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PTA Ortho Exam 2 > Lumbar Spine Tx by Dx > Flashcards

Lumbar Spine Tx by Dx Flashcards

1
Q

Spinal disorders that are primarily muscular in origin are…

common or uncommon?

A

uncommon

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2
Q

Spinal disorders that are primarily muscular that do occur can be classified as

A

strains, contusions and inflammations

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3
Q

What does a pt report w a muscle disorder

A
  • Relief with rest but will complain of stiffness

- Movement will initially hurt but activity will loosen up the stiffness

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4
Q

Objective findings for muscle disorders:

A
  • Pain usually referred over several spinal levels
  • Patient has trouble pinpointing the pain
  • *Pain on palpation of the muscle but no pain with palpation of the joint or with ligamentous testing
  • Neurological exam will have no true positive findings
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5
Q

Important Rehab Consideration

KNOW

A
  • It is not necessary to wait until the patient is pain free to begin active exercise.
  • If pain with exercise is present, it is not necessarily a harmful sign. If the pain is not severe, does not last and is not progressive, the exercise should be encouraged.
  • Experience shows that more long term harm is caused by too little activity than by too much ( Saunders)
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6
Q

Treatment of Muscle Disorders- ACUTE

A

-Rest
>Gentle activity in pain free range
-Postural support ; lumbar pillow or corset
-Identify functional position that reduces symptoms; usually in shortened position
-Modalities
-Begin gentle isometrics
>Prone: lift head from pillow or alternately lift leg from bed
>Supine: press head and neck into the pillow

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7
Q

Treatment of Muscle Disorders- SUBACUTE

A

-Gradually allow muscles to elongate
>Ex: put pillow under abdomen and do extension through greater ROM * only to tolerance
-Find position bias and progress exercises
-Modalities if needed

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8
Q

Treatment of Muscle Disorders- CHRONIC

A

-Restoration of full function and normal posture should be the most important goals of treatment
-Once acute symptoms are under control , determine the impairments and functional limitations and treat accordingly.
>Stiffness, weakness, postural changes

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9
Q

What are the Joint disorders w facet

A

Facet Impingement

Facet Strain

Facet Inflammation

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10
Q

What are the mechanisms of a facet impingement

A
  • usually a sudden unguarded movement involving backward bending, sidebending and/or rotation with little to no trauma
  • The synovial and capsular tissue that line the facet joint capsule become impinged between the joint surfaces
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11
Q

What will a pt report with facet impingement?

A

-Patient reports
>Rest relieves
>Movement hurts
>Certain passive and active movements are restricted and/or painful
>Will assume protective posture “locking”
&raquo_space;Some component of sidebending and rotation
&raquo_space;Pain and restriction will be present when attempting to move in the direction opposite the position of locking

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12
Q

Facet Sprain- history of?

what are the tests, palpations, S&S similar to?

A

History of moderate to severe trauma
Mobility tests, palpation and other signs and symptoms will be similar to joint impingement except movement may be generally more restricted and may involve more than one segment

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13
Q

Facet Inflammation- history of?

A
  • Insidious onset frequently following acute sprain or chronic posture sprain
  • Occur secondary to aggravation or overuse in the presence of degenerative joint/disc disease
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14
Q

What does a pt report w Facet Inflammation

A
  • Movement hurts
  • Complain of pain and stiffness at rest
  • May have intermittent numbness and tingling
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15
Q

Tx of Joint disorders: Principals of management

what does flexion do for the joint? vs extension?

A

widens the intervertebral foramina and separates the facet joints whereas extension decreases the size of the foramina and compresses the facet joints.

