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Patient Evaluation > MS pathologies > Flashcards

MS pathologies Flashcards

1
Q

Types of ARTHRITIS ?

A

Osteoarthritis (OA)/Degenerative Joint Disease (DJD)

Rheumatoid Arthritis (RA)

Gouty Arthritis

Septic Arthritis

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2
Q

Osteoarthritis (OA) 
aka Degenerative Joint Disease (DJD) patho ?

A

Progressive degeneration and loss of articular cartilage.

Underlying bone is damaged, with formation of new bone (osteophytes) at margins.

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3
Q

What is the key in dx OA ?

A 
key thing of OA is osteophytes - dx
degenerative condition (different from the others)
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4
Q

Is OA non inflammatory to inflammatory ?

A

NON - inflammatory

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5
Q

OA/DJD sxs ?

A

Slow onset, brief stiffness in AM or after overuse or inactivity

No generalized sxs of fatigue or malaise - not systemic disease just in joints itself

Usually additive

Commonly affects knees, hips, spine, wrists, DIP> PIP, not MCP ( helps you distinguish if from RA cause RA does not have DIP)

**athletes and obese cause pounding on joints , RA is more symmetrical **

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6
Q

OA / DJD PE, signs ?

A

↓ AROM and PROM, crepitus

Rarely warm or red (cause it is not inflammatory)

Bony enlargement (from osteophytes) - new simulated bone

Heberden’s nodes – nodules at DIP jt.

Bouchard’s nodes –nodules at PIP jt.

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7
Q

OA: Heberden’s nodes – nodules at ___ jt.

A

DIP

**osteophyte formation but they are not red swollen tender and stuff they are just hard a painless and the MCP joints are spared **

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8
Q

OA: Bouchard’s nodes –nodules at ___ jt.

A

PIP

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9
Q

OA / DJD - Treatment ?

A

NSAID’s

Pain meds (Tramadol) - opoid

Joint injections

Arthroplasty

rooster cone into the mixer and they inject it into the joint (synvisk)

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10
Q

RA patho ?

A

Autoimmune disorder, unknown trigger, slow onset

Chronic inflammation of synovial membrane

-secondary erosion of cartilage and bone - damage to ligaments and tendons

**more slow onset

and they feel really crappy cause it is systemic and inflammatory

erosion of cart. and bone and damage to ligaments and tendons **

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11
Q

RA sxs. ?

A

Symmetrically additive - usually both knee

Insidious onset, becomes chronic with exacerbations and remissions

Stiffness, lasting 1+ hours in AM or after inactivity (take them a while to get p and going)

Generalized sxs of weakness, fatigue, weight loss, fever

Females > Males

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12
Q

RA PE, signs ?

A

↓ AROM and PROM

Tender and warm joints, seldom red

+/- subcutaneous nodules on ulnar surface

PIP and MCP most, rarely DIP

Ulnar deviation of fingers

Swan neck deformity

Boutonniere deformity (less common)

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13
Q

Rheumatoid arthritis – swan neck and boutonniere deformities ?

A

top right is the swan hyper extension

inter osseous muscle atrophy cause they are not using the muscles look at bottom pic

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14
Q

Acute gouty arthritis what crystal in the joint cause what type of reaction ?

A

Monosodium urate crystals in joint cause an inflammatory reaction

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15
Q

Acute pseudogouty arthritis what crystal in the joint cause what type of reaction ?

A

(Pseudogout – calcium pyrophosphate crystals)

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16
Q

Acute gouty arthritis - symptoms ?

A

Sudden onset of severe pain, often 1st MTP joint
but also instep, ankles, knees, elbows ( classically big toe)

+/- hx of recent, excessive intake of food (purines - high protein - shrimp) or ETOH, fasting or injury

Usually one joint on first episode

Repeat episodes become more frequent and more severe

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17
Q

Acute gouty arthritis PE, signs ?

A

Very tender, hot and red

No stiffness, ↓ ROM is due to pain

Can be mistaken for cellulitis, septic arthritis

**looks like septic arthritis **

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18
Q

Acute gouty arthritis labs ?

