pain, no improvement to treatment)
3. Infection (systemic symptoms)
4. Spondyloarthropithies

Question 4

What aspect of the joint is ‘sprained’ in a lumbar facet sprain?

Answer 4

Sprain or degermation to joint capsule, ligaments or articulating bone surfaces

Question 5

Typical presentation of facet pain?

Answer 5

• Sharp pain with movement “grabs/catches”
• Dull ache / sensitized tissues
• Regional muscle spasms of paravertebral and myofascial tenderness
• +/-Somatic referred pain
• achey/burning/ not well defined
• Aggravated by extension, rotation
• Relieved: change of position, heat, Panadol
• Unilateral, pain and tenderness over the site

Question 6

What are some causes of Lx radiculopathy?

Answer 6

• Bone spurs
• Degeneration (ligaments, joint capsule)
• Disc protrusion
• Space occupying lesion

Question 7

Typical presentation of radiculopathy?

Answer 7

• Very defined leg pain- related to myotomes and dermatomes
• Can only have leg pain
• T12-L1 & L1-L2 = groin pain discs
• L4-L5 = back pain disc
• L5-S1 = leg pain disc

Question 8

What is spondylolothesis?

Answer 8

displacement of one vertebrae on the other

forwards slippage – more common

Question 9

What is the grading of spondylolithesis?

Answer 9

G1: vertebra has slopped to up to 25% over the vertebral body
G2: slippage > 25%
G3: Slippage > 50%
G4: Slippage > 75%

Question 10

What are the different types of spondylolithesis?

Answer 10

Isthmic spondylosthesis (most common)
•	Bilateral pars interatricularis fracture 
•	Often occurs at L5-S1

Degenerative Spondylolisthesis- at L4-5 and IVD degeneration and facet instability

Other types: congenital, traumatic, pathological

Question 11

What population usually sustains Labral tears?

Answer 11

• Athletic population- ball sports typically

* FAI & DDH can increase a labral tears

Question 12

Clinical signs/symptoms of a labral tear?

Answer 12

• Pain felt in a c shape
• Catching /clicking/giving way and painful- 50%
• Excessive feedback
• Progressed version of the pain
• Dull ache + sharp pain
• Limp, especially in the morning or any period of not moving
Referral is typically in the buttocks

Question 13

How long do disc protrusions of the low back take to resolve?

Answer 13

6 - 12 weeks

Question 14

What are the key management processes of vertebral dysfunction?

Answer 14

1. Keep moving !
2. Education
3. Reassurance
4. Simple pain relief- NSAIDs
5. Physical therapy
6. Relative rest
7. Post-acute phase exercises
8. Heat