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Advanced MSK > Lumbar Spine Syndromes > Flashcards

Lumbar Spine Syndromes Flashcards

1
Q

describe lifetime prevalence of LBP

A

60-80%

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2
Q

LBP risk factors

A

Sedentary occupations,
Work involving lifting, bending, awkward postures & physically demanding,
Smoking,
Obesity,
Low levels of PA,
Low socioeconomic status

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3
Q

trauma and degenerative causes of LBP

A

Facet Jt arthrosis
Spondylosis
Spinal Stenosis
PIVD
#, ligt sprain, muscular strain
Spondylolysis
Spondylolisthesis,
Ankylosing vertebral hyperostosis

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4
Q

Inflammatory causes of LBP

A

Ankylosing Spondylitis
Rheumatoid Arthritis

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5
Q

Metabolic causes of LBP

A

Paget’s Disease
Osteoporosis
Osteomalacia

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6
Q

Describe classification system of LBP

A

For pathology based models use maitland assessment
symptom based mode e.g leg pain vs leg pain only
movement dysfunction e.g. O Sullivan Sahrmann
risk stratification model e.g. keele startback

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7
Q

describe mechanical low back pain

A

somatic pain in muscles and joints
muscle imbalance

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8
Q

postural types

A

Swayback
Hyper-lordotic / Kypho-lordotic
Flatback
Kyphosis
not Dowager’s hump
Flat upper back
FHP – forward head posture
Scoliosis

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9
Q

features of lordotic posture

A

increased lumbar lordosis, anterior pelvic tilt & hyperextended knees.

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10
Q

list the muscles that become elongated and weak in lordotic posture

A

Anterior abdominals
Hamstrings may lengthen initially BUT may eventually shorten to compensate where posture is longstanding

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11
Q

list the muscles that become short and overactive in lordotic posture

A

Low back musculature
Hip flexors

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12
Q

features of kypho-lordotic posture

A

increased lumbar lordosis and thoracic kyphosis. Pelvis anteriorly tilted & most forwardly placed body segment.

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13
Q

muscles in kypho-lordotic posture that become elongated and weak

A

Neck flexors
Upper erector spinae
External Oblique

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14
Q

list the muscles that become short and overactive in kypho-lordotic posture

A

Sub-occipital neck extensors
Hip flexors

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15
Q

features of sway back posture

A

long kyphosis with pelvis most anterior body segment & flat low lumbar area. Hip joint moves anterior. Pelvis neutral & Hips & knees hyperextended.

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16
Q

list the muscles that become elongated and weak in sway back posture

A

Single joint hip flexors
External Oblique
Thoracic extensors
Neck flexors

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17
Q

list the muscles that become short and overactive in sway back posture

A

Low back musculature short but not strong

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18
Q

features of flat back posture

A

loss of lordosis with pelvis in posterior tilt.

19
Q

list the muscles that become elongated and weak in flat back posture

A

Single joint hip flexors

20
Q

list the muscles that become short and overactive in flat back posture

A

Hams
Maybe abdominals

21
Q

describe clinical pattern of acute locked back pain

A

subjective assessment
sudden onset - from sudden movement
may hear a click
spontaneous recovery 1-2/52

objective
observation - pt stuck in flexion or contralateral side flexion is position of ease
all movements of pain e.g extension ispilateral side flexion, regional spasms

22
Q

describe pathophysiology discogenic low back pain

A

Stage 1 –
Protrusion – circumferential annular tearing – posterolateral radial fissure produced

Stage 2 –
Prolapse – Nucleus escapes further into annulus & AF protrudes

Stage 3 –
Extrusion –Nucleus escapes beyond annulus completely

Stage 4 –
Sequestration – Nuclear material exits disc & becomes detached

23
Q

clinical pattern of discogenic low back pain

A

causes 90% radicular pain or can cause referred pain
subjective ax
work requiring prolonged lumbar flexion
cumulative e.g. desk job micro trauma or traumatic e.g. lifting injury
central or unilateral LBP and or leg pain
WB/compression painful

objective
observation - loss of lordosis due to spasm
gait avoid WB through leg on painful side
lateral shift
ROM - lumbar flexion most limited
PAVIM provocative PA midline cause shear stress to disc

24
Q

contributing factors to LBP

A

Genetic Predisposition - Fam Hx
Macro overload –
Twist / sudden high loading IN flexion
Trauma / fall on buttocks / RTA
Micro overload –
Repetitive Lifting / bending / twisting
Occupation
Manual work e.g. nursing, construction, assembly line workers
Sustained sitting postures e.g. desk job