A

↑ serum uric acid (but can be normal in 30% of patients) -

not diagnostic though - gives us a clue

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19
Q

What is dx study for GOUT ?

A

Definitive Dx – aspirate joint fluid

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20
Q

Acute gouty arthritis tx ?

A

NSAIDs - acute

Education re: prevention ( avoid triggers)

recurrent / chronic GOUT - allopurinol

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21
Q

Septic arthritis is a MS ____________ .

A

emergency

Can leave a permanent functional disability

**needs to be dx really quickly with bone destruction cause it really does not grow back **

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22
Q

Septic arthritis (SA): Bacteria in a joint causes ?

A

vascular congestion - taking up more space

increased synovial fluid - more space being taken up

destruction of articular cartilage

destruction of bone within one week of

onset - losing bone in one week

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23
Q

SA: Bacteria comes from one of 3 routes, which are ?

A

Hematogenous - IV drug user, LUPUS, strep or UTI ( small infections that can cause it )

Direct inoculation - severe trauma, surgery

Contiguous - someting nearby like a soft tissue abcess that erodes into the joint

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24
Q

SA sxs ?

A

rapid pain ( look like GOUT),

swelling

↓ROM

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25
Q

SA PE ?

A

fever

x-ray reveals effusion and narrowed articular cartilage ( as crowding takes place)

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26
Q

SA labs ?

A

joint aspirate – turbid, gray or creamy with ↓viscosity. Do a gram stain and C&S

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27
Q

SA tx ?

A

dependent on cause and culture
heme tx that

abscess - treat that

May need aspiration and ATB’s (not PO more parenteral)

May need surgical open debridement ( debride out dead bone)

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28
Q

SA prognosis ?

A

Dependent on virulent the bacteria and joint involved

Hip and ankle are more likely to have permanent damage
-finger heal better

**depend on how quick you are to figure it out and how much destruction has been done

from a replacement - then remove hardware and clean it out and then put it back in **

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29
Q

Other arthritides ?

A

Gonococcal (type of septic) type of septic joint

Psoriatic

Lyme

Etc.

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30
Q

Shoulder Rotator cuff made of the tendons of 4 muscles , which are ?

A

Supra spinatous

Infra spinatous

Teres minor

Subscapular

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31
Q

What muscle is most commonly involved in RC injuries etc ?

A

Supra spinatous

most commonly involved cause of location

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32
Q

Rotator cuff muscle purpose ?

A

They reinforce the joint capsule

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33
Q

What RC muscle can you not palpate ?

A

subscapularis

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34
Q

Impingement syndrome patho ? and what results ?

A

When the acromion, coracoacromial ligament, AC joint or coracoid process impinge (pinch) on bursa, biceps tendon and rotator cuff

Inflammation results

**something soft tissue wise is getting pinched by hard tissue -bone **

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35
Q

Impingement syndrome sxs ?

A

Gradual onset of ant and lat shoulder pain

Can’t sleep on affected side ( so sleep on back or other side )

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36
Q

Impingement syndrome PE, signs ?

A

+ impingement sign

↓ abduction ( cause it recreated pinch

Pain with flexion (near to ear)

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37
Q

Impingement syndrome tx ?

A

NSAIDs x 10-14 days

Rest

Stretching exercises

Injection of 10 ml mix of cortisone (depomedrol) & 1%

lidocaine - works right away

**quick and long term relief **

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38
Q

Rotator cuff tendinitis is one type of ?

A

impingement

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39
Q

Rotator cuff tendinitis is ?

A

the cuff is pinched under the acromion

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40
Q

Rotator cuff tendinitis caused by ?

A

repetitive overhead motions that cause the rotator cuff to be pinched under the acromion (throwing, swimming, etc.) painters

**acute - edema and hemorrhage

chornic - fibrosis and scarring down **

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41
Q

Rotator cuff tendinitis sxs. ?

A

pain when arm is overhead

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42
Q

Rotator cuff tendinitis PE, sign ?

A

+ impingement sign

Neer (ear) and Hawkins

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43
Q

Rotator cuff tendinitis tx ?

