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Musculoskeletal Injuries > Lumbar Spine and Pelvis Pathology and Assessment > Flashcards

Lumbar Spine and Pelvis Pathology and Assessment Flashcards

1
Q

What is the most common region in the vertebrae for low back pain?

A

L4/L5

Sacroiliac

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2
Q

State the normal arches of the spine (kyphosis, lordosis)

A

Cervical - lordosis
Thoracic - kyphosis
Lumbar - lordosis
Sacrococcygeal - kyphosis

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3
Q

What is normal thoracolumbar flexion and extension?

A

Flexion: 85 degrees
Extension: 35 degrees

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4
Q

What is normal lateral flexion and rotation of the thoracolumbar?

A

Lateral flexion = 45 degrees

Rotation = 120 degrees (40 degrees thoracolumbar, 80 degrees craniocervical)

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5
Q

What do anterior ligaments of the spine prevent?

A

Excessive extension

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6
Q

What do posterior ligaments of the spine prevent?

A

Excessive flexion

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7
Q

What does the nucleus pulposus do?

A

Resists compression forces to the vertebral end plates and translates vertical compression forces into circumferential tensile forces in annulus fibrosis

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8
Q

What does the annulus fibrosis do?

A

Resists tensile (nearly all directions), torsional and shear forces

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9
Q

What muscles are used for spine flexion?

A

Rectus abdominis
External and internal oblique
Psaos major and iliacus when foot is at 90 degrees fixed

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10
Q

What muscles are used for spine extension?

A 
Longissimus
Iliocostalis
Multifidi
Rotatores
Semispinalis capitis
Quadratus lumborum
Interspinalis
Intertransversarii
Latissimus dorsi when arm is flexed
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11
Q

What muscles are used for spine rotation?

A 
External oblique
Internal oblique
Multifidi
Rotatores
Transverse abdominis
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12
Q

What muscles are used for lateral flexion

A 
Iliocostalis
External and internal oblique
Longissimus
Quadratus lumborum
Psaos major
Intertransversarii
Spinalis
Latissimus dorsi
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13
Q

Explain the muscles involved, and the purpose of the anterior SLING

A

Adductors and obliques work together to allow rotation when launching something like a javelin

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14
Q

Explain the muscles involved, and the purpose of the posterior SLING

A

Gluteus maximus and latissimus dorsi working together to allow rotation when doing a golf swing

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15
Q

State an initial hypothesis for the following

  • Restricted motion of lumbar spine
  • Lower buttock pain exacerbated by a pattern of movement such as sidebending or rotation
  • Decreased extension
A

Zygapophyseal joint pain syndrome

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16
Q

State an initial hypothesis for the following

-centralisation or peripheralisation of symptoms during repetitive movements or prolonged periods in certain positions

A

Discogenic pain

17
Q

State an initial hypothesis for the following

  • Lower extremity parathesia
  • Lower extremity weakness
A

Sciatica or lumbar radiculopathy

18
Q

State an initial hypothesis for the following

-Pain in lower extremity exacerbated by extension and quickly relieved by flexion

A

Spinal stenosis

19
Q

State an initial hypothesis for the following

-Recurrent locking, clicking or catching of the low back

A

Lumbar instability

20
Q

State an initial hypothesis for the following

  • Low back pain exacerbated by stretch of ligament or muscle
  • Pain with contraction of muscle
A

Muscle/ ligament sprain or strain

21
Q

What percent of low back injuries are non specific?

A

90%

22
Q

What is the difference between spondylolysis and spondylolisthesis

A

Spondylolysis is a fracture through the lamina of the vertebrae with no displacement. Spondylolisthesis is a fracture of the lamina of the vertebrae with anterior displacement

23
Q

What are some subjective signs of spondylolysis?

A
  • Pain with lumbar extension, rotation and side flexion
  • Pain worsening with activity
  • Pain localised and deep
  • Stiff and sore in the morning
24
Q

What are some objective signs of spondylolysis?

A
  • Pain with lumbar extension, rotation and side flexion
  • Pain with quadrant testing
  • Pain on palpation
25
Q

What is the biggest risk factor for spondylolysis or spondylolisthesis

A

-Young athlete younger than 18 who performs a lot of extension activities

26
Q

Explain osteoarthritis in the lumbar spine and possible complications.

A

Growth of bony spurs, or wearing down of the joint cartilage

Complications occur when their is spinal nerve compression and hyperextension deformities

27
Q

What percentage of people with low back pain have sacroiliac joint dysfunction?

A

15-25%

28
Q

True or false, sacroiliac joint dysfunction results in neural symptoms such as pins and needles down the back of the leg.

A

False. It does not have any neural symptoms

29
Q

Explain form and force closure in relation to sacroiliac joint dysfunction

A

Force closure - lack of motor control or strength in muscles leading to poor stability forces across the pelvis
Form closure - reduced stability in the SIJ due to structural injury (ligaments etc)

30
Q

What are some subjective signs of sacroiliac joint dysfunction?

A

Deep and persistent pain
Sitting down too long is painful
Pain with walking, running or kicking

31
Q

What are some objective signs of sacroiliac joint dysfunction?

A
  • Positive Laslett cluster testing, (2/4 at least)
  • Positive stork test
  • Unilateral functional testing differences
  • Poor recruitment of hip
32
Q

What is discogenic pain?

A

A tear in the disc structure that causes compression on spinal nerves

33
Q

What are some subjective signs of disc injuries?

A
  • Constant back pain which worsens with flexion
  • Pain and stiffness in the morning
  • Pain down the leg
  • Pins and needles
  • Pain with coughing and sneezing
34
Q

What are some objective signs of disc injuries?

A
  • Flexion and extension ROM reduction
  • Repeated flexion causing pain
  • Positive SLR
  • Positive slump test
35
Q

True or false, patients with chronic low back pain have more positive special tests compared to acute and subacute

A

True, on average chronic low back pain reported 3 positive tests compared to 2 and 2

Musculoskeletal Injuries (14 decks)

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