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OMM M1T2E3 > Lumbosacral Strain and Sprain > Flashcards

Lumbosacral Strain and Sprain Flashcards

1
Q

What is the onset, peak and duration for IV medication?

A

Onset: 10-15 seconds
Peak: 15-30 minutes
Duration: 1-2 hours

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2
Q

What is the onset, peak and duration for IM medication?

A

Onset: 20 -30 minutes
Peak: 30-60 minutes
Duration: 3-4 hours

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3
Q

What is the onset, peak and duration for oral medication?

A

Onset: 20 -30 minutes
Peak: 1 - 2 hours
Duration: 3-6 hours

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4
Q

List the 7 myths of back pain

A

1 - slipped discs must have surgery
2 - xray, CT, MRIs can always identify cause of pain
3 - If you back hurts take it easy until pain goes away
4 - back pain is caused by injuries or heavy lifting
5 - LBP is disabling
6 - LBP requires xray
7 - bed rest is mainstay of therapy

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5
Q

Damage to ligamentous tissue

A

lumbar SPRain

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6
Q

Damage to muscular tissue

A

lumbar STRain

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7
Q

Describe sprain grading

A

Grade 0 - minimal overstretching
Grade 1 - microtearing
Grade 2 - partial tearing of ligament
Grade 3 - Complete rupture of ligament

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8
Q

Describe clinical features of grade 1.

A

moderate pain with tension
visible swelling
no visible bruising

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9
Q

Describe clinical features of grade 2.

A

Maximal pain with tension
visible edema
macrohemorrhage with bruising
Partially torn ligament

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10
Q

Describe clinical features of grade 3.

A 
May be painless with tension
significant edema
macrohemorrhage w/bruising
ligament completely ruptured
joint instability
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11
Q

Define sciatica

A

pain in sciatic nerves L4-S3

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12
Q

What is included in initial management?

A 
patient education
pain management
physical methods
activity alteration
work activities
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13
Q

What is involved in patient education?

A

reassurance - time line

coexisting sciatica - longer recovery 12 weeks

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14
Q

What is involved with pain management?

A 
use non prescription analgesics:
acetaminophen (Tylenol)
Ibuprofen (Motrin, Advil)
Naproxen (Aleve)
Try to avoid NSAIDs
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15
Q

What are some topical analgesics?

A 
lidocaine patch
salicylate cream (unproven)
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16
Q

List some types of opiates.

A 
Tramadol
Propoxyphene (IV)
Codeine (III)
Hydrocodone  (III)
Morphine (II)
Oxycodonoe (II)
Hydromorphone (II)
Meperidine (II)
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17
Q

A physiologic response of the body to the presence of a controlled substance.

A

Addiction

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18
Q

A physiologic response of the body to the removal of any medication.

A

Withdrawal syndrome

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19
Q

Are muscle relaxants any more effective than NSAIDs?

A

No

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20
Q

When would you use NSAIDs?

A

as an adjunct to bed rest for acute muscular injury (causes drowsiness)

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21
Q

Neurologic deficits in the distribution of nerve root with symptoms of reflex loss, sensory loss and muscle weakness.

A

Radiculopathy

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22
Q

Inflammation of a nerve root with radicular pain and muscle spasm.

A

Radiculitis

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23
Q

What coexists with every sprain and strain injury?

A

somatic dysfunction

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24
Q

When is manipulation safe and effective for acute LBP?

A

first month

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25
Q

When should you reevaluate?

A

if patient is unimproved after 4 weeks

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26
Q

When is manipulation indicated?

A

in the presence of radiculopathy or radiculitis due to degenerative disc disease

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27
Q

When might traction be effective?

A

may reduce disc protrusion

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28
Q

Which types of physical modalities have no proven efficacy?

A 
massage
diathermy
us
cutaneous laser treatment
biofeedback
TENS
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29
Q

Application of heat and cold is unproven but can give the patient something to do. (T/F)

A

True

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30
Q

In what position should patients be during bed rest?

A

supine with legs elevated

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31
Q

How long should bed rest last?

A

no more than 2-4 days

32
Q

What positions aggravate LBP?

A

sitting, bending forward

33
Q

How many minutes each hour should patient get into position of maximal comfort?

A

10-15 minutes every hour

34
Q

What equipment should be avoided when returning to aerobic activity?

A

treadmill

recumbent bicycle

35
Q

At the end of two weeks, activity should be up to how many minutes a day?

A

20-30 minutes

36
Q

What is the maximum number of months that activity should be restricted?

A

three months

37
Q

Based on pain level how long should one sit?