A

activity modification

PT

NSAIDs

injection

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44
Q

Rotator cuff tear from ?

A

Can be from chronic or
acute injury

**not inflamed it is now teared **

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45
Q

Rotator cuff tear chronic ?

A

Repeated impingement ex: heavy lifting

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46
Q

Rotator cuff tear acute ?

A

FOOSH (fall on an outstretched hand)

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47
Q

Rotator cuff tear can be ?

A

Tears can be partial or complete and are graded by severity

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48
Q

Rotator cuff tear sxs. ?

A

weakness

pain

trouble with ROM

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49
Q

Rotator cuff tear PE, signs ?

A

+ Drop Arm test ( abduct arm and then we ask them to lower it down and it will eventually just fall - not smooth)

Impaired active abduction – end up shrugging instead

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50
Q

Rotator cuff tear tx ?

A

depends on severity, and how active they are,

Rest

PT

surgery

**dont have to treat these it just depends on the patient **

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51
Q

How long does it take to heal a Rotator cuff tear after arthroscopic debridement ?

A

Takes 6-12 months after arthroscopic debridement
of a partial tear for a throwing athlete to resume athletics

(devastating to athletic career)

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52
Q

Calcific tendinitis patho ?

A

Degenerative process of a tendon, with deposits of calcium salts

Usually involves the supraspinatus tendon

More common in females, + 30y.o.

**deposit of Ca in the tendon **

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53
Q

Calcific tendinitis sxs ?

A

may be acute or chronic episodes of pain

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54
Q

Calcific tendinitis PE, sign ?

A

arm held close to the side, all directions of movement increase the pain (any movement hurts cause Ca salt are being pinch and moved on)

**the sub acromiun bursa may get inflamed as well **

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55
Q

Calcific tendinitis Tx ?

A

Remove the calcifications (arthroscopy)

Reduce the inflammation
-through cortisone injection

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56
Q

Biceps tendinitis patho ?

A

Inflammation of the long head of the biceps tendon

May resemble a rotator cuff tendinitis, or the two may co-exist

**treatment are a lot the same

lateral rotation will expose areas a lot better **

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57
Q

Biceps tendinitis sxs. ?

A

anterior shoulder pain

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58
Q

Biceps tendinitis PE, signs ?

A

+ Yergason test (resisted supination) and it aggravated biceps tendon

**elbow at 90 against the body and resist supination **

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59
Q

Biceps tendinitis tx ?

A

Activity modification

rest

NSAIDs

Steroid injection into sheath of tendon (if into tendon, can degenerate or rupture the tendon – “Popeye sign”
have to be really careful with these

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60
Q

Biceps rupture what defect ?

A

“Popeye defect”

**still some function of biceps and maybe no surgery for olde rman but a young kid then yea surgery to reattach it

tx - surgical correction if there is a complete tear of a tendon head **

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61
Q

Adhesive Capsulitis
 aka ?

A

“Frozen Shoulder”

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62
Q

Adhesive Capsulitis
 patho ?

A

Fibrosis of glenohumeral joint capsule

Usually unilateral, females>males, 40-60 y.o., older athletes

Sometimes have a hx of antecedent event such as a painful disorder of the shoulder or a disabling illness

**adhesive - its getting all stuck together ,its the whole joint ( glenohumeral joint) not just one aspect of the joint it is the whole thing , bedridden for a long time and joint is just frozen down , fibrous aphrodesious **

63
Q

Adhesive Capsulitis
 sxs. ?

A

diffuse, dull ache, no point tenderness. Worse at night.

64
Q

Adhesive Capsulitis
 PE, signs ?

A

progressive loss of ROM

all directions (dont wanna move it at all or sleep on it )

65
Q

Adhesive Capsulitis
 tx ?

A

ROM exercises (only way to break fibrous capsule and get it going)

PT

injections

NSAIDs

nerve stimulation (by PT), U/S

**walk finger up a wall for slow progression and try and go higher and higher each day

it will be awhile before it starts to get better **

66
Q

Adhesive Capsulitis
 prognosis ?

