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MSK (Spine) > lumbar presentations > Flashcards

lumbar presentations Flashcards

1
Q

LBP CPGs were created with an impairment-based classification system in mind. The classifications are:
-Acute LBP with___deficits.
-Acute/Chronic LBP w/ movement ___
-Acute LBP w/ related ___ pain
-Acute/Chronic w/ ___ pain
Acute/Chronic w/ related ___/___

A
  1. mobility
  2. movement coordination
  3. relate (referred)
  4. radiating
    related cog/affective
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2
Q

Excessive mobility in the spine or other joints + hx of previous episodes are prognostic indicators for ___pain, not chronic.

A

recurrent

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3
Q

Many of the prognostic indicators for chronic LBP relate to cog factors such as fear/low expectations, distress/depression, and passive coping style. What are 2 more physical indicators?

A

symptoms below the knee and high-intensity pain

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4
Q

Back pain is pretty prevalent in cancer pts- hence, asking re Hx is important. What are the common metastasis origins? (Think lead kettle minus 1)

A

prostate, breast, lung, and kidney

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5
Q

epidural abscesses occur when when bacteria is carried to the space by the blood but it’s often misdx—about___% of the time.

A

50%

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6
Q

Vertebral osteomyelitis and epidural abscesses are often concomitant and similar in that they both present in focal back pain and have nervey s/s but how do HPI differ?

A

EA: likely to occur after a fall-not always though

VM:Hx of infection (esp bladder)

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7
Q

what physical examination findings would support a dx of vertebral osteomyelitis?

A

fever, local tenderness, agg w/ percussion, neurologic s/s (cord/root),

confirmed via lab tests

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8
Q

what physical examination findings would support a dx of epidural abscess?

A

local/focal back pain, radicular s/s, paralysis

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9
Q

Henschke’s 4 Rules for spine fx (think osteoporosis )

A

age >70 years
significant trauma
prolonged corticosteroid use
sensory alt

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10
Q

Roman’s 4 rules for spine fx (think stress or osteoporosis)

A

age>52, no leg pain, BMI </=22, doesn’t exercise reg, female

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11
Q

spondylolysis is a fatigue fracture of the ___ that can be acquired, congenital or developmental. A majority of them are at level___

A

pars interarticularis; L5

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12
Q

Define a flail segment.

A

a bilat pars defect w/ attached multifidi

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13
Q

what are some demographic factors related to spondylolysis & spondylolisthesis

A

Greatest slip in ages 10-15
sports w/ repetitive ext (diving,gymnastics ,weight lifting, etc)
risk + high grade slip in women>men

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14
Q

spondylolysis & spondylolisthesis aggravating fx

A

extension activities, rotation

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15
Q

what physical examination findings would support a dx of spondylolysis & spondylolisthesis?

A

neurologic s/s
focal p!
excessive lordosis w/ possible step-off deformity
hamstring tightness?
+instability and spring test
»often decreased flex/ext via imaging as opposed to instability

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16
Q

When observing spondylolysthesis, we know that CT and MR’s are better than X-rays for confirming the dx. With these images, we are looking for a “______” (think puppy lol)

A

scotty dog sign WITH a collar

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17
Q

This medically/procedurally contracted condition most commonly results from bacterial infection secondary to a discography.

A

iatrogenic discitis

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18
Q

____ or _____ can be complications of iatrogenic discitis.

A

sepsis or epidural abscess

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19
Q

Three primary sources of discogenic pain are:

A

iatrogenic discitis, torsion/rotary injury, internal disc disruption

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19
Q

Falling, repetitive jumping and/or picking up heavy objects (multifidi stress) can lead to axial compression on the vertebral endplates and ultimately fx+ ___ (think nucleus leakage)

A

schmorl’s nodes

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20
Q

Schmorl’s nodes can indicate an interaction between the nucleus pulposus and the body, there is potential for _____of the nucleus matrix (inflammation present) or ____of the pH (inflammation absent). Either way it’s a bad time to be a nucleus.

A

degradation, lowering

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21
Q

Internal disc disruption is typically a result of these two MOI:

A

rotary or end plate injury

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22
Q

The 4 main consequences of an IDD are that:
*The nucleus is less able to bind ___(thus can’t withstand pressure as well) and relies more on ___.
*Discs lose height and may extend to form herniations.
*“_____ effect “as facet joints take on more load.
*_______formation.

A

water
annulus
“tripod effect”
osteophyte formation

23
Q

this is not considered a herniation, but instead a _____. It involves between 50-100% of the disc circumference.

A

bulging disc

24
Q

Herniation:
This _____ herniation is considered to be _____ because it involves 25-50% of the disc.

A

protrusion; broad based

25
Q

Herniation:
This _____ herniation is considered to be _____ because it involves <25% of the disc.

A

protrusion; focal

26
Q

Herniation:
This herniation is considered to be _____ because of its shape.

A

an extrusion

27
Q

Herniation:
This herniation is considered to be _____ because of it’s free fragment.