A

no pain - 50 minutes
mild pain - 40 minutes
moderate - 30 minutes
severe - 20 minutes

38
Q

Based on pain level how much should a man lift?

A

no pain - 80 lbs
mild pain - 60 lbs
moderate - 20 lbs
severe - 20 lbs

39
Q

Based on pain level how much should a woman lift?

A

no pain - 40 lbs
mild - 35 lbs
moderate - 20 lbs
severe - 20 lbs

40
Q

When would you do routine testing during the first month?

A

when a red flag was listed during physical examination

41
Q

Why would you wait?

A

reduce potential of labeling asymptomatic age related changes in lower back

42
Q

What two things should be combined when looking at imaging?

A

combine patient’s physical condition and location of pain with imaging

43
Q

How long will a bone scan remain positive?

A

2-4 years; must be interpreted with xray, CT, or MRI

44
Q

What is the initial imaging modality for LBP?

A

xray (MRI is second)

45
Q

If there is unresolved radicular pain what test would the physician use?

A

electromyography (EMG), nerve conduction velocity (NCV) (motor system & peripheral nerve function)

46
Q

What will a EMG/NCV differentiate between?

A

nerve root damage & peripheral nerve lesion

will not discover CNS etiologies

47
Q

What system will an SSEP & DEP evaluate?

A

sensory system

48
Q

An SSEP or DEP must be used in conjunction with what test and why?

A

must be used in combination with at least NCV to differentiate peripheral nerve from spinal cord or cortical dysfunction

49
Q

If the EMG/NCV or SSEP/DEP are positive, what should be done next?

A

use nervous system electrodiagnostic evaluation to guide MRI imaging

50
Q

What are MRIs best at demonstrating?

A

soft tissue pathology- herniated disc, spinal tumors, abscesses

51
Q

What is CT used for?

A

delineating bone pathology such as small fracture fragments

52
Q

What would you use in combination with CT for diagnosing intraspinal pathology?

A

myelogram (gold standard 99% accurate)

53
Q

List the order of the risk of complications.

A
  1. CT/myelogram
  2. myelogram
  3. bone scan
  4. CT
  5. xray
  6. MRI
54
Q

Compare open vs closed MRI

A

Open
0.2 - 0.3 T
peripheral joints

Closed
1.5 - 3.0 T
spinal

55
Q

When would you use a vertical MRI?

A

when standard MRI was negative but patient has persistent radicular symptoms worse in the seated or erect posture

56
Q

During CBC, a WBC might indicate?

A

infection, leukemia

57
Q

During a CBC, a RBC might indicate?

A

anemia; could be due to marrow replacement by tumor

58
Q

During a urinalysis, RBC might be evidence of?

A

kidney stones, bladder or renal cancer

59
Q

During a urinalysis, WBC might indicate?

A

UTI

60
Q

During a urinalysis, nitrates might indicate?

A

UTI

61
Q

During a urinalysis, crystals may indicate?

A

propensity for stone formation

62
Q

How do you calculate ESR in men?

A

age/2

63
Q

How do you calculate ESR in women?

A

age + 10/2

64
Q

What would a high ESR indicate?

A

presence and intensity of inflammatory process

65
Q

What ESR method is preferred?

A

Westergren method

66
Q

What units are ESRs reported?

A

mm/hour

67
Q

Does a normal ESR exclude malignancies or other serious diseases?

A

NO but it does exclude polymyalgia rheumatic or temporal arteritis

68
Q

How is a ESR useful?

A

detecting occult diseases

69
Q

ESR assists with differential diagnosis. Is ESR increased in MI or Angina? appendicitis or ruptured ectopic pregnancy? rheumatoid arthritis or osteoarthritis?

A

MI
appendicitis
RA

70
Q

ESRs over 100mm/hour indicate..?

A 
presence of metastic cancer
osteomyelitis
subacute bacterial endocarditis
giant cell arteritis
polymyalgia reheumatica
71
Q

What supportive care is available?

A

medical management of pain
therapeutic exercise
OMT

72
Q

When is OMT contraindicated?

A

HVLA is contraindicated in spondylolisthesis and herniated nucleus pulposus

73
Q

What is in the initial phase? second phase?

A

initial - relief of symptoms

second - return to activity

74
Q

Extreme elevation of ESR could indicate?

A 
malignancy (colon/breast)
hematologic disease 
collagen disease (RA)
renal disease
serious systemic infections
75
Q

When is EMG/NCV not useful?

A

in the absence of radicular symptoms

76
Q

In some cases EMG/NCV may not be positive for __ weeks.

A

4-6 weeks

OMM M1T2E3 (9 decks)

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