LUMBAR SPINE Flashcards
localized L3 px is where
knee
Describe localized T9 px
btwn the medial iliac crests
localized L4 px
abdominal or testicular area
or band around the ankle
localized L5 px
general upper lumbar
L5/S1 localized px
coccyx or medial buttocks
deep, vague ache to buttock…think what kind of px
discogenic
Anterior thigh pain, pain signals enter above L2, referred pain to anterior groin/ thigh)
lower lumbar disc
px at PSIS is usually from
lumbar region issues
neurogenic px for L1 goes where
above the iliac crest or at groin
neurogenic px for L2
across the iliac crest anterior proximal thigh
neurogenic px L3
below the iliac crest/ above the greater trochanter anterior-medial aspect of distal thigh/ anterior-medial lower leg
neurogenic px L4
across the greater trochanter anterior-lateral thigh/ anterior-medial distal leg/ hallux
neurogenic px L5
across the ischial tuberosity Lateral thigh/ lateral distal leg/ dorsum of foot/ middle 3 toes
neurogenic px S1
medial to the ischial tuberosity posterior thigh/ posterior lower leg/ lateral foot and toe 5
neurogenic px S2
saddle area or medial heel
diverticulitis viserogenic px is where
left lower quadrant, low pack pain/ pelvic pain; can refer to hip/ thigh with abscess formative
Affects ages of 40-60+years
Pain is usually bilateral
Occurs in calf (foot, thigh, hip, or buttocks)
NO burning or dysethesia
Pain consistent in all spinal positions
Pain is brought on by physical exertion, relieved promptly by rest (1-5 min)
Pain is increased by walking uphill
Decreased or absent pulses in LE
Color and skin changes in feet; cold, numb, dry, or scaly skin; and poor nail and hair growth
intermittent claudication (vascular claudication of LS plexus)
A disorder of the elderly
Pain is usually bilateral and occurs in back, buttocks, thighs, calves, and feet
Burning and numbness present in LE
Pain is decreased in spinal flexion and increased in spinal extension and with walking
Pain is decreased by recumbency (walking uphill)
Pain is relieved with prolonged rest (may persist hours after resting)
Normal pulses
spinal stenosis
3 parts to a lumbar vert
body
pedicle
post elements
the function of the body of the vertebrate
WB - compression
3 main parts of the post elements
lamina
pars
mamillary process
what is the lamina
bony protective covering over neural contents
significance of mammillary process
where multifidi attach
nucleus of the IVD resists what force
comprssion
nucleus is type __ collagen
2
anulus fibrosis is type ___ collagen
1
anulus resists what type of force
tensile forces
function of IVD
transmit force btwn bodies
aid in proprioception
with distraction, what fibers of AF are effected
ALL with distraction
with shearing forces, what fibers of AF are effected
only those in the line of force
optimal stimulus for regeneration of AF is
rotation
optimal stimulus for regeneration of NP is
compression/decompression
where the end plates don’t cover the AF, but rather the AF fibers insert in to the bone of the body of the vertebrae is called
sharpey fibers
the principal WB of lumbar spine is the ___joints
interbody
function of facet joints (or zygoapophaseal joints)
locking to prevent anterior translation
optimal stimulus to regenerate facet joints
compress/decompress
PLL and LF resists lumbar
flexion
ALL resists
lumbar ext
what also resists lumbar ext
bony spinous processess
what limits rotation
liggs and facet joints
area on body where there is no movement of neural tissue as other tissues move
tension point
during a side bend, the ___ side of the joint closes and the ___ side opens
ipsi closes
contra opens
facets of L1-L4 are vertically oriented, so this facilitates __ and __
flexion and ext
what motion is limited for L1-L4
rotation and side bending
facets of L5 and S1 resist what motions
flexion and ext
in neutral spine, what motions are coupled
SB and Rot are opposite
in extended spine, what motions are coupled
SB and Rot are opp
in flexed spine what motions are coupled
SB and rot are SAME
quadrant movement is
combined (not natural)
so in ext combined/quadrand movement is
SB and rot are same
IDD means
internal disc disruption
tearing of AF through the end plate can lead to extrusion. before this occurs, the pt often has
schmorls nodes at that location
primary MOI of a lumbar disc injury would be what motions
repetitive lifting or bending with rotation in a neutral spine
avulsion fxs are due to
lack of anchoring of AF fibers
if disc materials migrate out of of the annular fibers it is considered
EDD
type of disc disorder where the fissures occur inside out (IDD)
transverse radial
which will have pos tension signs, IDD or EDD
EDD
where is radicular px for L1
groin and above iliac crest
where is radicular px for L2
ant proximal thigh and at iliac crest
where is radicular px for L3
below iliac crest and medial distal thigh
where is radicular px for L4
hallux and GT
where is radicular px for L5
dorsum of foot and middle toes and IT
where is radicular px for S1
lateral foot and 5th toe and medial to IT
radicular px for S2/S3
saddle and medial ankle
hallux radicular area is which lumbar vert again
L4 hallux
order of severity of HNP
TLE (protrusion, prolapse, extrusion)
2 types of prolapse