A

sequestered

28
Q

In the same way the the disc can migrate in the transverse plane to impact SC or nerve roots, it can also move ___/____

A

superiorly/inferiorly

29
Q

talk through torsion MOI step by step.
1. axis of rotation starts @ ____ and lim by _____
2. Forced rotation changes axis to ____ and the opp ____ rotates backwatds+ shearing force on disc
3. Shear + rotary loading > potential ___

A
  1. posterior 1/3 of disc, z-joint
  2. z-joint (both blanks)
  3. tearing of annulus
30
Q

While initial trauma is still a factor regardless , pain from disc pathologies can be ___or ___

A

acute or chronic

31
Q

Pain descriptions for disc pathology are usually: (think type, frequency and location)

A

dull and constant ache thats recurrent and worsens in intensity over time
central but not well localized

32
Q

Aggravating fx of disc pathology include:
(hint: R.E.A.D. the room, my back hurts!)

A

-recumbency
-end range rotation
-activities that increase compression (sitting, coughing, etc)
-day duration/ disk

33
Q

in a physical examination of someone with disc pathology, we might expect to see postural abnormality (ex lat shift), pain in CPAs, LMN s/s and (3)

A

multidirectional trunk ROM lim
directional preference in rep motion (+centralization)
+SLR test

34
Q

how might the HPI of radicular pain differ between someone who is acute vs chronic?

A

acute- likely trauma related to twisting or lifting
chronic- insidious but feels like its peripheralizing as the condition progresses

35
Q

describe the symptomatology of radicular pain

A

shooting band-like pain that is aggravated with closing the foramen

36
Q

what physical examination findings would support a dx of radicular pain?

A

potential lateral shift and/or disc bulge, lim foramen closing, tenderness/turgor in paraspinals

37
Q

what special test findings would support a dx of radicular pain?

A

+ slump test
+SLR
+Well leg raise

38
Q

spinal stenosis is foraminal closing that is often described as degenerative. Structures that may contribute to this are: bulging discs, z joint hypertrophy (or osteophytes), ____(2)

A

thickening ligaments (potentially PLL), and spondylolisthesis

39
Q

this calf and sometimes thigh pain is common in over half of pts with L-spine stenosis.

A

neurogenic claudification

40
Q

list the common demographics for degenerative spinal stenosis

A

age >65, chronic LBP

41
Q

A person notes they are experiencing: UMN (OR LMN) s/s, pain aggravated by prolonged positioning/relieved w/ recumbency or UE support and pain in both legs that > their LBP. What is at the top of your differential

A

central canal degen spinal stenosis

42
Q

what physical examination findings would support a dx of degen spinal stenosis

A

diminished lumbar lordosis
painful/lim ext + lat flex ROM that improves w/ flexion
shortened HS/tight hip flex
UMN/LMN s/s

43
Q

Our CPRs for lumbar stenosis note 4/5 factors are pretty helpful in CONFIRMING a dx. What are the 5 factors?

A

bilat s/s
leg pain>back
pain w/ walking and standing
alleviating w/ rest
age >48

44
Q

T/F: Similar to what occurs in other spinal regions, z-Joint pain typically refers to the buttock and thigh in reliable, defined patterns.

A

FALSE. honestly they can refer all the way to foot in some cases

45
Q

thes 3 pathologies are contributors to the development of degen z-joint pain

A

OA, spondyloarthropathy, DDD/disc spondylosis

bonus: hx of prior injury can also relate

46
Q

what patient reports would encourage you to make acute z-joint OA part of your diff dx?

A

sudden oset and/or trauma
acute “locked back”
pain assoc w/ opening/closing z-joint space

47
Q

what components of your physical examination might cue you into an acute z-joint dx?

A

-slouched and potentially lat shifted posture
-pain and lim ROM (worst w/ ext)
-pain w/ spring testing /UPA
-tender, guarded paraspinal

48
Q

the insulating fat pads of the spine, ie: meniscoids, move ___ (into/out of) the joint during flexion and ____(into/out of) it during extension. After trauma, they can become highly irritable loose bodies.

A

flexion: OUT
ext: IN

49
Q

NM instability aka muscle imbalance often comes w/ recurrent hx. what other pt reports are characteristic of this dx?

A

constant LBP, prolong position, quick movement, flexion

+ pop,lock and drop it!

(pop/clunk noises, locking/catching, painful flex /getting up from ‘dropping it’ lol )

50
Q

what physical examination findings would support a dx of NM instability?

A

aberrant and or lim trunk AROM
joint or muscular hypermobility
paraspinal guarding/tenderness

51
Q

what special tests would support a dx of lumbar NM instability?

A

Prone instability test
passive lumbar ext test

52
Q

thoracolumbar fascia fat herniations, aka _____, present as innervated and palpable nodules in the posterior layer of the fascia.Rarely the ONLY issue, they can be treated with______ . They can also be asymptomatic.

A

back mice; needling and steroid injections

53
Q

LBP is often associated with fatty infiltration and atrophy of the ___. The typical conditions related to these morphologic changes include (3)

A

multifidi;
post-op (fusion!), recurrent unilat LBP, chronic LBP

54
Q

Proposed rationale for why the likelihood of recurrent/ chronic LBP increases with fatty infiltration–in addition to worsening intervention prognosis– is that…

A

there is an alteration in muscle recruitment potentially related to reflex inhibition.

55
Q

While a hx of low load, repetitive motions might prioritize trigger points in a differential diagnosis, the 3 requirements of an official dx are:

A

taut band
twitch response
local and referred tenderness

MSK (Spine) (7 decks)

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