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OCS study > Lumbar spine > Flashcards

Lumbar spine Flashcards

1
Q

Defining characteristics of cauda equina syndrome

A

Risk factors: herniated discs, acute rapid onset, lumbar stenosis, chronic/gradual onset, spinal surgery

Presentation: back pain with saddle anesthesia, bowel and bladder disturbances, unilateral symptoms progressing to bilateral, alternating leg pain, presence of new motor weakness, greater than 50 years old

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2
Q

Signs and symptoms of cauda equina

A

Bowel and bladder disturbances, alternating leg pain, saddle anesthesia, unilateral/bilateral radicular pain dermatome and myotome changesWhy is acute or extreme and rapid onset of lower back pain in adults older than 50 a red flag

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3
Q

Why is acute or extreme and rapid onset of lower back pain in adults older than 50 a red flag

A

Large discs typically do not cause issues in older adults. Suspect cauda equina syndrome

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4
Q

Fracture of lumbar spine risk factors

A

Severe trauma
female
Advanced age: > 65 years old female > 75 years old male previous spinal fracture especially with low impact
Frequent use of corticosteroids (75 mg over for three months)
cancer
osteoporosis
severe falls

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5
Q

What is the vertebral compression fracture CPG

A

Female
Greater than 70 years
Significant trauma in younger old populations
Prolonged corticosteroid use
3/4 equals 100% specificity

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6
Q

What are signs that you would look for an exam to encourage referral to imaging? What Type of imaging?

A

Use of CPG in addition to:
midline tenderness to palpation (can be below fracture area) neurological signs
spinal deformity
contusion or abrasion if sustained from fall

X-ray with lateral view MRI to differentially diagnose fracture between metastatic disease or myeloma

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7
Q

What risk factors would you suspect with spinal malignancy?

A

Age over 50, history of cancer (not a risk factor in isolation)

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8
Q

Which organs metastasized to the spine

A

PBKTL prostate breast kidney thyroid liver

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9
Q

What are signs and symptoms of spine metastasis

A

Severe pain that comes and goes
Night pain
Systematically unwell
Thoracic pain
Greater than 5% body loss over six months
Neurological signs
Spinal tenderness
Weird feeling in legs with altered sensations
Lab tests: ESR and hematocrit

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10
Q

What are the normal ranges for ESR

A

Under 50 years old: less than 15-20 Over 50 years old: less than 20-30

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11
Q

How much weight loss is suspicious of cancer?

A

weight loss of five per cent or more in six months

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12
Q

Risk factors for a spinal infection, what signs or symptoms would you see?

A

Risk factors: Immunosuppression, surgery, IV drug use, social environmental risk factors: homelessness, prison, or work exposure, tuberculosis history or recent or pre-existing infection

Signs and symptoms include: fatigue, spine pain, neuro symptoms, infection symptoms get worse instead of wax/waning wiht maliganacy

Differentiate between malignancy using ESR, see reactive proteins normal white count does not rule out a spinal infection

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13
Q

What are the four main treatment selections based off the treatment based classification for lower back pain

A

Traction
Specific Exercise
Stabilization
Manipulation

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14
Q

Which patients benefit from manipulation according to the CPG

A

No symptoms distal to the knee symptom
Onset <16 days low
Fab Q score <19
Lumbar hypomobility
Hip internal rotation >35° for at least 1 hip

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15
Q

Which patients benefit from Specific exercise according to the CPG

A

Directional preference
Symptoms that centralize or peripheralize with lumbar range of motion
Symptoms distal to butt
> 50 years old

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16
Q

Which patients benefit from Stabilization according to the CPG

A

Patients younger than 40 greater
General flexibility (postpartum SLR range of motion >91°
Instability catch or aberrant movement
+ Prone instability test

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17
Q

Which patients benefit from traction according to the CPG

A

Signs and symptoms of nerve root compression: Crossed SLR test
No movements centralize
Symptoms peripheralize with flexion AND extension

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18
Q

According to the treatment selection based on the lumbar TBC what is the cascade of events for intervention selection

A

Symptom modulation treatment criteria for selection
> movement control
> functional optimization

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19
Q

Which patients can be classified under the symptom modulation category for the lumbar interventions CPG

A

High Irritability
ODI greater than 40
7 out of 10 pain
High disability
Volatile symptoms

