Mechanical Spinal Pain Syndrome-1 Flashcards
3 points to determining a strain?
- Localised pain
- Muscle spasm
- A normal neurological examination
What is a muscle strain?
- Pain as their main complaint
- Pain is limited to a small local area
- Pain does not radiate to extremities
- Pain due to muscle strain will worsen with activity and can be relieved by rest
- Non-radiating
- Associated with mechanical stress or prolonged abnormal posture
- Results from overuse or over stretching of a muscle
Symptoms of back strain may be associated with what diseases/disorders?
- spondyloarthropathies
- benign tumours of the spine
Localised back pain also develops in patients with ligamentous sprains (disruption of the attachment of ligament to bone). How can you test for this?
Ligament sprains do not cause pain for active or passive extension. Pain is caused when the damaged ligament is stressed in flexion
What are the three categories of a lumbar strain?
MILD STRAIN
- subjective pain without objective findings
- patients usually able to return to customary activity in less than a week
MODERATE STRAIN
- limited range of spinal motion
- paravertebral muscle spasm and pain
- resume full activity in less than 2 weeks
SEVERE STRAIN
- tilt forward or leans to one side
- patients have trouble moving around
- can take up to 3 weeks to recover full function
Posterior facets syndrome physical examination of the lumbar spine
- Low back stiffness especially in morning/inactivity
- Palpable local muscle spasm
- Pain will be relieved by Williams flexion exercise (knee to chest, hold 30 seconds while laying on back, pain should reduce if facet syndrome)
- Straight leg raise should be slightly diminished due to pain pain
Management for posterior facet syndrome?
- manipulation and corrective exercises
- exercises to strengthen abdominal muscles
- injection of anesthetic solution into facet joints
Manipulations proven highly effective 7-10 days
S.I joint tests
- distraction test
- thigh thrust
- gaenslens test
- compression test
- sacral thrust test
Difference between a sprain and a strain
Sprain is ligament and joint capsule.
Strain is muscle and tendons.
What is a posterior facet syndrome
Pain originating from any structure of the facet joints, including:
- fibrous capsule
- synovial membrane
- hyaline cartilage surfaces
- bony articulations
Activities that increase the pain in a posterior facet syndrome in lumbar spine
- Sleeping on abdomen
- Sitting in an upright position
- Lifting a load in front of the body at or above the waist line
- Working with the hands and arms above the head
- Arising from sitting
What process happens in a posterior facet syndrome in lumbar spine
Postural changes resulting in either a increase lumbosacral angle or lumbar lordosis result in a posterior displacement of the centre of gravity. This allows the facet joint to become more weight bearing leading to gradual degeneration
Clinical features of posterior facet syndrome in the cervical spine
Pain radiating from the sub occipital region, the shoulders or mid back
Often there is a previous history or hyper extension injury to the neck or other trauma
Posterior facet syndrome dermatome referral
Learn this
Physical examination for posterior facet syndrome of cervical spine
First X-rays Kempts test ( patients extends neck, rotates and then lateral rotates, dr applies downwards pressure)
