Midterm - New Week 2 Flashcards
How many LBP patients report 1 or more additional episode of back pain within a year
65%
What are 5 ways to injure your low back?
- Repetitive microtrauma
- Sustained, postural loads
- Single traumatic event
- Sudden unguarded movement
- Normal activity with unstable spine
What are 6 non-specific mechanical low back pain injuries?
- disc derangement
- facet syndrome
- sprain
- myofascial pain syndrome
- joint dysfunction
- extensor strain
What are 6 low back pain and neuro damage injuries
- lumbar disc herniation
- spinal canal stenosis
- fracture
- osteophytic compression of a nerve
- nerve root adhesions
- spondylolisthesis or structural instability
What should be included in the patient education about pain
- Pain perception is not always correlated to the damage
- It’s important to return to normal activity
- Improve ADLs
- Prognosis is favorable for pain relief and return of function
What are three first line medications that may be prescribed for a patient with LBP? Second line?
- NSAIDS (anti-inflammatory - ibuprofen, naproxen)
- Paracetamol (analgesic - acetaminophen/ Tylenol)
- Muscle relaxant (flexeril)
Second line - Tramadol (narcotic - ultramarines
What are the 5 main tool boxes of conservative management?
- chiropractic manipulation
- soft tissue manipulation
- behavioral modification
- exercise therapy
And patient education PAAP
What three things might happen to a disc?
- disc derangement
- disc herniation
- disc degeneration
What 5 pathoanatomical issues can cause lumbar pain? What percent from each issue?
- disc (40%)
- facet (5-60% if part of OA)
- sprain
- strain
- fracture
Direction of disc herniation is (same/opposite) direction of the load?
Opposite
What is the key clinical predictor of discogenic pain?
Pain centralization
+LR 2.1-9.4
What four structural changes are related to facet syndrome?
- OA
- capsule tears
- synovial cysts
- articular cartilage injury
What are 5 things to know about the pain referral for facet syndrome?
- Overlapping territories (nondermatomal)
- To the front and back of leg
- Sometimes as far as the foot
- Referred pain may not be contiguous
- Referred pain from facets and discs overlap
How is a facet block performed?
Fluoroscopic guidance, intra-articular joint space in injected with corticosteroids and local anesthetic & contrast medium
- first injection with with short acting anesthetic (lidocaine) and the patient records duration of pain relief in a diary
- second injection 1-2 weeks later, longer lasting (bupivacaine) and the patient again charts pain relief in a diary
- diagnose if >80% pain relief
- third block can performed with saline (placebo)
If any indicators or abnormalities are present with muscle testing you should then
Use repetitive and sustained muscle testing
To see how they fatigue (how quickly)
What other issues would accompany foot drop and L5 nerve root lesion?
Extensor hallicus longus weakness and peroneals eversion
Sensory loss in 2st toe, radicular ain down posterior thigh lateral leg and medial 1-3 toes
What findings would accompany foot drop and L4 nerve root lesion
Tib anterior weakness (dorsiflexion/inversion)
Sensory loft medial leg/ankle and pain down lateral thigh, medial leg and dorsum of foot
What findings would accompany foot drop and common perineal nerve lesion?
- injury around head of fibula
- history of degenerative knee changes
- non-dermatomal sensory changes @ anterolateral lower leg and dorsum of foot
- possible evidence of weak foot eversion, dorsiflexion, to extension and steppage gait
- pain and tinels sign over lateral fibula neck