A

chronic, lasting months to years, but may resolve spontaneously (fully or partially)

67
Q

Acromioclavicular arthritis is it common ?

A

yes

68
Q

Acromioclavicular arthritis patho ?

A

Degenerative changes to the A/C joint, usually as a result of prior trauma

**AC joint

pinpoint right to it

movement of the scapula it painful
**

69
Q

Acromioclavicular arthritis sxs. ?

A

pain at AC joint

70
Q

Acromioclavicular arthritis PE, signs ?

A

movement of scapula is painful

movement of glenohumeral joint is NOT

71
Q

Acromioclavicular arthritis tx ?

A

cortisone injections

shave arthroscopy

shave back bone to provide more joint space

surgical excision of acromial head

72
Q

Subacromial bursitis usually between ?

A

Bursa between acromion and head of humerus inflames

73
Q

Subacromial bursitis tender where ?

A

below tip of acromion (below top peak of the shoulder)

74
Q

Subacromial bursitis pain w/ ?

A

Pain with abduction and rotation

75
Q

Subacromial bursitis tx ?

A

NSAIDs

injections

76
Q

Olecranon bursitis patho ?

A

Swelling and inflammation of olecranon bursa

Can be secondary to trauma, RA, gout, etc.

**tip of elbow

can get inflamed and it gets as big as a tennis ball (6cm in diameter)**

77
Q

Olecranon bursitis sxs. ?

A

asymptomatic or painful, acute or chronic

78
Q

Olecranon bursitis PE, signs ?

A

swelling, can become quite large

can reach 6 cms in diameter

79
Q

Olecranon bursitis Tx. ?

A

Can aspirate (get culture) and inject but can recur

Apply compression wrap after aspiration - unless it will just fill back up

  • *get a culture if you are worried about infection if it is warm and hot and red
  • *
80
Q

Rheumatoid Nodules what are they ?

A

Subcutaneous nodules can develop at pressure points on extensor surface of ulna in patients with RA or rheumatic fever - strep

Firm and nontender

**dont have to be treated but you ant to treat the arthritis **

81
Q

Lateral Epicondylitis aka ?

A

tennis elbow

82
Q

Lateral Epicondylitis patho ?

A

Secondary to repetitive extension of wrist against resistance or repetitive pronation/supination of forearm

**back hand swing

cashiers**

83
Q

Lateral epicondylitis sxs. ?

A

pain and tenderness of lat. epicondyle, increased with movement against resistance

84
Q

Lateral epicondylitis Tx. ?

A

– RICE

stop offending activity (rest), ice,

compression, elevation

  • cortisone injection
  • strengthen forearm - to help balance load
  • elastic band around elbow
    to change point of pull - take pressure off insertion point - same thing as taping a catheter
85
Q

Medial Epicondylitis aka ?

A

Pitcher’s, Golfer’s, or 
Little League elbow

86
Q

Medial Epicondylitis patho ?

A

Secondary to repetitive flexion of wrist against resistance

87
Q

Medial Epicondylitis sxs ?

A

pain and tenderness of lat. epicondyle, increased with movement against resistance

88
Q

Medial Epicondylitis Tx ?

A

– RICE

stop offending activity (rest), ice,

compression, elevation

  • cortisone injection
  • strengthen forearm - to help balance load
  • elastic band around elbow
    to change point of pull - take pressure off insertion point - same thing as taping catheter
89
Q

Ulnar nerve entrapment patho ?

A

Ulnar nerve (“funny bone”) is impinged at the elbow

90
Q

Ulnar nerve entrapment caused by ?

A
  • trauma
  • prolonged bed rest - patient cant move and then in same position for a long time
  • compression - cast or swelling of the elbow
91
Q

Ulnar nerve entrapment sxs. ?

A

numbness of 4th and 5th finger, tender ulnar groove, decreased dexterity, 5th finger weakness

92
Q

Ulnar nerve entrapment tx ?

A

avoid repetitive activity, take pressure off elbow so nerve can settle back down

rarely surgery to relive nerve compression

93
Q

Most common soft tissue tumor of the hand and wrist its benign ?

