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MSK 2 > Lumbar Spine Classification/Diagnoses > Flashcards

Lumbar Spine Classification/Diagnoses Flashcards

1
Q

DDD profile

A

55-60

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2
Q

DJD profile

A

55-60

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3
Q

Disc (IDD, EDD) profile

A

young (20-40)

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4
Q

Difference in body chart/location of symptoms for DDD vs. DJD

A
  • DDD = the disc can present with bilateral LBP symptoms (one side can be greater); can refer to buttock
  • DJD = facet can be local pain & refer to buttock, posterior thigh, groin
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5
Q

Body chart/location of symptoms difference between EDD & IDD

A
  • IDD = local unilateral pain, spreads with progression; referral to buttock
  • EDD = bilateral paravertebral pain
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6
Q

Pain difference between ProT & PPL

A
  • ProT = bilateral paravertebral with buttock/leg pain in partial or complete dermatomal line
  • PPL = little to no lumbar pain, posterior leg pain
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7
Q

Prolapse body chart/location of symptoms

A

-leg pain is greater than back pain; dermatomal pattern

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8
Q

Extrusion body chart/location of symptoms

A

-leg pain is greater than back pain; poly-segmental (radicular & non-radicular pain)

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9
Q
A

IDD body chart

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10
Q
A

EDD body chart

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11
Q
A

Facet body chart

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12
Q
A

Protrusion body chart

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13
Q
A

Prolapse Body Chart

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14
Q
A

Extrusion body chart

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15
Q
A

Lateral Stenosis Body Chart

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16
Q
A

central stenosis body chart

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17
Q
A

DDD/DJD Body Chart

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18
Q

Differences of pain between ProL & Ext

A
  • ProL: leg pain > back pain; dermatomal pattern
  • ExT: leg pain > back pain; poly-segmental (radicular & non-radicular pain)
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19
Q

Difference of pain between chronic lateral spinal stenosis and DRG with lateral spinal stenosis

A
  • chronic: proximal worse than distal
  • DRG: paresthesia & radicular lancinating pain
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20
Q

Lateral Spinal Stenosis Profile

A

40-60

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21
Q

Central Stenosis Profile

A

60-70

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22
Q

Facet profile

A

chronic > 55-60

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23
Q

What kinds of things might a patient who has instability complain of?

A
  • catching, unilateral pain, deep dull ache
  • back feels weak or feels as if it will “give way” with certain movements
  • sharp pain with sudden or unexpected movement of the trunk
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24
Q

Agg factor difference between stenosis and disc involvement?

A

Flexion is an agg factor for disc involvement and extension is an agg factor for stenosis

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25
Q

History of DDD/DJD (spondylosis)

A

Episodic; repeated annular tearing

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26
Q

History differences with ProT and ProL

A

ProL: typical fast onset

ProT: recurrent history

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27
Q

Which lumbar spine disorder produces disabling pain with minor provocations?

A

Instability

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28
Q

OE Exam tests to rule in facet lumbar disorder

A

quadrant, ROM

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29
Q

Which parts of the OE help you to differentiate between stenosis and DDD/DJD (spondylosis)

A
  • BOTH will be painful with side bending
  • flexion will hurt for DDD/DJD (spondylosis)
  • extension will be painful & limited for stenosis
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30
Q

Agg factors of facet joint dysfunction?

A

more pain with standing vs. sitting; 3-D motion extension (cartilage) vs. flexion (capsule)

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31
Q

Instability agg factors

A

-prolonged postures (sitting, standing, bending, semi-flexed postures), forward bending, sudden unexpected movements, return to erect posture after FB, lifting, loading in extension. Night: possible clunking with position change. AM: ache usually worsens as day progresses

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32
Q

If a patient had a disc with nerve root involvement, how would you tell (based off of agg factors) which is affecting the patient more, the disc or the nerve root involvement?

A
  • flexion, sitting = disc
  • standing, walking = nerve root involvement
  • sneezing would hurt with both
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33
Q

Acute disc activity limitations

A
  • cough/sneeze
  • repeated bending, sitting, lifting, stooping
34
Q

Chronic disc activity limitations

A
  • sitting in lordosis
  • carrying in extension
  • pain with stooping
35
Q

Activity limitation complaints if there is adverse neurodynamic component involved with LS disorders

A
  1. getting in/out of a car, taking a bath, kicking a football, prolonged sitting (slump)
  2. any activity that includes leg extended (gait, kicking) - SLR
  3. any activity in which knee is bent toward buttocks, such as hurdling (PKB)
  4. 24 hour pattern: symptoms may be worse at night (posture). symptoms may be worse in AM due to night position. Worse at end of day - latent effect from sustained posture or repetitive activity
36
Q

lateral spinal stenosis ease factors

A

flexing spine (sitting or squatting, walking uphill)

37
Q

Instability history

A
  • gradual or episodic
  • history of recurrent dysfunction that becomes more pronounced with each successive episode
  • minor provocations produce disabling pain
38
Q

Potential findings if adverse neurodynamic component is involved during neurodynamic testing

A
  1. knee flexed in standing
  2. compensatory movements that fit with a neurodynamic dysfunction during active movement testing
  3. increase tension to active movements (lumbar flexion + neck flexion/extension, etc.)
  4. palpate nerve & find reproduction of symptoms with nerve palpation
  5. reproduce symptoms with neurodynamic tests
39
Q

