Lumbopelvic Medical Screening Flashcards
When conducting a Lumbopelvic Medical Screen, what are medical considerations we should look for?
Viscerogenic:
- Neoplastic Conditions
- Spinal Infection
- Abdominal Aortic Aneurysm
Neuromusculoskeletal:
- Spinal Fractures
- Cauda Equina
With Viscerogenic Conditions, What are the Clinical Findings for Neoplasim’s?
- Age > 50 y.o
- Hx of cancer (Especially lung, breast, or prostate)
- Unexlained Weight Loss (> 10 over 3 months)
- Failure of Conservative Therapy (after 1 month)
- Night Pain
With Viscerogenic Conditions, what is the Diagnostic Clustor for Neoplams?
- Age > 50
- Hx of Cancer
- Unexplained weight loss
- No improvement after one month of conservative treatment
(1/4 for a sensitivity of 100%)
Viscerogenic Conditions
With Neoplasms, What is Metastatic Spinal Cord Compression (MSCC)?
This is a neoplastic condition of the spine that leads to vertebral body collapse or direct tumor growth that can cause irreversible neurological damage
- Patients can experience pain and structural spinal instability and eventually lead to paraplegia, quadriplegia, and bowel and bladder incontinence
With Metastatic Spinal Cord Compression, what are the most common cancers to metastasize to the spine?
What are the early signs for MSCC?
Prostate, Breast and Lung (making up 50% of cases)
- About 25% of patients will have MSCC as the first sign of cancer
Early Signs:
- Pain intensifying over time
- Worse with valsalva maneuver (coughing, sneezing and strainig bowel movements)
- Increased pain with lying supine
What does the mnemonic “Red FLags” stand for when assisting clinicians recognize for MSCC quickly?
- Refferred/radiating pain, that is multisegmental or band like
- Escalating pain, which is poorly responsive to treatment
- Different character, or site to previous sx
- Funny feelings, odd sensations, or heavy legs
- Lying flat, increases back pain
- Agonizing pain, causes anguish or despair
- Gait disturbances, unsteadiness, especially on stairs (not just a limp)
- Sleep grossly disturbed, due to pain being worse at night
With Viscerogenic Conditions, what are different Pathologies for Spinal Infection?
- Tuberculosis
- Discitis
- Spinal Abscess
With Viscerogenic Conditions, how may a patient present with Spinal Infection?
- Pain
- Fever
- Neurologic Dysfunction
- Recent infection (e.g., UTI, skin infection)
- IV drug user
- Immunosuppressive disorders
- Poor living conditions
- Recent spinal surgery (key risk factor)
With Viscerogenic Conditions, how may a patient present with Abdominal Aortic Aneurysm (Triple A)? What type of patients have a great risk of developing this? What are the associated risk factors?
- May present with Back, Abdominal or Groin pain
- Patients with Peripheral Vascular Disease and Coronary Artery Disease have a great risk
Associated Risk Factors:
- Age > 50
- Smoker
- Hypertension
- Diabetes Mellitus
The absence of an Aortic Pulse, as well as a pulse with less than 4 cm can also help RULE OUT triple A
With Neuromuscular Conditions, what may a patient history look like if they have a Spinal Fracture?
What are the Red Flags of Spinal Fx?
- Hx of trauma
- Prolonged steroid use
- Age > 70
With Neuromuscular Conditions, what is the Diagnostic Cluster for Spinal Compression Fracture?
This is Roman’s Dx cluster
- Age > 52
- No presence of leg pain
- Body mass index < 22
- Does not regularly exercise
- Female gender
If patient have 4 or more there is a probability of the patient having a compression fractue and should be reffered to imaging
With Neuromuscular Conditions, what is Cauda Equina Syndrome?
A LMN lesion where the lumbosacral nerve roots have been compromised and the patient is experiencing a loss of sensory, motor and reflex function
With Neuromuscular Conditions, what may be the cause of Cauda Equina Syndrome?
- Large Central Disc Herniation (at L4/L5 or L5/S1)
- Trauma or Fracture
- Tumor, MSCC, or pathological fracture
- Central Canal stenosis (caused by spondylolysthesis)
- Epidural hematoma
- Abscess
- Infection
With Neuromuscular Conditions, Why may you hear in the Subjective history with a patient with Cauda Equina Syndrome?
- Bowel and Bladder Dysfunction
-Urinary retention with overflow incontinence - Reduced sensation in the saddle region
- Sexual dysfunction
- Bilateral LE sx
-Radicular pain, weakness and sensory loss (common in the L4, L5 and S1 distribution) - Perianal pain
Since Cauda Equina Syndrome is a LMN lesion, what should take place in the Neurological Examination?
- Reflexes
- Strength (Lower limbs)
- Sensation (Lower limbs)
