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Musculoskeletal 2 > Lumbar Spinal Stenosis > Flashcards

Lumbar Spinal Stenosis Flashcards

1
Q

Stenosis

A

Narrowing of the spinal canal

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2
Q

Which is most common: central canal stenosis or intervertebral foraminal stensosis?

A

Intervertebral Foraminal Stenosis

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3
Q

Possible causes of Central Canal stenosis?

A

Potential spinal cord compression (significant central disc herniation) or possible Cauda Equina syndrome

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4
Q

What is the cause of Intervertebral foraminal stenosis?

A

Spinal nerve root compression

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5
Q

Which type of stenosis has a worse prognosis?

A

Central canal stenosis

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6
Q

Lumbar spinal stenosis is caused by the degenerative aging process of what? And what can they all lead to?

A

Disc degeneration, Hypertrophy of facet joints, ligamentum flavum, Osteophytes, disc bulges; lead to less space for the nerve root in the spinal canal

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7
Q

Lumbar stenosis elements from pt history: Age

A

> 50

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8
Q

Lumbar stenosis elements from pt history: LBP and or LE symptoms with ________________

A

standing/walking

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9
Q

Lumbar stenosis elements from pt history: relief with ______________

A

sitting

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10
Q

Lumbar stenosis elements from pt history: improved walking tolerance with _____________

A

Flexion

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11
Q

Lumbar stenosis elements from pt history: pain worse in _________ with __________ which _____________

A

AM; initial WB; improves throughout the day

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12
Q

Lumbar stenosis common finding from Physical Exam: limited/painful _________________

A

lumbar extension AROM

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13
Q

Lumbar stenosis common finding from Physical Exam: centralization with _____________ and peripheralization with _______________ (repeated movement testing)

A

Flexion; Extension

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14
Q

Lumbar stenosis common finding from Physical Exam: tightness of _________________

A

hip flexors, hamstrings

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15
Q

Lumbar stenosis common finding from Physical Exam: weakness of __________________

A

Hip extensors/Abductors

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16
Q

Lumbar stenosis common finding from Physical Exam: May show + _______________ signs with Neuro exam

A

neurological compression

17
Q

Lumbar stenosis common finding from Physical Exam: discomfort with ______________

A

prone lying

18
Q

Lumbar stenosis common finding from Physical Exam: + _____________ of lumbar spine assessed with spring testing

A

Hypomobility

19
Q

Lumbar stenosis common finding from Physical Exam: Pain provocation with ________________

A

spring testing

20
Q

Lumbar stenosis common finding from Physical Exam: Limited ______ mobility, especially _________________

A

hip; Hip IR ROM

21
Q

What are the most common levels to test for lumbar stenosis symptoms due to the fact that over 95% of lumbar pathology happens at these levels?

A

L4/L5 and L5/S1

22
Q

S1 strength testing

A

Calf raises

23
Q

L5 strength testing

A

Great toe EXT

24
Q

L4/L5 strength testing

A

ankle dorsiflexion

25
Q

Many pts with stenosis have LE symptoms and difficulty walking due to compression of ________________ (neurogenic)

A

spinal nerves

26
Q

What disease can also present with LE symptoms, be aggravated with walking, and mimic neurogenic symptoms?

A

Peripheral Vascular Disease

27
Q

What is used to differentiate between Neurogenic and vascular symptoms?

A

Bicycle test

28
Q

Bicycle test

A

Pt rides stationary bike in upright position (lumbar spine extended) and then rides in flexed position (lumbar spine flexed)

29
Q

Interpretation of the bicycle test

A

If patient gets LE symptoms in both positions around the same time period or distance ridden = Vascular
If patient get symptoms in extended position and does not get symptoms in flexed position or rides an increased distance before symptom onset = neurogenic

30
Q

Red Flags in the Lumbopelvic region

A

Cancer cluster, Cauda Equina Symptoms, and + UMN signs/pathological reflexes

31
Q

Cancer cluster

A

Age >50, previous history of cancer, unexplained weight loss, and failure to respond to conservative treatment

32
Q

+ UMN signs/pathological reflexes

A

Clonus, Babinski, and Hoffman’s

33
Q

Lumbar spinal stenosis pts often fit into what treatment-based categories?

A

Specific Exercise - Flexion and Mobilization

34
Q

If a pt with lumbar spinal stenosis has symptoms that are consistently present distal to the knee, and have + signs of nerve root compression, they may often be placed in what treatment-based classification?

A

Traction

35
Q

Recommended Manual Therapy Interventions for Lumbar Stenosis

A

Manual lumbar traction, long-axis distraction, lumbar roll, lateral hip glide/specific directional hip mobs based on restrictions, hip flexor/hamstring/piriformis contract-relax stretching, and mobilizations to the thoracic spine to promote extension

Musculoskeletal 2 (4 decks)

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