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OCS > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

Prevalence varies on

A
  • Sex (women>men)
  • Age
  • Education (lower education means increased prevalence as well as longer duration)
  • Occupation
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2
Q

In patients with acute LBP risk of flare up…

A
  • at 1 year 65% reported another episode
  • 2 months was median time to another episode
  • 60 days was median total duration
  • may have 20%-35% recurrence rates over a period of 6-22 months and 45% over 3 years
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3
Q

Prognostic factors for development of recurrent LBP

A
  • hx of previous episodes
  • excessive spine mobility
  • excessive mobility of other joints
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4
Q

Prognostic factors for development of chronic LBP

A
  • presence of symptoms below the knee
  • psychological distress or depression
  • fear of pain, movement, and reinjury, or low expectation of recovery
  • pain of high intensity
  • passive coping style
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5
Q

Acute LBP with mobility deficits

A
  • pt demonstrates restricted spinal ROM and segmental mobility. Pt’s symptoms are reproduced with provocation of the involved segments
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6
Q

Acute LBP with movement coordination impairments and LBP with radiating pain

A
  • pain occurs with initial to mid ranges of active or passive ROM with intervention strategies focused on movements that limit pain.
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7
Q

Subacute LBP with mobility deficits, with movement coordination impairments, and with radiating pain

A
  • Pain occurs with mid to end ranges of active or passive motions
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8
Q

Chronic LBP with movement coordination impairments and with radiating pain

A
  • pain occurs with sustained end range movements or positions
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9
Q

Acute LBP with referred LE pain

A
  • High irritability, intervention strategy is focused on centralization of symptoms.
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10
Q

Acute and subacute LBP with related cognitive and affective tendencies and chronic LBP with generalized LBP.

A
  • intermittent strategies focus on addressing relevant cognitive and affective tendencies and pain behaviors with patient education and counseling.
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11
Q

Factors most helpful in identifying spinal fractures

A
  • age >50 y/o
  • female
  • hx of major trauma
  • pain and tenderness
  • co-occurring, distracting/painful injury
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12
Q

Red flags for back related tumor

A
  • constant pain not affected by position or activity
  • age >50
  • Hx of CA
  • Failure of conservative treatment within 30 days
  • Unexplained weight loss
  • No relief with bed rest
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13
Q

Red flags for cauda equina syndrome

A
  • urine retention
  • fecal incontinence
  • saddle anesthesia
  • sensory or motor deficits in feet (L4, L5, S1)
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14
Q

Red flags of back related infection

A
  • recent infection
  • concurrent immunosuppressive disorder
  • deep constant pain, increases with weight bearing
  • fever, malaise, swelling
  • spine rigidity, accessory mobility may be limited
  • fever: tuberculosis osteomyelitis, pyogenic osteomyelitis, spinal epidural abscess
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15
Q

Red flags of spinal compression fx

A
  • hx of major trauma
  • age >50, age >75= increased specificity
  • prolonged use of corticosteroids
  • point tenderness over fracture site
  • increased weight bearing
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16
Q

Red flags for abdominal aneurysm

A
  • back abdominal or groin pain
  • presence of peripheral vascular disease or CAD and associated risks (>50 y/o, smoker, hypertension, diabetes)
  • smoking hx
  • family hx
  • age >70
  • non-caucasion
  • female
  • aortic pulse >5cm
  • symptoms not associated with movement stress
  • abdominal girth >100cm
  • presence of bruit in central epigastric area
  • palpation of abnormal aortic pulse
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17
Q

MDIC for Oswestry

A
  • 10 points or 30% change from baseline
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18
Q

Manipulation/mobilization classification

A

(presence of 4 or more increases probability of success from 45%-95%)

  • symptoms <16 days
  • no symptoms distal to knee
  • lumbar hypomobility
  • at least 1 hip with >35 of IR
  • FABQ-W score less than 19
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19
Q

Stabilization classification

A

(>3 needed to be positive)

  • age <40 y/o
  • positive prone instability test
  • presence of aberrant movements with motion testing
  • SLR >91
20
Q

Traction

A
  • 35%-50% of bodyweight
  • those with extension bias and a positive crossed straight leg raise had a better likelihood of success
  • 84.6% in the traction had success.
21
Q