central - PLL just irritated
PPL (primary, post lat) - goes outside of PLL
extrusion is so severe bc
it ruptures PLL
“sick disc” unstable
extrusion
if pt c/o sensory sx first think
primary dorsal root with secondary disc
if pt c/o motor sx first think
primary disc 2ndary ventral root
type of stenosis where there is loss of disc ht
the spinal canal encroaches around the nerve
lateral
pt will present with px where for DDD/DJD
B LBP
age fro DDD/DJD
55-60 ish
what relieves px for DDD/DJD
unloading the joint (laying down)
typically, do DJD/DDD pts have hx of episodes
yes
is neurodynamic testing feasible for DDD/DJD
no
what form of assessment is a must for DDD/DJD
central PA (pushing on spinous processes with heel of hand to assess mvmt)
IDD/EDD typical age
20-40
IDD Presents with px where
local unilateral
what relieves px for IDD EDD
unloading the joint (like DDD/DJD)
are neurodynamic tests pos or neg for IDD EDD
neurodynamic tests are pos for EDD only
what motion increases px with IDD EDD
flexion
reporting pulling like a tight string is an ex of
adverse neurodynamic (extraneural)
primary way to injure an IVD is
repetitive mvmt
rotation while not in neutral
avulsion fxs occur dt
inadequate anchoring of the AF
avulsion usually occurs with what population
younger pts
circumferential tear of AF at the endplate is
schmorls node
px where is common with avulsion fx
leg px
when annulus migrates through the AF
EDD
type of IDD fissure that is circumferential
concentric delamination
nerve root lesions that are lateral, the pt shifts to which side
opp
nerve root lesions that are medial, pt shifts to which side
same
two types of adverse neurodynamics
extraneural and intraneural
sitting in prolonged lordosis bothers what pathologies
DDD/DJD/ IDD/EDD
describe location of px with a protrusion
bilateral paravertebral px, may go into buttock but breaks up at leg (not complete dermatomal pattern)
describe location of px with prolapse
prolapse- px in leg and lumbar and in complete dermatome pattern
describe px with extrusion
leg and lumbar in full/complete dermatome pattern.
may take over entire limb and be poly sectional
with a PPL disc issue, the px is usually where
px is not in lumbar, but rather it is all leg
protrusion or prolapse has fast onset
prolapse
will neurodynamic testing (SLR or slump) be pos for disc with nerve root involvement
yes
what type of disc issues would yield pos neuro exam findings
prob not protrusion or central
but PPL and extrusion would
shoulder lesion is
lateral shift to opp
axillary lesion is
medial shift to same
S2 is level of
PSIS
unilateral leg px with patchy dermatome pattern
extension hurts and standing hurts but flexion feels better
lateral stenosis
differentiate btwn px location of lateral and central stenosis
lateral - patchy dermatomal pattern
central -many segments and bilateral px (back and leg)
there is often a loss of ___ with stenosis
reflexes
stenosis has pos or neg neuro tests
pos
with facet issue, are neuro tests pos or neg
neg
facet px is
local px (can refer, but not radiating)
what causes px for facet joint
standing
decreases with sitting
what test is always pos for facet
quadrant
sharp px with sudden movment reports of weak or giving way feeling px increases during the day no neuro sx unilateral px ab muscle activation decreases sx
instability
protrusion vs prolapse
protrusion - Displacement of nuclear material beyond inner annulus causing bulge in outer annulus without escape of nuclear material (outer annulus is intact).
prolapse - Displacement of nuclear material beyond inner annulus WITH ESCAPE of nuclear material
injury or deficit to pars is which spondy
spondylolysis
Anterior slippage and inability to resist shear forces relative to the vertebra below.
spondylolithsthesis (top vert slips forward)
segmental levels of tension points
C6, T6, L4
when a pt shifts to a side, you name the shift by
direction of the shoulders
differences btwn stenosis and vascular claudication
stenosis- px decreases uphill
claudication -px increases uphill (px comes on with physical exertion)
stenosis- burning
claudication - no burning
stenosis - normal pulses
claudication -decreased pulses
px with 3d movement is indicative of issues at the_____
facet
antlike, dry, woody, dragging, electricity, crawling
intraneural adverse neurodynamics
whiplash or some form of invasive trauma predisposes a pt to
neurodynamic adverse sx
observing a pt and seeing knee flexed indicates
they are trying to take neural tension off sx
double crush syndrome
added effect on the neural sx (increased down the chain)
what is axoplasmic flow
flow of nutrients in the nervous sx (if altered it can cause double crush syndrome)
with stenosis, does flexion or ext feel better
stenosis - flexion feels better
ext or standing is pxful
what do you have to rule out with stenosis
vascular claudication
which has sx of burning px, vascular claudication or stenosis
stenosis
facet pts are usually around what age
60-70
facet px refers to where
buttock or post thigh
with facet, which hurts worse, standing or sitting
standing
which conditions are episodic
DDD/DJD EDD/IDD Disc
instability can be
what are the lumbar spine disorders
flexion ext rot rot with flex rot with ext
