Lumbosacral Strain and Sprain Flashcards
What is the onset, peak and duration for IV medication?
Onset: 10-15 seconds
Peak: 15-30 minutes
Duration: 1-2 hours
What is the onset, peak and duration for IM medication?
Onset: 20 -30 minutes
Peak: 30-60 minutes
Duration: 3-4 hours
What is the onset, peak and duration for oral medication?
Onset: 20 -30 minutes
Peak: 1 - 2 hours
Duration: 3-6 hours
List the 7 myths of back pain
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
Damage to ligamentous tissue
lumbar SPRain
Damage to muscular tissue
lumbar STRain
Describe sprain grading
Grade 0 - minimal overstretching
Grade 1 - microtearing
Grade 2 - partial tearing of ligament
Grade 3 - Complete rupture of ligament
Describe clinical features of grade 1.
moderate pain with tension
visible swelling
no visible bruising
Describe clinical features of grade 2.
Maximal pain with tension
visible edema
macrohemorrhage with bruising
Partially torn ligament
Describe clinical features of grade 3.
May be painless with tension significant edema macrohemorrhage w/bruising ligament completely ruptured joint instability
Define sciatica
pain in sciatic nerves L4-S3
What is included in initial management?
patient education pain management physical methods activity alteration work activities
What is involved in patient education?
reassurance - time line
coexisting sciatica - longer recovery 12 weeks
What is involved with pain management?
use non prescription analgesics: acetaminophen (Tylenol) Ibuprofen (Motrin, Advil) Naproxen (Aleve) Try to avoid NSAIDs
What are some topical analgesics?
lidocaine patch salicylate cream (unproven)
List some types of opiates.
Tramadol Propoxyphene (IV) Codeine (III) Hydrocodone (III) Morphine (II) Oxycodonoe (II) Hydromorphone (II) Meperidine (II)
A physiologic response of the body to the presence of a controlled substance.
Addiction
A physiologic response of the body to the removal of any medication.
Withdrawal syndrome
Are muscle relaxants any more effective than NSAIDs?
No
When would you use NSAIDs?
as an adjunct to bed rest for acute muscular injury (causes drowsiness)
Neurologic deficits in the distribution of nerve root with symptoms of reflex loss, sensory loss and muscle weakness.
Radiculopathy
Inflammation of a nerve root with radicular pain and muscle spasm.
Radiculitis
What coexists with every sprain and strain injury?
somatic dysfunction
When is manipulation safe and effective for acute LBP?
first month
When should you reevaluate?
if patient is unimproved after 4 weeks
When is manipulation indicated?
in the presence of radiculopathy or radiculitis due to degenerative disc disease
When might traction be effective?
may reduce disc protrusion
Which types of physical modalities have no proven efficacy?
massage diathermy us cutaneous laser treatment biofeedback TENS
Application of heat and cold is unproven but can give the patient something to do. (T/F)
True
In what position should patients be during bed rest?
supine with legs elevated
How long should bed rest last?
no more than 2-4 days
What positions aggravate LBP?
sitting, bending forward
How many minutes each hour should patient get into position of maximal comfort?
10-15 minutes every hour
What equipment should be avoided when returning to aerobic activity?
treadmill
recumbent bicycle
At the end of two weeks, activity should be up to how many minutes a day?
20-30 minutes
What is the maximum number of months that activity should be restricted?
three months
Based on pain level how long should one sit?
no pain - 50 minutes
mild pain - 40 minutes
moderate - 30 minutes
severe - 20 minutes
Based on pain level how much should a man lift?
no pain - 80 lbs
mild pain - 60 lbs
moderate - 20 lbs
severe - 20 lbs
Based on pain level how much should a woman lift?
no pain - 40 lbs
mild - 35 lbs
moderate - 20 lbs
severe - 20 lbs
When would you do routine testing during the first month?
when a red flag was listed during physical examination
Why would you wait?
reduce potential of labeling asymptomatic age related changes in lower back
What two things should be combined when looking at imaging?
combine patient’s physical condition and location of pain with imaging
How long will a bone scan remain positive?
2-4 years; must be interpreted with xray, CT, or MRI
What is the initial imaging modality for LBP?
xray (MRI is second)
If there is unresolved radicular pain what test would the physician use?
electromyography (EMG), nerve conduction velocity (NCV) (motor system & peripheral nerve function)
What will a EMG/NCV differentiate between?
nerve root damage & peripheral nerve lesion
will not discover CNS etiologies
What system will an SSEP & DEP evaluate?
sensory system
An SSEP or DEP must be used in conjunction with what test and why?
must be used in combination with at least NCV to differentiate peripheral nerve from spinal cord or cortical dysfunction
If the EMG/NCV or SSEP/DEP are positive, what should be done next?
use nervous system electrodiagnostic evaluation to guide MRI imaging
What are MRIs best at demonstrating?
soft tissue pathology- herniated disc, spinal tumors, abscesses
What is CT used for?
delineating bone pathology such as small fracture fragments
What would you use in combination with CT for diagnosing intraspinal pathology?
myelogram (gold standard 99% accurate)
List the order of the risk of complications.
- CT/myelogram
- myelogram
- bone scan
- CT
- xray
- MRI
Compare open vs closed MRI
Open
0.2 - 0.3 T
peripheral joints
Closed
1.5 - 3.0 T
spinal
When would you use a vertical MRI?
when standard MRI was negative but patient has persistent radicular symptoms worse in the seated or erect posture
During CBC, a WBC might indicate?
infection, leukemia
During a CBC, a RBC might indicate?
anemia; could be due to marrow replacement by tumor
During a urinalysis, RBC might be evidence of?
kidney stones, bladder or renal cancer
During a urinalysis, WBC might indicate?
UTI
During a urinalysis, nitrates might indicate?
UTI
During a urinalysis, crystals may indicate?
propensity for stone formation
How do you calculate ESR in men?
age/2
How do you calculate ESR in women?
age + 10/2
What would a high ESR indicate?
presence and intensity of inflammatory process
What ESR method is preferred?
Westergren method
What units are ESRs reported?
mm/hour
Does a normal ESR exclude malignancies or other serious diseases?
NO but it does exclude polymyalgia rheumatic or temporal arteritis
How is a ESR useful?
detecting occult diseases
ESR assists with differential diagnosis. Is ESR increased in MI or Angina? appendicitis or ruptured ectopic pregnancy? rheumatoid arthritis or osteoarthritis?
MI
appendicitis
RA
ESRs over 100mm/hour indicate..?
presence of metastic cancer osteomyelitis subacute bacterial endocarditis giant cell arteritis polymyalgia reheumatica
What supportive care is available?
medical management of pain
therapeutic exercise
OMT
When is OMT contraindicated?
HVLA is contraindicated in spondylolisthesis and herniated nucleus pulposus
What is in the initial phase? second phase?
initial - relief of symptoms
second - return to activity
Extreme elevation of ESR could indicate?
malignancy (colon/breast) hematologic disease collagen disease (RA) renal disease serious systemic infections
When is EMG/NCV not useful?
in the absence of radicular symptoms
In some cases EMG/NCV may not be positive for __ weeks.
4-6 weeks