Findings in pain free MRI’s

A
  • bulging discs 52%
  • degenerative discs 90%
  • herniated discs 28%
  • rate of surgery increases with MRI
22
Q

Spinal stenosis

A
  • pathological process involving bone ligaments, and synovial elements. Progressively compresses the neural and vascular elements in spinal canal
  • variable combo of static back pain, radicular LE pain, or neurogenic claudication
  • typically exacerbated with standing/walking/extension and eased by sitting and relaxing
23
Q

Radiologic findings for spinal stenosis

A
  • moderate changes: 24%-78%
  • severe changes: 8%-30%
  • symptomatic population: 5%-10% of older adults
24
Q

Central spinal stenosis

A
  • associated mainly with axial back pain and neurogenic claudication
  • motor or sensory radicular symptoms are possible
  • L4-L5 most common, followed by L3-L4 and L5-S1
25
Q

Lateral spinal stenosis

A
  • subarticular recess area

- unilateral or bilateral

26
Q

Foraminal stenosis

A
  • unilateral radiculopathy with pain and possible weakness of corresponding muscular territory
27
Q

Risk factors of spinal stenosis

A
  • obesity
  • smoking
  • lifestyle
  • genetic factors
28
Q

Management of spinal stenosis

A
  • Physical therapy including manual and exercise has positive effects regardless of severity
  • PT and therapy = equivalence in outcomes (surgery for non responders)
29
Q

Spondylolisthesis

A
  • congenital
  • isthmic IVD dysfunction
  • ->horizontalization of the lamina, facets, sacral morphology
  • traumatic
  • pathologic
30
Q

Disc degeneration (normally occurring)

A
  • contained (protrusion)
  • extrusion (prolapse)
  • sequestration (fluid is spreading around)
  • vertical prolapse (shmorl’s nodes)
31
Q

Spinal cord herniation

A
  • causative factor of Brown-Sequard syndrome
  • ->weakness or paralysis on one side of the body and a loss of sensation on the opposite side.
  • Condition of the cervical spine, immobility of the spinal cord (demyelination)
  • Caused by prolapsed cervical disc, malignancy/tumors, stenosis
32
Q

5th lumbar nerve root compression

A
  • pain in SIJ, buttock, inner 3 toes, medial sole of foot
  • neural tension
  • possible lateral deviation with flexion
  • weakness in peroneals, EH, hip ABD’s
  • decreased reflexes
33
Q

4th sacral nerve root compression

A
  • pain in lower sacral region, peroneal, genital
  • neural tension (-)
  • saddle parasthesia
  • limitation of any lumbar motion
  • bladder, bowel, genital dysfunction (urinary retention)
  • diminished anal reflexes
34
Q

Signs of central sensitization

A
  • chronic long standing pain
  • widespread pain, multiple pain areas
  • hyperalgesia
  • high fear avoidance
  • kinesiophobia
35
Q

Movement control

A
  • reversal of lumbopelvic rhythm
  • gower’s sign
  • hypermobility
  • painful “catch”
  • think core training and NMP
36
Q

Manual therapy

A
  • acute centralized back pain
  • no pain below the knee
  • segmental hypomobility
  • hip IR>35
  • FABQ-W >18
37
Q

Directional preference

A
  • centralization phenomenon with directional movement
38
Q

Traction and/or immobilization

A
  • radicular signs/symptoms
  • pain does not centralize with extension
  • (+) dural signs (crossed SLR)
  • severe unrelenting pain.
39
Q

Beighton score

A
  • pinkies to extension >90 (+1 pt for each hand)
  • thumbs to forearm flexors (+1 pt for each hand)
  • elbows hyperextend >10 (+1 pt for each side)
  • knees hyperextend >10 (+1 pt for each side)
  • touch floor with palms (+1 pt)
40
Q

McBurney’s point

A
  • 1/3-1/2 distance from ASIS to belly button

- deep tenderness or rebound tenderness

41
Q

Liver and gallbladder

A

R shoulder and upper trap, right low back pain

42
Q

Lung and diaphragm

A

Neck, left upper trap

43
Q

Heart

A

L pec and T4 region

44
Q

Pancreas

A

Just below xyphoid process

45
Q

Stomach

A

Just below xyphoid process below T4

46
Q

Gallbladder

A

R upper torso below R ribs

47
Q

Kidney

A

LBP

OCS (11 decks)

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