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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
Q

What causes Type VI spondylolisthesis?

A

iatrogenic

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26
Q

Describe type VI spondylolisthesis

A

Occurs above or below a spinal fusion

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27
Q

What spondylolisthesis grades are the most common?

A

II and III

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28
Q

Type II (isthmic) spondylolisthesis occurs in ____ patients, whereas type III (degenerative) spondylolisthesis occurs in ____ patients spondylolisthesis

A

younger

older

29
Q

The incidence of spondylolisthesis increases from 4.4% at age 6 to _ by adulthood

A

6%

30
Q

Only __% of patients with grade II spondylolisthesis develop symptoms

A

50

31
Q

MeyerdingGrading

Grade 0 = \_\_\_\_\_
Grade 1 = _-\_\_%
Grade 2 = \_\_-\_\_%
Grade 3 = \_\_-\_\_%
Grade 4 = \_\_-\_\_%
A

Normal

1-25%

26-50%

51-75%

76-100%

32
Q

Symptoms associated with spondylolisthesis are worsened with what movement?

A

extension

33
Q

What are subtle signs of grades 1 and 2 spondylolisthesis?

A
  • hamstring tightness
  • hyperlordosis
  • palpable step defect of SP
34
Q

What test may indicate active spondylitic defect or facet syndrome?

A

stork test/one-leg standing lumbar extension test

35
Q

What are the signs of patients with grade 3 or greater spondylolisthesis?

A
  • symmetric transverse skin furrow
  • hyperlordosis
  • anterior pelvic tilt
  • significant hamstring stiffness
36
Q

What does intervention for spondylolisthesis depend on?

A

presenting symptoms, rather than degree of slip

37
Q

Describe conservative treatment for spondylolisthesis

A
  • 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
Q

What is the course of treatment for grades III and IV spondylolisthesis?

A

surgery

39
Q

Sciatica is most common in what patient population?

A

Active people and those who sit frequently

40
Q

It is estimated that __ million Americans suffer from LBP and sciatica annually

A

80

41
Q

List the 3 most common causes of sciatica from most to least common

A

1) occupational causes
2) trauma
3) improper lifting mechanics, gluteal injections, lipomas, and unusual furniture

42
Q

What are patient complaints of sciatica?

A

unilateral buttock and posterior leg pain and paresthesia

43
Q

True or False

Neurological deficits are common in patients with sciatica

A

False

44
Q

What movements may increase sciatica related pain?

A

Resisted ER or passive IR

45
Q

What are the 6 cardinal features of piriformis syndrome?

A

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
Q

If pririformis syndrome is due to muscular spasm and/or tightness what is the conservative treatment regimen? If conservative fails?

A

aggressive stretching and massage of the muscle

local anesthetic block to muscle

47
Q

When is ankylosing spondylitis onset usually?

A

mid 30s

48
Q

What are the symptoms of ankylosing spondylitis?

A
  • loss of lumbar lordosis
  • increased thoracic kyphosis
  • decreased chest expansion
49
Q

What are the 2 special tests to help diagnose ankylosing spondylitis?

A
  • chest expansion test

- modified Schober’s test

50
Q

Describe a positive chest expansion test

A

2.5 cm below the average is considered abnormal

51
Q

Describe a positive modified Schober’s test

A

If the difference is less than 5 cm it is considered abnormal

52
Q

What is the treatment protocol for ankylosing spondylitis?

A

Gentle mobilizations (grade 5 contraindicated), stretching, and postural and breathing exercises

53
Q

Describe the complaints associated with multiple myeloma

A

50 years old with complaints of persistent LBP unrelieved by rest and typically worse at night and may be associated with rib pain

54
Q

What do radiographs reveal in multiple myeloma?

A

Osteopenia with lytic lesion in spine, ribs and skull (“punched out” or “rat-bite” lesions)

55
Q

True or False

Multiple myeloma is similar to metastasis in that it effects the posterior elements of the spine, such as the pedicles

A

False

56
Q

Where are the most common METS related to metastatic carcinoma from?

A

breast, lung, and kidney

57
Q

If a patient is unresponsive to conservative care for __ month(s) it is highly suggestive of cancer, especially in patients greater than 50 years

A

1 month

58
Q

What do radiographs revel in metastatic carcinoma?

A

osteolytic process (missing or “one-eyed” pedicle) or osteoblastic (ivory vertebrae)

59
Q

Osteolytic process may increase serum ____ levels

A

calcium

60
Q

Osteoblastic process may increase alkaline _______ levels

A

phosphatase

61
Q

Describe the symptoms associated with infectious spondylitis

A
  • deep back pain made worse with pressure or percussion of SP’s
  • fever
  • difficulty sleeping d/t pain
62
Q

Does infectious spondylitis involve the disc, vertebral body, or both?

A

Both

63
Q

What do radiographs revel in infectious spondylitis?

A

bony lysis followed by sclerosis in the vertebral bodies

64
Q

What is the most common finding in asymptomatic abdominal aneurysm patients?

A

pulsatile mid or upper abdominal mass

65
Q

What do radiographs revel in abdominal aneurysm?

A

enlarged calcific margin of aorta

66
Q

Where do the majority of AAA’s occur?

A

Between L2 and L4

67
Q

An expansion greater than __ cm is considered an aneurysm

A

3.5

68
Q

When is surgical consult for a AAA required?

A

when the expansion is greater than 4-6 cm

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

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