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Musculoskeletal II > Lumbar Spine part 1 > Flashcards

Lumbar Spine part 1 Flashcards

1
Q

What is the strongest predictor of further incidence of LBP?

A

Hx of LBP

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2
Q

What is the percent of LBP that have compression fracture and neoplasm?

A

4% and 1%

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3
Q

Prevalence of prolapsed IVD

A

1-3%

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4
Q

Lumbar flexion:

A

40-50

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5
Q

Lumbar extension:

A

15-20

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6
Q

Lumbar axial rotation

A

5-7

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7
Q

Lumbar lateral flexion

A

20

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8
Q

Kinematics of T/L flexion shown through an 85° arc:

A

35° of thoracic flexion and 50°of lumbar flexion

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9
Q

Kinematics of T/L extension shown through an arc of 35°-40°:

A

20°-25° of thoracic extension and 15° of lumbar extension

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10
Q

T/L axial rotation shown through an ~40° arc

A

sum of about 35° of thoracic rotation and 5° of lumbar rotation

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11
Q

Kinematics of T/L lateral flexion shown through ~45° arc

A

sum of 25° of thoracic lateral flexion and 20° of lumbar lateral flexion

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12
Q

Schmorl’s node

A

local area of bone collapses under end plate to create a pit or crater that gradually forms

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13
Q

When does Schmori’s node occur?

A

This type of injury associated with spinal compression when spine is in neutral ROM (i.e., not flexed, bent or twisted)

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14
Q

What leads to spondylolisthesis?

A

Repeated, cyclic full spine flexion and extension leads to fatigue within arch (repeated stress reversals), thereby leading to a pars fracture

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15
Q

Mobility or stability for spondylolisthesis?

A

stability

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16
Q

Orientation of each collagen fiber of annulus fibrosus (AF?

A

65 degrees from vertical

every other layer running in same direction

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17
Q

IVD has three major components

A

nucleus pulposus, annulus fibrosis, and end plates

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18
Q

How are collage fibers of each lamina oriented?

A

obliquely oriented and obliquity runs in opposite direction in each concentric lamella

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19
Q

Four general conclusions about annulus injury and resulting bulging or herniation

A

Appears disc must be bent to full ROM in order to herniate
Disc herniation associated with repeated loading in range of thousands of times (implicating role of fatigue as injury mechanism)
Data link herniation with sedentary occupations and sitting posture
Herniations tend to occur in younger spines, those with higher water content and more hydraulic behavior

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20
Q

Disc Bulge

A

Expansion of disc material beyond its normal border (e.g., a normal disc during compression, or a degenerated disc with decreased disc height) – the AF is bulging

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21
Q

Protrusion

A

Discrete localized bulge in the AF, the disc material is displaced (i.e., the NP has protruded through the inner layers of AF) – a true herniation

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22
Q

Extrusion

A

NP has protruded through all layers of AF, but remains attached to disc of origin

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23
Q

Sequestration

A

A free disc fragment is located in epidural space can migrate superiorly, inferiorly, medially, or laterally

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24
Q

Damage to annulus of disc (herniation) appears to be associated with:

A

fully flexing spine for repeated or prolonged period of time

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25
Q

Rotatores and Intertransversarii

A

Typically function of small rotator muscles of spine, which attach to adjacent vertebrae, are delineated as creating axial twisting torque

26
Q

What often gives function of lateral flexion?

A

Intertransversari

27
Q

Rotatores and intertransversarii muscles have 4-7 times more what than multifidus?

A

muscle spindle

28
Q

Extensors: Longissimus, Iliocostalis, and Multifidus Groups

A

Major extensors of thoracolumbar spine are the longissimus, iliocostalis, and multifidus groups

29
Q

How many slow twitch fibers does the thoracic section contain?

A

about 75%

30
Q

What is flexion of the torso accomplished through?

A

hip flexion

31
Q

Rectus Abdominis

A

major trunk flexor and most active during sit-ups and curl-ups

32
Q

Three layers of abdominal wall

A

external oblique, internal oblique, and transverse abdominis

33
Q

Flexion relieving position or movement:

A

facet joint involvement
low back strain
lateral stenosis

34
Q

Extension relieving position or movement:

A

disk involvement

nerve root irritation (herniation)

35
Q

Rest relieving position or movement:

A

neurogenic claudation

36
Q

Reports of restricted motion of lumbar spine associated with LB or buttock pain exacerbated by pattern of movement that indicates possible opening or closing joint restriction (i.e., decreased extension, right sidebending, and right rotation)

A

Zygapophyseal joint pain syndromes

37
Q

Reports of centralization or peripheralization of symptoms during repetitive movements or prolonged periods in certain positions

A

Possible discogenic pain

38
Q

Reports of lower extremity pain/paresthesias, which is greater than LBP. May report experiencing episodes of lower extremity weakness

A

Possible sciatica or lumbar radiculopathy

39
Q

Pain in lower extremities exacerbated by extension and quickly relieved by flexion of spine

A

Possible spinal stenosis

40
Q

Patient reports of recurrent locking, catching, or giving way of low back during active motion

A

Possible lumbar instability

41
Q

Reports of LBP exacerbated by stretch of either ligament or muscles. Might also report pain with contraction of muscular tissues

A

Muscle/ligamentous sprain/strain

42
Q

Lumbar red flags:

A

Severe trauma
Fever or recent bacterial infection
Saddle anesthesia
Severe or progressive neurological complaints
Recent onset bladder dysfunction associated with onset LBP
Unexplained weight loss
History of cancer
IV drug abuse, HIV or immunosupression
Pain worse with recumbency or worse at night
Constant progressive, non-mechanical pain (no relief with bed rest)
Age of onset 55 years

43
Q

A Sensitive test helps rule

A

out disease (when the result is negative) Sensitivity rule out or “Snout”

44
Q

Sensitivity=

A

true positives/(true positive + false negative)

45
Q

Specificity=

A

true negatives/(true negative + false positives)

46
Q

Lumbar yellow flags:

A

factors that increase risk of developing, or perpetuating chronic pain and long-term disability including work loss associated with LBP

47
Q

Patellar reflex

A

L3/L4

48
Q

Medial Hamstring

A

L5/S1

49
Q

Lateral Hamstring

A

S1/S2

50
Q

Posterior tibial

A

L4/L5

51
Q

Achilles reflex

A

S1/S2

52
Q

Lumbar Coupled Motion

Patterns in Neutral

A

Ipsilateral SP rotation except L5 (can be either way)

53
Q

Lumbar Coupled Motion

Patterns in Flexion

A

Contralateral SP rotation

54
Q

L1

A

Hip flexion

55
Q

L2

A

Hip flexion, hip abduction

56
Q

L3

A

Knee extension

57
Q

L4

A

Ankle dorsiflexion

58
Q

L5

A

Foot/toes dorsiflexion

59
Q

S1

A

Plantar flexion foot/toes, ankle eversion, hip extension

60
Q

S2

A

Knee flexion

61
Q

S3

A

Foot intrinsics

Musculoskeletal II (14 decks)

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