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722: Clinical Management of the Musculoskeletal System II > Lumbar Spine (Part 2) > Flashcards

Lumbar Spine (Part 2) Flashcards

1
Q

Where does L3/L4/L5 disc pain refer to?

A

the anterior thigh region

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2
Q

Where does L4/L5/S1 disc pain refer to?

A

posterior thigh region

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3
Q

__% of patients with lumbar disc herniation recover within the first 2 weeks and __% recover within 6 weeks

A

50

70

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4
Q

Disc herniation symptoms are ____ to the knee

A

distal

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5
Q

Facet syndrome symptoms are ____ to the knee

A

proximal

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6
Q

What are the signs of facet syndrome?

A
  • Absence of neurological deficits and nerve root tension signs/tests
  • flexion/extension AROM provokes pain
  • Hypomobility with PPIVM and/or PPAIVM (spring testing)
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7
Q

Spinal stenosis is more common in those __ years of older

A

65

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8
Q

What signs and symptoms are sensitive to spinal stenosis?

A
  • age greater than 65
  • pain below the butt
  • pain that is worsened with walking
  • poor balance
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9
Q

What 6 neurological tests are specific to spinal stenosis?

A
  • vibration deficit
  • pin prick deficit
  • weakness
  • absent Achilles reflex
  • abnormal Rhomberg test
  • thigh pain with 30 seconds of extension
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10
Q

What are the 7 predictor variables for the diagnosis of lumbar spinal stenosis?

A
  • age 60-70
  • symptoms present > 6 months
  • symptoms improve when bending forward
  • symptoms improve with bending backward
  • symptoms exacerbated while standing up
  • intermittent claudication present
  • urinary incontinence
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11
Q

Based on the clinical prediction rule a score greater than _ indicates a meaningful shift in the probability that the patient DOES lumbar spinal stenosis

A

7

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12
Q

Based on the clinical prediction rule a score less than _ indicates a moderate shift in the probability that the patient does NOT lumbar spinal stenosis

A

2

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13
Q

What percentage of spinal stenosis patients have resolution of symptoms without intervention?

A

30%

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14
Q

How are spondylolisthesis types classified?

A

according to causation

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15
Q

What causes Type I spondylolisthesis?

A

dysplastic

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16
Q

Describe type I spondylolisthesis

A

Congenital abnormality in upper sacrum or neural arch of L5, allowing displacement

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17
Q

What causes Type II spondylolisthesis?

A

isthmic

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18
Q

Describe type II spondylolisthesis

A

A lytic or fatigue fracture of pars, or elongated but intact pars, or acute fracture of pars

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19
Q

What causes Type III spondylolisthesis?

A

degeneration

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20
Q

Describe type III spondylolisthesis

A

Secondary to degenerative arthrosis of z-joints or discovertebral articulation

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21
Q

What causes Type IV spondylolisthesis?

A

trauma

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22
Q

Describe type IV spondylolisthesis

A

Secondary to fractures in area of neural arch other than pars

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23
Q

What causes Type V spondylolisthesis?

A

pathology

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24
Q

Describe type V spondylolisthesis

A

In conjunction with bone disease (e.g. Paget’s disease, osteoporosis)