T/F: neurodynamic testing with IDD would be negative

A

true

40
Q

T/F: neurodynamic testing with EDD would be negative

A

false

41
Q

neurological exam findings with protrusion

A

negative or mild neurological signs

42
Q

axillary lesion

A

if bulge is medial to nerve root, the patient shifts to the same side

increased pain with contralateral sidebending; slump pain is > SLR

43
Q

neurological exam findings with central ProL

A

negative segmental; possible reduced DTRs

44
Q

neurological exam findings with PLL ProL

A

positive

45
Q

neurological exam findings with ExT

A

positive

46
Q

lateral spinal stenosis neurological exam findings

A
  • dorsal & ventral: hypo or a-reflexia
  • dorsal: sensation
  • ventral: motor loss (segmental paresis)
47
Q

shoulder lesion

A

if bulge is lateral to nerve root, the patient shifts to the opposite side (most common)

increased pain with ipsilateral sidebending; slump pain > SLR pain

48
Q

avulsion fracture profile

A

younger population, traumatic history, spontaneous resolution of symptoms

49
Q

transverse radial fissures

A

annulus splits from inside to out; seen in acute disc related disorders

50
Q

rim lesion

A

transverse annular tear; partial detachment of annulus to the rim of vertebral body; starts mid & goes to post/sup portion of the disc

51
Q

concentric delamination

A

circumferential tear; nucleus loses water, annulus buckles & layers separate all around

52
Q

Similarities & differences in IDD & EDD

A
  • Similarities: young, non-capsular pattern
  • Differences: IDD will present with negative tension signs & EDD will have positive tension signs
53
Q

Reasons/causes of lateral stenosis

A

facet joint hypertrophy, loss of IVD height, IVD bulging, & spondylolisthesis

54
Q

Potential causes for central stenosis

A

facet joint arthrosis, thickening & bulging of the ligamentum flavum, bulging of the IVD, and spondylolisthesis

55
Q

Which portion of spine anatomy is spondylolysis a defect of?

A

pars interarticularis

56
Q

T/F: spondylolysis occurs unilaterally

A

F - occurs both unilaterally and bilaterally

57
Q

Which view on an x-ray is best to image spondylolisthesis?

A

oblique view of an x-ray

58
Q

definition of spondylolisthesis

A

anterior slippage & inability to resist shear forces relative to the vertebra below

59
Q

Where is the most common site for spondylolisthesis to occur?

A

L5-S1

60
Q

Which spine disorder can spondylolisthesis progress to?

A

instability

61
Q

Potential causes of spondylolisthesis?

A

-congenital, isthmus, degenerative, traumatic or pathologic

62
Q

extraneural

A

movement in relation to mechanical interface

63
Q

Examples of interface tissue (extraneural)

A

-soft tissue, tunnels, nervous system relatively fixed

64
Q

intraneural

A

involving connective tissue and/or neural tissue

65
Q

Potential causes/examples of intraneural adverse neurodynamics

A

-edema within nerve, fibrosis within dura, etc.

66
Q

altered axoplasmic flow

A

-an alteration in the pressure gradients that exist within the fluids, tissues & surrounding structures of the nervous system. if the alteration is significant enough it can affect changes in blood flow and axonal transport. The nerve then becomes more susceptible to being compromised & the target tissue is more susceptible to trophic changes

67
Q

double crush injury (altered axoplasmic flow)

A

-injury at a distal site along the nerve could have an additive effect leading to injury to a proximal site along the nerve

68
Q

reversed crush injury (altered axoplasmic flow)

A

-injury at a proximal site along the nerve could have an additive effect leading to injury to a distal site along the nerve

69
Q

Other potential causes of lumbar spine pain?

A
  • pediatric considerations [non-specific low back pain]
  • back-related tumor
  • back-related infection
  • spinal fracture
70
Q

Profile of pt with back-related tumor

A

-age > 50; history of cancer; unexplained weight loss; failure-conservative therapy

71
Q

profile of pt with back-related infection (spinal osteomyelitis)

A

-recent infection; intravenous drug user; concurrent immunosuppressive disorder

72
Q

spinal fracture profile/presentation

A

-history of trauma; prolonged use of steroids; age > 70 yrs

73
Q

L1 refers to:

(Non-radicular)

A

Groin

74
Q

Upper Lumbar (or T9) Refers to:

(non-radicular)

A

Lower Lumbar Pain

(L4/L5-Bilat or unilat)

75
Q

L3 Refers to:

(Non radicular)

A

“L3 in the knee”

76
Q

L4 Refers to:

(Non radicular)

A

“in the ankle: (band around ankle and gr trochanter)

Lower abdominal symptoms, testicular pain

77
Q

L5/S1 refers to:

(Non-radicular)

A

coccyx symptoms

78
Q

L5 refers to:

(Non-radicular)

A

upper lumbar pain

79
Q

Discogenic Referral

(Non-radicular)

A

vague ache to buttock/LE

Deep spot of pain in buttock

Lower Lumbar disc: ant thigh pain/groin

80
Q
A

MSK 2 (16 decks)

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