-With extension may have compression of nerve root and intermittent neuro symptoms

(any compromise of the foraminal opening (swelling) reduces the space)

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16
Q

Important Rehab Consideration for Joint disorders

KNOW

A

-Generally will tend to start treatment with movements toward the position the person is assuming and then gradually work toward opposite direction

-i.e. patient holding head in left SB and rotation
»Work into left SB and rotation first and then work towards right SB and rotation

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17
Q

Tx of Joint disorders- ACUTE

A

-Lumbar corset to protect the area
>Discontinue device as acute symptoms decrease so the muscles can learn dynamic control
-Functional position of comfort
>Flexion bias: supine with hips and knees flexed
&raquo_space;Will provide maximal opening of intervertebral foramina to minimize impingement of the facet and nerve root

-Traction
>Gentle intermittent joint distraction and gliding techniques can inhibit painful muscle response and provide synovial fluid movement within the joint for healing
&raquo_space;Grade 1 or 2 ; avoid stretching the joint capsule

-self traction
-Joint Mob/manip.
>* facet impingement responds well and quickly to manipulation

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18
Q

Tx of Joint disorders- SUBACUTE/CHRONIC

A
  • Hypomobile joints require stretching through joint mobilization
  • Develop dynamic stability through muscle control in the hypermobile regions
  • Patient education: avoid positions of hyperextension such as reaching or looking over head for prolonged periods of time
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19
Q

Herniated nucleus pulposis (HNP) is classified as the disorder in which

A

there is displacement of the nuclear material and other disc components beyond the normal confines of the annulus

HNP protrusion most common in the L4-5 and L5-S1 discs

20
Q

Which vertebral body does the existing root take the name of

A

that the exiting root takes the name of the vertebral body under which it travels into the neural foramen

L4-5 disc pathology usually affects the L5 root rather than the L4 root

21
Q

Protrusion:

A

describes the condition in which there is displacement of the nuclear material beyond the normal confines of the inner annulus, producing a discrete bulge in the outer annulus; no nuclear material escapes

-With or without nerve root involvement

22
Q

Extrusion

A

is a disorder in which the displaced nuclear material extrudes into the spinal canal through disrupted fibers of the annulus

23
Q

Sequestration

A

is a condition in which the nuclear material escapes into the spinal canal as free fragments that may migrate to other locations

24
Q

herniation of the disc between L4-L5 compresses the which lumbar root? L4 or L5

A

L5

25
Q

A large herniation of L5-S1 compromises which nerve roots?

A

compromises not only the nerve root crossing it (1st sacral nerve root) but also the nerve root emerging through the same foramen ( 5th lumbar nerve root)

picture in ppt

26
Q

Massive central sequestration of the disc at l4-L5 level involves all of the….

A

Massive central sequestration of the disc at L4-L5 level involves all of the nerve roots in the cauda equina and may result in bowel and bladder symptoms

27
Q

Disc Disorders is caused by what

A

Caused by cumulative effects of months or even years of forward bending and lifting and/or sitting in a slumped, forward bent posture

-See generalized loss of mobility, especially spinal extension and overall decline in general fitness

28
Q

Progression of HNP protrusion:

as it progresses what is the order of pain? (3 components)

A

-occurs gradually over time
-Early stages asymptomatic
-As protrusion progresses
>First experiences back pain
>Then back and leg pain
>Then back , leg pain and neurological involvement

29
Q

What is Sciatica?

A

diagnosis of compression of the sciatic nerve (L4-5, S1-3) secondary to a disc protrusion

-Sciatic nerve experiences an inflammatory response and subsequent damage secondary to the compression from the disc
>Produces pain that increases with certain postures due to an increase in disc pressure
&raquo_space;Greatest with sitting, lifting, forward bending , twisting, sneeze or cough

30
Q

Disc disorders the pt will report?

A

-Prolonged sitting will cause pain to move from back to leg
-Difficulty when assuming an erect posture after sitting or lying down
-After standing and walking around usually obtains some relief of pain
-Reports pain greater on one side of back
-Referred leg pain is usually unilateral
-May report sudden onset of symptoms
&raquo_space;Usually relating to forward bending or prolonged sitting, this sudden onset is believed to be “ the straw that broke the camels back”
-May report occupation or activity that relates a long history of a flexed lumbar posture
-Multiple episodes over several months or years

31
Q

Aging process does what

A

Each decade the composition of the annulus fibers and nucleus pulposis is altered and there is a decrease in overall stability
>Disc problems most commonly seen in 40-60 year olds

32
Q

Dx tests?