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20
Q

Which patients can be classified under the movement control category for the lumbar interventions CPG

A

Moderate Irritability
ODI greater than 21-40
3-6 out of 10 pain
moderate disability
stable symptoms

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21
Q

Which patients can be classified under the functional optimization category for the lumbar interventions CPG

A

low Irritability
ODI greater than 0-20%
1-3 out of 10 pain
low disability
Controlled symptoms

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22
Q

Which interventions are appropriate for the symptom modulation patient category

A

Directional preference
Manipulation mobilization
Traction
Active rest (encourage active participation without fearful wording pain under 24 hours is consideration for acuity)

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23
Q

Which interventions are appropriate for the movement control patient category

A

Sensory motor exercises
Stabilization exercises
Flexibility exercises
(think nerve glides)

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24
Q

Which interventions are appropriate for the functional optimization patient category

A

Strength and conditioning
work/sport specific exercises
aerobic exercise
general fitness

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25
Q

What are defining characteristics of disc herniation with nerve root involvement

A

Positive straight leg raise test with referred pain
Dermatomal pain at location in accordance to nerve roots Corresponding sensory or motor weakness
3/4 present

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26
Q

How do you distinguish intravertebral disc pain from facet joint pain

A

IVD Will have centralizing pain,
Facet joint pain will have no relief with rest and possible centralization

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27
Q

What are defining characteristics of spondylolisthesis

A

Intravertebral slip via palpation or inspection
Segmental hyper mobility with motion testing
Positive leg extension test in elderly

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28
Q

What are defining characteristics of Spinal stenosis

A

Age over 48
Bilateral symptoms
leg pain > lower back pain
pain with walking and standing
relief with sitting

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29
Q

What is the SI joint cluster of tests

A

Laslett rules
3/5 positive:
distraction
compression
thigh thrust
gaensleans
sacral thrust

Other cluster
TTP at PSIS
no centralization

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30
Q

Characteristics of disc herniation with nerve root involvement

A

Corresponding nerve root sensory and motor weakness
Positive SLR with referred pain
Dermatomal pain at location in accordance to nerve root

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31
Q

Characteristics of spondylolisthesis

A

Intravertebral slip via palpation or inspection
segmental hypermobility with motion testing
+ leg extension test and elderly

32
Q

Which myotomes are tested with toe and heel walking

A

L4,5 Ankle dorsiflexion (L4,L5) Great extension (L5)
S1 Ankle PF (L5,S1)

33
Q

According to the 2021 LBPCPG what are the recommendations for ACUTE low back pain

A

Active education should be provided not passive
include 1:1 biopsychosocial factors for pain
Self management techniques such as remaining active and pacing with back protection techniques.
Counsel and favorable and natural history of acute lower back pain

34
Q

According to the 2021 LBPCPG what are the recommendations for CHRONIC low back pain

A

Education should not be standalone or passive
PNE must be done with manual therapy or exercise
Active treatment is better than standalone education

35
Q

Which treatments were performed following the manip CPG study

A

Treatment:
manips: SI,Chicago/ Million dollar roll sidlying rotational manipulation
Exercise: pelvic tilts

36
Q

How can you distinguish radiculopathy from mononeuropathy

A

Radiculopathies will have symptoms lumbar/spine
Radiculopathy will follow nerve root pattern for sensation and motor changes
If severe enough weakness will show up later

37
Q

Hip flexion nerve root

A

L2-L3

38
Q

Knee extension nerve root

A

L 2,L3 ,L5

39
Q

Ankle dorsiflexion nerve roots

A

L4, L5

40
Q

Great toe extension nerve roots

A

L5

41
Q

ankle plantarflexion nerve roots

A

L5 S1

42
Q

knee flexion nerve roots

A

L4, L5, S1, S2

43
Q

What nerve roots contribute to the plantar reflex

A

L2,3,4
Also known as the babinski reflex

44
Q

What nerve roots contribute to the achlles reflex

A

S1 S2

45
Q

What is an aggravating factor and what is involved with femoral nerve neuropathy

A

Weak hip flexion if entrapment is above inguinal ligament

Motor and sensory changes

Pain with hip extension

46
Q

What is an aggravating factor and what is involved with saphrenous nerve neuropathy

A

Sensory changes only

47
Q

What is an aggravating factor and what is involved with obturator nerve neuropathy

