Mehlman spinal: spondylolythesis/disc hern/lumbosacral strain 04-08 (3) Flashcards
M. Disc herniation.
Radiculopathy down an arm –> herniation?
Cervical disc herniation.
M. Disc herniation.
Radiculopathy down a leg –> herniation?
lumbosacral disc herniation.
M. 24M lifts a heavy box + gets lower back pain with paraspinal muscle spasm + positive straight-leg raise test + no radiating pain; next best step in Mx (management)?
answer = no further studies indicated;
x-ray is the wrong answer here.
M. Straight-leg raise test should ordinarily be positive in ……?
sciatica, but the test is not very reliable and has false-positives
M. For simple lumbosacral strain, do not do…?
dont do xray.
M. simple lumbosacral strain –> Tx?
Tx is exercise as tolerated + NSAIDs if necessary. Bed rest is the wrong answer for Tx.
M. 24M lifts a heavy box + gets lower back pain that radiates down a leg; next best step in Mx?.
x-ray –> in this case, we think about disc herniation.
Although x-ray does not detect the herniation, it’s still the next best step before MRI in order to rule out other things like vertebral mal-alignments
M. Nei i spine tema, bet buvo prie lecture.
Bell palsy; next best step in Mx?
“no further studies indicated” –> the wrong answer is “nerve conduction studies.”
M. Spondylolithesis. definiton?
,,step-off” of one vertebra relative to other.
arba
,,step-off” between infra/suprajacent vertebrae.
,,step-off” of one vertebra relative to other?
M. Spondylolithesis.
M. Spondylolithesis. They will say one vertebrae ,,juts out” or ,,step-off” compared to those above/below it.
.
M. Spondylolithesis. etiology?
can be due to trauma or idiopathic.
M. Disc herniation. definition?
herniation of nucleus pulposus through a tear in annulus fibrosus.
M. Disc herniation. Lifting heavy thing/bending over –> occurs shooting pain down the leg = radiculopathy = Dx?
Disc herniation.
answer can be ,,herniated nucleus pulposus”.
M. Disc herniation.
Be aware of radiculopathy differences L4, L5, S1.
.
M. Disc herniation.
Cervical herniation IS A THING.
.
M. Disc herniation.
Patient has shooting pain down an arm = Dx?
Cervical radiculopathy
C8 disc herniation.
M. Disc herniation.
Del diagnostikos yra biski consufed.
What to do IF SUSPECTED?
If suspected, newest NBMEs want “no diagnostic studies indicated.
For mere radiculopathy (i.e., radiating pain), no imaging
necessary on new NBME content.
M. Disc herniation.
Del diagnostikos yra biski consufed.
What to do IF SUSPECTED + MOTOR/SENSORY Abnormalities?
” X-ray and MRI are not indicated unless there is motor/sensory abnormality (i.e., weakness or numbness)
M. Disc herniation. Tipo jeigu tik plinta skausmas, tai nieko, o jeigu jau yra parestezijos hujezijos, tada imaging.
.
M. Disc herniation.
Straight leg test?
Straight-leg raise test is not reliable.
M. Disc herniation.
Straight leg test when is positive?
Mere pain alone is a negative test.
The test is only positive when they say it reproduces radiculopathy/radiating pain.
M. Disc herniation.
There is a 2CK Q where they say straight-leg test causes pain (i.e., negative test) and answer is “no further management indicated” (i.e., Dx is only lumbosacral strain).
.
M. Disc herniation. Tx?
Tx is NSAIDs + light exercise as tolerated.
M. Disc herniation. Wrong answer on Tx?
Bed rest is wrong answer on USMLE.
M. Lumbosacral strain.
Patient has paraspinal muscle spasm following lifting of heavy box without radiculopathy = Dx?
Lumbosacral strain.
M. Lumbosacral strain.
Patient has paraspinal muscle spasm following lifting of heavy box with radiculopathy = Dx?
the answer is disc herniation instead
M. Lumbosacral strain.
Straight-leg test?
Test can cause pain (i.e., negative test). The test is only positive if
they it reproduces radiating pain
M. Lumbosacral strain.
Imaging?
DO NOT DO X RAY.
very HY for 2 CK.
Apparently lumbar spinal x-rays are one of the most frivolously ordered tests, and USMLE wants you to know that you do not order one for simple lumbosacral strain.
M. Lumbosacral strain. Tx?
same as in herniation.
Tx is NSAIDs + light exercise as tolerated. Bed rest is wrong answer on USMLE
UW. Lumbosacral strain.
Causes?
Strain of paraspinal muscles, tendons, intervertebral ligaments.
Sudden or unbalanced muscle contractions (eg lifting, twirting)
Risk factors: obesity, spinal deformity or degeneration, muscle weakness
UW. Lumbosacral strain.
CP?
Pain in lumbar area; may radiate to buttocks, hips, thighs (above knee)
Paraspinal tenderness
No neurologic deficits; negative straight-leg raising test
UW. Lumbosacral strain.
Mx??
Moderate activity
NSAIDS
Non-BZD muscle relaxants.
