Mechanical Spinal Pain Syndrome-2

Question 1

Lumbar disc herniations are believed to result from?

Answer 1

Annular fibrosus, leaving the disk susceptible to annular fissuring and tearing

Question 2

The intervertebral discs are arranged in four concentric layers

Answer 2

1. Outer annulus fibrosus
2. Fibrocartilaginous inner annular fibrosus
3. Transition zone
4. Nucleus pulposus

Question 3

What common levels of a herniated disc are?

Answer 3

L4-5, L5-S1

Question 4

Lumbar Herniated disc is characterised by what?

Answer 4

Sharp, burning stabbing pain radiating down the posterior or lateral aspect of the leg in S1 S2 distributions

Question 5

A central herniated lumbar disc may also compress nerve roots of the cauda equina syndrome resulting in what?

Answer 5

• trouble urinating
• incontinence
• impotence
• bowel or bladder dysfunction

Question 6

Physical examination of lumbar herniated disc, what should you do?

Answer 6

Motor, sensory and reflex functions should be assessed to determine affected nerve root levels ( nerve root lesion signs are positive in patients diagnosed with a herniated disc)
Straight leg raise (supine, leg raised to 90 degrees, with severe pain felt in the back of affected leg)
Femoral nerve stretch test ( patient prone or in lateral decubitus position, hip extended and knee flexed)

Question 7

Cervical herniated disc- physical examination

Answer 7

Neck pain- unilateral
Sensory or motor dysfunction may be present without significant pain
Made worse by extension and rotation of neck (decreases size of neural Foramen)
Holding arm above head ( shoulder abduction sign) decompressed exiting nerve root
Spurling sign (axial compression and rotation of spine should reproduce pain)

Question 8

Treatment for cervical radiculopathy (herniated cervical disc)

Answer 8

Immobilisation
Traction
Pharmacotherapy
Physical therapy and manipulation

Question 9

Immobilisation for cervical radiculopathy

Answer 9

• may reduce symptoms in the inflammatory please

- immobilisation with a cervical collar is not yet proven to work)

Question 10

Traction in management of cervical radiculopathy?

Answer 10

Distracts the neural formen and decompressed the affected nerve root
Best used when acute muscular pain had subsided and should not be used in patients with signs of myelopathy

Question 11

Physical therapy and manipulating for cervical radiculopathy

Answer 11

In the first 6 weeks after onset of pain gentle range of motion and stretching exercises supplemented by massage and modalities such as heat, ice and electrics, stipulations can be used

Question 12

Referral of cervical radiculopathy when?

Answer 12

• treatment is unresponsive of 6 week period
• motor weakness persisting for more than 6 weeks
• progressive neurological deficit
• signs and symptoms of myelopathy
• instability or deformity of spine

Question 13

What occurs in lateral entrapment syndrome?

Answer 13

Degeneration on both facet and disc
Loss of disc height
Subluxation of facets
Superior facet to move upward and forward on the inferior facet
Impingement upon the pedicle above causing narrowing of the intervertebral foramina

Question 14

Lateral entrapment syndrome pain commonly in?

Answer 14

Patient may or not may complain of pain
If pain occurs it is usually in:
- buttock
-trochanter in region
- posterior thigh to the knee ( may sometimes for down back of calf or down lateral aspect of calf and to ankle and foot)
- Patient may also complain of altered sensation or hypes thesis In the L5 S1 dermatome

Question 15

Tests for lateral entrapment syndromes

Answer 15

1. Patients lies on side of pain, clinician stands behind, holds chest and trunk with one hand and rotates pelvis forward towards the other side
2. Patient stands clinical holds pelvis from behind, an assistant rotates chest and trunk to one side and then to another
3. Patient lies face down, clinician with left hands places pressure on lumbar spine, with right hand clinican flexes both knees so heels touch buttocks

Question 16

Management of lateral entrapment syndrome?

Answer 16

Trail of manipulation
Avoidance of Lumbar rotation
Flexion distraction
Physiological therapies for pain control e.g. Ice, heat, electrotherapies

Question 17

What are the intervertebral discs responsible for?

Answer 17

Attachment of vertebral bodies to each other
Providing flexibility
Absorbing and distributing loads applied to spina, column

Question 18

what is a acute herniated nucleus pulposus in the lumbar spine

Answer 18

annular degeneration that leads to a weakening of the annular fibrosus, leaving the disc susceptible to annular fissuring and tearing

Question 19

what are the most common levels for a herniated disc

Answer 19

L4-L5, L5-S1

Question 20

What are the symptoms of an acute herniated nucleus pulposus

Answer 20

sharp burning stabbing pain radiating down the posterior or lateral aspect of the leg to below the knee

Question 21

A central herniated disc may also compess the nerve root of the cauda equina syndrome resulting in;

Answer 21

difficulty urination
incontinence
impotence
bowel or bladder dysfunction

Question 22

what tests should you perform do test for acute herniated nucleus pulposus in the lumbar spine

Answer 22

straight leg raise

femoral nerve stretch

Question 23

what is the management for acute herniated nucleus pulposus in the cervical spine

Answer 23

immobilization
traction
pharmacotherapy
physical therapy and manipulation

Question 24

What are the two causes of lateral entrapment syndrome?

Answer 24

1. structural changed narrow the lateral canal

2. recurrent dynamic narrowing occurs because the superior articular process moves back and forth