A

Ganglion

94
Q

Ganglion description ?

A

Round, cystic structure (soft ans squishy), often pedunculated (stalk), connecting the cyst to the joint capsule or tendon sheath

**Contains synovial fluid

usually on the dorsal surface of the wrist

make sure it is not pulsatile cause it could be an aneurysm **

95
Q

Ganglion sxs. ?

A

usually painless unless large

96
Q

Ganglion tx. ?

A

none, unless symptomatic

  • aspirate and inject with steroid,but often recur will help scar it down
  • excise ir recurrent
  • may disappear spontaneously

smash it with a book is the old tx

97
Q

Ganglion is most often on __________, over carpals or radial aspect of wrist

A

dorsum of wrist

98
Q

Carpal Tunnel Syndrome patho ?

A

Carpal tunnel lies along the palmar aspect of wrist, covered by the transverse carpal ligament

Median nerve runs through
this tunnel innervating thumb,
2nd, 3rd and half of 4th digits

**this ligament is not stretchy **

99
Q

Carpal tunnel syndrome epidemiology ?

A

trauma to wrist, acute or chronic inflammation, overuse, pregnancy, amyloidosis, CHF

100
Q

Carpal tunnel syndrome sxs. ?

A

numbness, burning, tingling in thumb, 2, 3 and ½ 4 digits.

Awakens pt. at night, worse with driving, typing, phone (flexion)

**wake up at night and shake wrists **

101
Q

Carpal tunnel syndrome PE, signs ?

A

Phalen’s – sxs recreated with sustained wrist flexion

Tinel’s – sxs recreated with tap over median nerve - more reliable

Thenar atrophy - if more long term

102
Q

Carpal tunnel syndrome tests ?

A

Electromyelogram (EMG) - nerve conduction study

**delay in nerve conduction with this , this exam is mainly for insurance purposes **

103
Q

Carpal tunnel syndrome tx ?

A

splint, especially at night,

decrease repetitive movements

change keyboard height,

steroid injection,

surgery (92% effective) - Carpal Tunnel Release

Takes several months for sxs to resolve

**numbness in the hand can also come from damage to the cervical region and mostly likely carpal tunnel **

104
Q

Acute Flexor Tenosynovitis patho ?

A

Infection of flexor tendon sheath

105
Q

Acute Flexor Tenosynovitis follows a ?

A

May follow local injury - from infection

**can spread infection to fossa of the palm so treat aggressively and quickly **

106
Q

Acute Flexor Tenosynovitis may be tender where?

A

Tender along tendon sheath - cause it is tenosynovitis

107
Q

Acute Flexor Tenosynovitis what is painful ?

A

Finger extension is painful - cause it is stretching tendon

108
Q

Felon patho ?

A

Fingertip injury, infection of finger pad fascial space

**penetrating problems or cat bites

can spread to fossal spaces quickly **

109
Q

Felon sxs, signs ?

A

Pain, swelling, dusky redness

110
Q

Felon tx ?

A

I/D

111
Q

Dupuytren’s contracture patho ?

A

Thickened fibrotic plaque of a flexor tendon

Progressive, nodular thickening develops on distal palmar surface, often of the ring or middle finger

**permanent contracture ,sometimes both finger and maybe both hands and it happens overtime not just over night **

112
Q

Dupuytren’s contracture etiology ?

A

Etiology unknown, but ↑ association with epilepsy meds, alcohol abuse, DM, family history

Usually 40-60 y.o.
Males>females
Northern European ancestry

113
Q

Dupuytren’s contracture sxs. ?

A

flexion contracture at MCP joint (or PIP, DIP)

Cannot extend digit – even with force

114
Q

Dupuytren’s contracture tx ?

A

Xiaflex injection

  • Fasciectomy, with post op
    stretching exercises

**post op a lot of ROM exercises **

115
Q

DeQuervain’s tenosynovitis patho ?

A

Inflammation of tendon sheaths of

  • abductor pollicis longus (abductor of thumb)
  • extensor pollicis brevis
116
Q

DeQuervain’s tenosynovitis sxs. ?

