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Musculoskeletal > Lumbar Spine Disc Herniations > Flashcards

Lumbar Spine Disc Herniations Flashcards

1
Q

What is the most common direction of herniation?

A

posterolateral

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2
Q

Central disc herniation results in (unilateral/bilateral) s/s.

A

bilateral s/s

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3
Q

(true/false) Prognosis for a central disc herniation is good

A

false

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4
Q

What segments account for >90% of lumbar disc herniations?

A

L4/L5, L5/S1

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5
Q

What are the 4 stages of disc herniation in order?

A
  1. Disc bulge (degeneration)
  2. disc protrusion
  3. Disc extrusion
  4. Disc prolapse
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6
Q

Disc herniation stage:
Cracks in the annulus causing symmetrical flattening of the disc in all directions

A

disc bulge (1)

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7
Q

(true/false) Disc bulges cause radicular pain.

A

false (local)

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8
Q

(true/false) Disc protrusion causes local pain.

A

true

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9
Q

Disc herniation stage:
nucleus pulposus pushes into the outer layers of the annulus fibrosis but doesn’t break through the annulus fibrosis

A

disc protrusion (2)

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10
Q

Disc herniation stage:
fragments of the nucleus pulposus completely break through the annulus fibrosis

  • can aggravate nerve roots causing myotomal weakness and inflammation
A

disc extrusion (3)

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11
Q

What stage of disc herniation is commonly the beginning of when medication is being prescribed?

A

Stage 3: disc extrusion

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12
Q

Disc herniation stage:
fragments of the nucleus pulposus and annulus fibrosis detach completely from the disc

A

disc prolapse

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13
Q

What population commonly presents with lumbar disc herniation(s)?

A

Age 30-55

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14
Q

When looking at patient history, those with lumbar disc herniation have LBP and/or LE symptoms with ___ and ____ combined.

A

sitting and lumbar flexion combined (ex: putting shoes on)

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15
Q

What provides relief for lumbar disc herniation?

A

standing, walking, prone-lying, EXT, sitting in a chair with hip elevated (offloading the LE)

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16
Q

A patient’s symptoms of lumbar disc herniation can be increased due to what?

A

increased abdominal pressure (sneezing, coughing, laughing)
prolonged WB postures (despite being in EXT)

17
Q

Lumbar disc herniation causes painful/limited ____.

A

FLX

18
Q

Those with lumbar disc herniation have centralization with ____ and peripheralization with _____ during repeated movement testing.

A

Extension, flexion

19
Q

(true/false) Patients with lumbar disc herniations can demonstrate a lateral shift in sitting and/or standing.

A

True

20
Q

(true/false) Lumbar disc herniations can show a (+) neurological compression test

A

true

21
Q

Those with Lumbar disc herniations often show (hypo-reflexive/hyper-reflexive) DTRs and spring testing corresponding to the level of the herniation.

A

hyporeflexive

22
Q

(true/false) It is possible to have sensory and/or motor loss in the dermatome/myotomal levels affected by a disc herniation

A

true

23
Q

When performing a physical exam, observe the patient’s gait for _____. How do you test for this?

A

Foot drop

Test with heel/toe walking to test (L4-S1 motor functions)

24
Q

A person with a lumbar disc herniation is (+/-) for the SLUMP test and have a (+) SLR of ___-___ degrees.

A

(+) slump
(+) SLR 30-70 degrees –> can potentially have a (+) crossed SLR test)

25
Q

What test has a high specificity for diagnosis of centrally herniated discs?

A

(+) Crossed SLR test

26
Q

What are the red flags for lumbar disc herniation?

A
  • cancer cluster
  • cauda equina symptoms
  • (+) UMN signs/pathological reflexes
  • complete foot drop and/or unable to extend the great toe
  • multi-level myotomal weakness
27
Q

What is the cancer cluster?

A

Age > 50
unexplained weight loss
PMH of cancer
failure to respond to conservative treatment
Increased ESR

28
Q

What TBC do disc herniations fit into? How do you know which to choose?

A
  • Specific exercise - Extension (s/s are distal to the knee and there are (+) signs of nerve root compression)
  • Traction
  • Mobilization/manipulation (if s/s are proximal to the knee)
29
Q

Early morning ___ movements can increase risk of re-injury in a patient who has lumbar herniation.

A

flexion

30
Q

What exercises can you have a patient perform in the morning to provide them some relief prior to getting out of bed?

A

LTRs
Prone lying
prone press-ups

31
Q

How should one encourage maintenance of lumbar lordosis during the day?

A

sitting with a lumbar roll/towel roll

32
Q

(true/false) Having long periods of sitting throughout the day is recommended for a patient with lumbar herniation.

A

false (standing rest breaks are recommended)

33
Q

(true/false) MRI findings do not always correlate with clinical symptoms.

A

true

Musculoskeletal (23 decks)

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