A 
Radiologic testing – x-rays
EMG
Myelogram
Discography
CT scan
MRI
33
Q

What will this pt present like clinically

A

-Patient sits in slumped posture with lumbar spine flexion; self tractions
-May have lateral shift
>As gel moves posteriorly the patient tends to shift his weight in an anterior direction flattening the lumbar lordosis.
Also shifts torso away from painful side
-May or may not have positive neurological signs
-Spinal segment will be tender to palpation
-X-rays will be negative

34
Q

When the herniation is lateral to the nerve root

A

The shift is to the side opposite of the sciatica because a shift to the same side would elicit pain

35
Q

When the herniation is medial to the nerve root

A

The shift is toward the side of eth sciatica because shifting away would irritate the root and cause pain

36
Q

Clinical examination:

A
  • Correction of lateral shift = centralization of pain
  • Forward bending limited due to severity of pain and muscle guarding
  • Repeated lumbar flexion = increased pain and pain that lingers
  • Extension after shift correction is restricted and may centralize pain
  • Has all the signs and symptoms of HNP protrusion
  • Positive neurological signs
  • Strength loss, decreased muscle stretch reflexes, loss of sensation and a positive SLR test
  • X-ray may show narrowed disc space
  • Spinal flexion in recumbent position may afford relief of some symptoms
37
Q

Changes with S&S

A

-Patients will have similar histories, signs and symptoms as patients with protrusion except that the peripheral symptoms will predominate
-Symptoms may change suddenly, become intermittent or follow an inexact or incomplete dermatomal pattern
-Patient has a gradual worsening history
>HNP protrusion without NR signs - with NR signs – extrusion - sequestration

38
Q

Treatment of Disc Disorders - ACUTE

A

-With severe symptoms bed rest( short duration) is indicated with short periods of walking
>Promotes lumbar extension
>Stimulated fluid mechanics
>Helps reduce swelling in the disc and connective tissue

39
Q

ACUTE Tx for lateral shift

A

Lateral shift correction
>Should centralize pain
>Have patient perform extension exercises after
>May need to be performed several times before patient can hold on their own
>Patient instructed to constantly self correct shift

40
Q

ACUTE Tx for passive extension

A 
-Positioned prone 
Use pillows if necessary
Lie for several minutes
-Prone on elbows
Maintain position
Move in and out of the position
-Prone on hands
Maintain position
Move in and out of the position
41
Q

Acute pt education

A

-Frequently repeat the extension activities and lateral shift corrections
-Immediately stop any activity if pain worsens or peripheralizes during exercise
-Maintain an extended posture with passive support
-While sitting, use a towel roll or lumbar pillow
-Avoid sitting on low, soft chairs or couches
-When rising from a sitting position, maintain lordosis
-When in acute pain, drive as little as possible
-When driving a car, keep the seat close enough to the steering wheel to allow maintenance of the lordosis
-When in acute pain avoid all bending and lifting
-Use a firm support for resting and sleeping
>Pin a towel around your waist to maintain lordosis
* Patient must absolutely avoid positions and activities that increase the intradiscal pressure or that cause a posterior force on the nucleus (flexion)

42
Q

Important Rehab Consideration

ACUTE

A

*Isometric activities ( resisted pelvic tilt exercises, straining, Valsalva maneuver) as well as active back flexion exercises increase intradiscal pressure above normal and must be avoided in acute phase

Exercises, mobilizations and activities involving rotation must be avoided initially

43
Q

Additional Tx options for Acute

A

Traction
Modalities
Support or corset

44
Q

Treatment of Disc Disorders- SUBACUTE

A
  • Teach simple spinal movement in pain free ranges using pelvic tilts
    • Supine, sitting, standing, all 4’s
  • Patient finishes all exercises with an extension activity
  • Teach basic stabilization techniques utilizing core trunk muscles
  • Walking, swimming
45
Q

Management when disc symptoms have stabilized

A
  • Emphasis during this stage are recovery of function, development of a healthy back care plan, and teaching the patient how to prevent recurrences
  • Patient is taught that following any flexion activity to perform extension
  • If prolonged flexed posture is necessary, break up activity and perform extension
46
Q

Disc disorders - OUTCOMES

A
  • Most improve with conservative treatment in 2-4 months

- Healing of the disc can occur and scarring can reinforce the posterior aspect and annular fibers

PTA Ortho Exam 2 (2 decks)

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