Midterm: Musculoskeletal Complaint

Question 1

Radicular pain with weakness and sensory loss over an area innervated by a nerve root (dermatomal distribution) most likely is…

Answer 1

Radiculopathy

Question 2

What type of pattern do radiculopathies follow?

Answer 2

Dermatomal

Question 3

What condition involves spinal cord damage or dysfunction?

What does it involve?

Answer 3

Myelopathy

Basically anything involving the spinal cord, meninges and perimeningeal space surrounding spinal cord

Question 4

Do myelopathies result in loss of function?

Answer 4

Yes, significant

Question 5

What are some important palpatory landmarks involving the neck?

Answer 5

Spinous Process
Facet Joints
Paracervical muscles

Question 6

What does a spurling test/maneuver try to elicit?

Answer 6

Radiculopathy

-nerve root compression

Question 7

What is Spondylosis?

Answer 7

Synonymous for Osteoarthritis of Vertebrae

Defect in Pars interarticulars with subsequent spinal nerve root compression

Question 8

In advanced spondylosis, what four conditions arise?

Answer 8

Radicular pain
Neuropathy
Compression fractures
Spondylolisthesis (step off)

Question 9

What specific population is scoliosis most common in?

Answer 9

Adolescent girls

Question 10

What is the most common way to test for scoliosis?

Answer 10

Forward bending test

-clinical evident for curvatures 30 degrees or more

Question 11

What positions make lumbar stenosis worse?

Answer 11

Back extension

Question 12

What back position alleviates lumbar stenosis pain?

Answer 12

Back flexion

Question 13

This is pain in the lower extremities that is caused by lumbar stenosis. It is relieved almost immediately and is NOT due to vascular compromise?

Answer 13

Pseudoclaudication

Question 14

How do you differentiate pseudoclaudication (lumbar stenosis) from true claudication?

Answer 14

Pseudoclaudication is relieved immediately and is not associated with vascular compromise

Question 15

What occurs with Disk herniation?

Answer 15

Pain with flexion/prolonged sitting
Radicular Pain
LE weakness
Straight Leg test with pain at less than 70 degrees

Question 16

In a disk herniation, will a straight leg raise test of the contralateral leg reproduce symptoms in the affected leg?

Answer 16

Yes

Question 17

What is sciatica?

Answer 17

Basically disk herniation or piriformis compression that follows the radicular pattern of the sciatic nerve going from butt pain that travels down into knee

Question 18

If a patient has disk herniation with urinary retention, saddle anesthesia, progressing weakness, and neuro deficits how would you treat?

Answer 18

Surgical emergency

-immediate MRI

Question 19

Is imaging recommended for back pain within the first six weeks?

Answer 19

Nope, not unless there are red flags

-90% will resolve within 6 weeks

Question 20

Aggravating symptoms with flexion and prolonged sitting suggest that the lesion is where?

Answer 20

Anterior spine disk problems

Question 21

Aggravating symptoms with extension suggest that the lesion is where?

Answer 21

Facet joints, stenosis, or SI joint

Question 22

What are some red flag symptoms for malignancy?

Answer 22

Unexplained weight loss, failure to improve w treatment, pain >6 weeks, pain at night/rest
-pt older than 50 w other risk factors as well

Question 23

What are some red flag symptoms for infection?

Answer 23

Fever
Rest pain
Recent infection
History of immunocompromised or IVDU

Question 24

Is nerve root impingement back pain dominant or leg dominant?

Answer 24

Leg

Back is probably more functional impairment