25
Q

Clinical pattern of radiculopathy

A

back pain and leg pain caused by compression or irritation of nerve root
paraesthesia or numbness
myotomal weakness
burning, shooting pain in dermatomal innervation field
NDT - leg pain reproduced in SLR

26
Q

If patient has low back pain and some burning shooting pain in anterior thigh pain. With reduced deep tendon reflex of patella and myotomal weakness of quads and tibialis anterior and loss of sensation of medial knee and skin. what does the patient have

A

radiculopathy in disc level L3-L4

27
Q

If patient has low back pain and some burning shooting pain in posterior thigh pain and lateral calf pain. With no reduced deep tendon reflex and myotomal weakness of extensor hallucis longus and loss of sensation of 1st toe. what does the patient have

A

radiculopathy of L4-L5

28
Q

If patient has low back pain and some burning shooting pain in posterior thigh pain and posterior calf pain. With reduced deep tendon reflex of achilles tendon and myotomal weakness of peroneii and gastroc and loss of sensation of lateral foot and heel. what does the patient have

A

radiculopathy L5-S1

29
Q

Causes of radiculopathy

A

DISC HERNIATION
FORAMINAL STENOSIS
DEGENERATION: Osteophytes from disc / facet jts
VERTEBRAL CYSTS & TUMOURS etc.
EPIDURAL DISORDERS
Lipoma, angioma
Infections
MENINGEAL DISORDERS
Cysts of nerve root sleeve
NEUROLOGICAL DISORDERS
Diabetes
Neural cysts & tumours

30
Q

clinical pattern of cauda equina syndrome

A

bowel and bladder disturbance
saddle paraesthesia/anaesthesia
gait difficulty

31
Q

what would be assessed in a suspected cauda equina patient

A

assess the following actions to see the possible aggravating activities and how they relate to the suspected pathological structure
Sitting
Sit to stand after prolonged sit
Standing
Walking
Driving
Cough / sneeze
Turning in bed
Running
Lifting
Bending to put on shoes & socks

32
Q

how does the nucleus propulsus change with age

A

Proteoglycan content ↓ - 30% by age 60
PG composition changes
↑ Collagen content

33
Q

how does the IVD structure change with age

A

NP dries & becomes solid & granular  less able to WB  more WB direct to AF.
NP & AF coalesce. AF may develop cracks
Overall disc is stiffer  more resistant to deformation but less able to recover from creep.

34
Q

how does the vertebral body change with age

A

Disc height maintained  any trunk height loss due to ↓ VB height
End-plate thins & bows into VB
↓ bone density due to loss of trabeculae

35
Q

how does the facet joint change with age

A

Subchondral bone thickens
Gross thickening & cartilage irregularity
Osteophytes develop along capsule & Ligt Flavum attachments

36
Q

spondylosis

A

disc degeneration - annulus bulges, height is lost
osteophyte develop circumferentially
reactive changes in surrounding tissue
facet joints may become hyperextended
IV foramen reduce osteophyte

37
Q

clinical pattern of spondylosis

A

subjective
LBP and/or leg pain
pain worse in EOD
stiffness worse in am

Objective
PAVIM hypo not reactive unless very acute
potential sequelae - narrow IVF, radiculopathy

38
Q

facet joint arthropathy clinical pattern

A

usually secondary to disc degeneration

subjective pain
pain lateral can radiate below knee but most commonly in gluteal region, thigh, or groin

objective
Pain STS after prolonged sitting, standing or hyperextension
ease with flexion
physical - central PA, NAD, unilateral PA painful

39
Q

spinal stenosis

A

SPONDYLOSIS / FACET JOINT ARTHROSIS  canal stenosis
canal volume minimal in extension  flexion is POE
Fowler’s position (90:90)
Potential sequelae
Neurogenic claudication
Bicycle test

40
Q

spondylolysis

A

a bilateral defect in pars interarticularis probably due to genetics, congenital weakness and micro or macro trauma.

41
Q

spondylolisthesis

A

bilateral defect in pars interarticularis and leads to a forward slip

42
Q

clinical pattern of spondylolisthesis

A

Extension most painful
+/- step deformity
PAIVM – pain & ‘reactive’

43
Q

red flags to identify - indications of serious spinal pathology

A

Significant trauma
Fever
Unexplained weight loss
Severe, unremitting night pain
Hx of Ca
Thoracic Pain
IV Drug use or Steroid use
Progressive neurological deficit
Disturbed gait, saddle anaesthesia
Bladder or bowel dysfunction

Advanced MSK (18 decks)

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