A

sensory changes, very small over medial thigh
Weakness after exercise
pain with Adductor stretch

48
Q

What is an aggravating factor and what is involved with lateral femoral cutaneous femoral nerve neuropathy

A

Compression of midsection via belt clothing or weight
No motor symptoms
Only sensory loss over anterior lateral thigh

49
Q

What is an aggravating factor and what is involved with peroneal nerve injury?
which nerve root can it mimic and how to differentiate it? how to distinguish deep peroneal

A

Ankle plantar flexion and inversion will be affected
Can look like L5 radic.
Muscles not innervated by L5 and not peroneal N.:
Glutes, posterior tibialis, hamstrings (but not short head of biceps) will be spared
If deep peroneal is affected eversion is spared only sensory changes between toes one and two occur

50
Q

How to distinguish L3/4 neuropathy from femoral mononeuropathy

A

L3/4 radic: Positive straight leg raise (Sciatic N has L3/4 contributions), posterior tib, Glute med/min, adductor weakness

51
Q

How can you differentiate saphenous neuropathy from L4 radiculopathy

A

L4 will have pain with lumbar movement, motor changes to post tib, glute med/min, adductor magnus and will have quad weakness

52
Q

Deep peroneal nerve muscle innervation.

A

Anterior muscles of leg. Tibialis anterior extensor digitorum extensor hallicus longus and tertius
Sensory function: Supplies the triangular region of skin between the 1st and 2nd toes

53
Q

Superficial peroneal nerve muscle innervation

A

Motor impulses to the peroneus longus and peroneus brevis muscles, every and plantar flexion
Sensory information from the anterior leg and almost the entire foot dorsum

54
Q

What structure is the only direct dynamic check of anterior shear forces of L5/S1

A

Deep erector spinae

55
Q

What muscles place tension across the thoraco lumbar fascia

A

Deep erector spinae, gluteus maximus, minimus, transverse abs

56
Q

What are type 1, 2 and three spinal mechanics

A

Type 1 neutral mechanics vertebral rotation and sidebending happen in opposite directions in a neutral spine position
Type 2: non- neutral mechanics during flexion and extension, vertebral rotation and side bending happened to the same side
Type 3: spinal motion in one plain reduces the amount available in other planes

57
Q

Cholecystitis pain referral

A

Right lower thoracic/lower lumbar region

58
Q

Pancreatitis pain refferal

A

Left posterior shoulder and upper trap

59
Q

Penetrating duodenal ulcer pain refferal

A

Midline thoracolumbar junction
Not perforated duodenal ulcer which refers to right posterior shoulder

60
Q

Liver pathology pain referral

A

right anterior shoulder

61
Q

L5 dermatome myotome

A

Dermatome: lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
Myotome: Extensor hallucis, hamstring and calf atrophy

62
Q

S1 dermatome myotome reflex

A

D: toes 4 and 5
M: gastroc
R: achilles tendon

63
Q

L4 dermatome myotome reflex

A

D: big toe
M: Tibialis anterior
R: (patellar tendon)

64
Q

s2 dermatome myotome reflex

A

D: leg posterior thigh and plantar calcaneus
M: hamstring,
R: lateral hamstrings

65
Q

C7

A

Dermatome: digits 2-4
Myotome: triceps
Reflex: triceps

66
Q

C8

A

Dermatome: medial forearm
Myotome: none
Reflex: noen

67
Q

C5

A

Dermatome: middle deltoid
Myotome: biceps
Reflex: biceps

68
Q

spondylolisthesis

A

Forward slipping movement of the body of one of the lower lumbar vertebrae on the vertebra or sacrum below it
Step off deformity
Pars inticularis deformity
Treatment: Stabilization exercises

69
Q

C6

A

Dermatome: thumb
Myotome: wrist extensors
Reflex: brachioradilais

70
Q

Which body position increases intravertebral disc pressure the most

A

sitting, not standing

71
Q

what do the internal obliques do

A

right oblique = trunk rotation to the right

72
Q

hip flexion

A

L2 L3

73
Q

Knee extension

A

L2 L3 L4

74
Q

ankle DF

A

L4 L5

75
Q

Big toe extension

A

L5

76
Q

Ankle Plantar flexion

A

L5 S1

77
Q

Knee flexion

A

L5 S1 S2

OCS study (10 decks)

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