Lumbar Spine Flashcards
Spine Cancer SPecificity
Older Age
Night Pain (can’t improve it)
Pain at Rest
History of Cancer + Unexplained weight loss (best way to determine)
Cauda Equina Syndrome
-disrupts motor & sensory function to the lower extremities & bladder
-LMN syndrome
-Rapid symptoms within 24 hrs
-urinary retention
-history of back pain
-loss of sphincter tone/sacral sensation loss (saddle paresthesia)
Vertebral Facture Specificity Cluster
-Older age + trauma (most specific)
-Osteoporosis
-Corticosteroid use
Myelopathy
-UMN signs (hypermobile, non-dermatomal, (+) pathological reflexes)
-originates from compression of spinal cord
-bowel/bladder dysfunction
-Dysphagia (difficulty swallowing)/Dysarthria (difficulty talking)
-Ataxic Gait
Myelopathy Clinical Diagnosis/Prediction Rule
Gait Deviation (ataxic)
(+) Hoffman’s
(+) Inverted Supinator
(+) Babinski
Age > 45 years
*3 of 5 is .99 specificity
Stages to a Disc Herniation
Normal
Degeneration
Prolapse
Extrusion
Sequestration
Pain Rating Outcome Measures
0 - 10 scale
Visual Analog Scale or Numeric Pain Rating Scale
*MCID is 2.4 for LBP
STarT Back Screening Tool
Helps stratify those patients who need less care and those who need more cognitive-behavioral based care
classified as low, medium or high risk of poor outcome
Modified Oswestry Disability Index
Rates level of disability
0-20% minimal disability
21-40% moderate disability
41-60% severe disability
61-80% crippled
81-100% either bed-bound or exaggerating
*MCID is 12%
Fear Avoidance Beliefs Questionnaire (FABQ)
2 Subscales: Physical Activity & Work
W-Score higher than 29 indicates poor return to work status
PA-score higher than 14 indicates poor treatment outcomes
Tampa Scale of Kinesiophobia (TSK)
quantifies patient’s fear of movement
>37 indicates clinically relevant kinesiophobia
Pain Catastrophizing Scale
maladaptive pain response characterized by
-Rumination (i can’t stop thinking about how bad it hurts)
-Magnification (i’m afraid something serious may happen)
-Helplessness (there is nothing I can do to reduce my pain)
> 30 means they’re catastrophizing
Short Form 36
questions regarding patient’s perceived health, activity limitations, physical and emotional health problems, social activity, pain, energy & emotions
2 item Depression Screen
“During the past month, have you often been bothered by feeling down, depressed or hopeless?”
“During the past month, have you often been bothered by little interest or pleasure in doing things?”
Lower Cross Syndrome
Long & Weak abdominals + glutes
Short & Tight hip flexors + spinal extensors
Increased Lumbar Lordosis
Pathological Reflexes UMN
spasticity of affected muscles
hyperreflexive DTR, clonus
Babinski
Pathological Reflexes LMN
flaccidity of affected muscles
hyporeflexive or absent DTR
muscle atrophy
no pathological reflexes
Flexor Endurance Test
Raise trunk off table until scapulae clear
Useful in determining excessive anterior/posterior muscle strength/endurance ratios
Double Straight Leg Lowering Test
Notice when lumbar spine begins to arch, ASIS rotates anteriorly or patient fails to keep legs lifted
Tests for muscle tightness
Thomas Test (psoas tightness)
Rectus Femoris Test/Kendall (rectus femoris tightness in supine)
Ely’s Test (rectus femoris tightness in prone)
Thomas Test
LE can be supported because Psoas only crosses the hip
(+) = straight leg raises off the table & stretch is felt in anterior hip
Kendall Test
LE is unsupported because rectus femoris crosses hip & knee
(+) = extension of knee on the side being tested when opposite hip is flexed
Ely’s Test
(+) = hip on same side flexes
Crossed (Well) SLR Test
Performed on uninvolved leg and if (+) neurological symptoms will reproduce on involved leg (LE flat on table)
(+) indicates potential for large disc herniation