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25
What causes Type VI spondylolisthesis?
iatrogenic
26
Describe type VI spondylolisthesis
Occurs above or below a spinal fusion
27
What spondylolisthesis grades are the most common?
II and III
28
Type II (isthmic) spondylolisthesis occurs in ____ patients, whereas type III (degenerative) spondylolisthesis occurs in ____ patients spondylolisthesis
younger older
29
The incidence of spondylolisthesis increases from 4.4% at age 6 to _ by adulthood
6%
30
Only __% of patients with grade II spondylolisthesis develop symptoms
50
31
Meyerding Grading ``` Grade 0 = _____ Grade 1 = _-__% Grade 2 = __-__% Grade 3 = __-__% Grade 4 = __-__% ```
Normal 1-25% 26-50% 51-75% 76-100%
32
Symptoms associated with spondylolisthesis are worsened with what movement?
extension
33
What are subtle signs of grades 1 and 2 spondylolisthesis?
- hamstring tightness - hyperlordosis - palpable step defect of SP
34
What test may indicate active spondylitic defect or facet syndrome?
stork test/one-leg standing lumbar extension test
35
What are the signs of patients with grade 3 or greater spondylolisthesis?
- symmetric transverse skin furrow - hyperlordosis - anterior pelvic tilt - significant hamstring stiffness
36
What does intervention for spondylolisthesis depend on?
presenting symptoms, rather than degree of slip
37
Describe conservative treatment for spondylolisthesis
- pelvic positioning initially to provide symptomatic relief - followed by an active lumbar stabilization program and stretching (rectus femoris and iliopsoas muscles) to decrease anterior pelvic tilting
38
What is the course of treatment for grades III and IV spondylolisthesis?
surgery
39
Sciatica is most common in what patient population?
Active people and those who sit frequently
40
It is estimated that __ million Americans suffer from LBP and sciatica annually
80
41
List the 3 most common causes of sciatica from most to least common
1) occupational causes 2) trauma 3) improper lifting mechanics, gluteal injections, lipomas, and unusual furniture
42
What are patient complaints of sciatica?
unilateral buttock and posterior leg pain and paresthesia
43
True or False Neurological deficits are common in patients with sciatica
False
44
What movements may increase sciatica related pain?
Resisted ER or passive IR
45
What are the 6 cardinal features of piriformis syndrome?
1) History of trauma to sacroiliac and gluteal regions 2) Pain in region of SIJ, greater sciatic notch, and piriformis muscle, extending down lower limb and causing difficulty in walking 3) Acute exacerbation of symptoms by lifting or stooping 4) Palpable, sausage-shaped mass over piriformis muscle 5) Positive SLR test (6) Gluteal atrophy
46
If pririformis syndrome is due to muscular spasm and/or tightness what is the conservative treatment regimen? If conservative fails?
aggressive stretching and massage of the muscle local anesthetic block to muscle
47
When is ankylosing spondylitis onset usually?
mid 30s
48
What are the symptoms of ankylosing spondylitis?
- loss of lumbar lordosis - increased thoracic kyphosis - decreased chest expansion
49
What are the 2 special tests to help diagnose ankylosing spondylitis?
- chest expansion test | - modified Schober's test
50
Describe a positive chest expansion test
2.5 cm below the average is considered abnormal
51
Describe a positive modified Schober's test
If the difference is less than 5 cm it is considered abnormal
52
What is the treatment protocol for ankylosing spondylitis?
Gentle mobilizations (grade 5 contraindicated), stretching, and postural and breathing exercises
53
Describe the complaints associated with multiple myeloma
50 years old with complaints of persistent LBP unrelieved by rest and typically worse at night and may be associated with rib pain
54
What do radiographs reveal in multiple myeloma?
Osteopenia with lytic lesion in spine, ribs and skull (“punched out” or “rat-bite” lesions)
55
True or False Multiple myeloma is similar to metastasis in that it effects the posterior elements of the spine, such as the pedicles
False
56
Where are the most common METS related to metastatic carcinoma from?
breast, lung, and kidney
57
If a patient is unresponsive to conservative care for __ month(s) it is highly suggestive of cancer, especially in patients greater than 50 years
1 month
58
What do radiographs revel in metastatic carcinoma?
osteolytic process (missing or “one-eyed” pedicle) or osteoblastic (ivory vertebrae)
59
Osteolytic process may increase serum ____ levels
calcium
60
Osteoblastic process may increase alkaline _______ levels
phosphatase
61
Describe the symptoms associated with infectious spondylitis
- deep back pain made worse with pressure or percussion of SP’s - fever - difficulty sleeping d/t pain
62
Does infectious spondylitis involve the disc, vertebral body, or both?
Both
63
What do radiographs revel in infectious spondylitis?
bony lysis followed by sclerosis in the vertebral bodies
64
What is the most common finding in asymptomatic abdominal aneurysm patients?
pulsatile mid or upper abdominal mass
65
What do radiographs revel in abdominal aneurysm?
enlarged calcific margin of aorta
66
Where do the majority of AAA's occur?
Between L2 and L4
67
An expansion greater than __ cm is considered an aneurysm
3.5
68
When is surgical consult for a AAA required?
when the expansion is greater than 4-6 cm

722: Clinical Management of the Musculoskeletal System II (12 decks)

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