A

pain at base of the thumb in “anatomical snuff box”

when thumb is adducted and wrist is ulnarly deviated it will stretch these tendons and it is a positive sign

(e.g. lifting frying pan)

117
Q

DeQuervain’s tenosynovitis PE, signs ?

A

Finkelstein test

Enclose thumb

Sharply deviate wrist ulnarward

Elicits pain = + sign

118
Q

DeQuervain’s tenosynovitis Tx ?

A

– rest

  • thumb spica splint to prevent wrist deviation
  • steroid injection
  • surgical release

**put it in a spica splint **

119
Q

Trigger Finger (Stenosing Tenosynovitis) patho ?

A

Painless nodule on flexor tendon, causes “catching” or “triggering” after forceful flexion. Nodule is trapped by annular pulley

120
Q

Trigger Finger (Stenosing Tenosynovitis) more common in ?

A

DM

121
Q

Trigger Finger (Stenosing Tenosynovitis) tx ?

A

steroid injection or rarely, surgery

this one you can extend but you need force : Dupuytren’s contracture you cant extend at all!

122
Q

Low Back Pain (LBP) prevalence ?

A

Common – 60-90% of population will experience LBP at some point

Expensive to the economy due to missed work, medical care, etc. +$100 billion/year

123
Q

Low Back Pain, what is important to get ?

A

Hx is important! - may be able to diagnose by history

Leg and buttock pain that does NOT go below the knees is most likely mechanical (sprain, strain, arthritis), not neurological

**not below the knees then most likely Muscouskeletal **

124
Q

Low Back Pain, pain questions ?

A

Location

Duration

Severity

Quality ( neurologic is more burning and MS is more sharp and achy)

Timing

radiation

Similar sxs. before

response to previous tx and did it help

125
Q

Risk factors for acute and chronic low back pain ?

A

Smoking

Obesity, poor conditioning

Age 30-50 years

Female gender

Work that is sedentary or perceived as stressful

Lower educational level

Workers’ compensation cases

Certain psychological characteristics
-people who like illness behavior

126
Q

Low Back Pain – RED FLAGS Potentially indicate ?

A

Infection
Malignancy
Serious and/or emergent condition

127
Q

Low Back Pain – RED FLAGS ?

A

Age <20 or +70 years (think more urgent things like fracture or malignancy )

Hx of cancer or recent wt loss
indicator of ongoing malignancy

Hx of fever, immunosuppression, immunocompromise, IVDU

New or progressive neurologic defect (incontinence, saddle anesthesia, b/l sciatica) - things involving spinal cord

Major trauma

Sxs +6 weeks - chronic - not usually MS by this point, something else is going on

128
Q

Low Back Pain - Physical ?

A

Check skin
rash (shingles-zoster), bruising or edema

Check posture
leaning to one side, walking funny, guarding things?

Abdominal exam
aorta dilation in a aneurysm

Neuro exam – sensation, strength and DTR’s
deep tendon reflexes

Rectal exam – tone (no everyone with back pain)
spinal cord conditions can cause loss of rectal tone

MuscSkel – SLR and Contralat SLR
straight leg raise - put stretch on nerve and retreat pain down the back down the leg ( radicular pain, not quad pain)

**undress patient - look at skin, asking the patient to point to where it hurts is very helpful , if it is more midline then concern for spine but side then not as worrisome **

129
Q

LBP is divided into 3 groups ?

A
  1. Nonspecific LBP – 85%
  2. LBP potentially associated with spinal condition
  3. LBP associated with another cause
130
Q

LBP: nonspecific LBP ?

A

No additional work up needed

GENERALLY DO FINE W.O TX.

131
Q

LBP: ass. w/ spinal condition ?

A

Stenosis (pressure on cord), sciatica (inflammation), fracture, etc.

132
Q

LBP: ass. w/ another cause ?

A

CA, infection, etc.

secondary to CA or infection

133
Q

Low Back Pain - Nonspecific: most common is ? for example ?

A

mechanical

  • Lumbosacral strain/sprain (pull a muscle or tendon)
    going to get better no matter what you do
134
Q

Low Back Pain - Nonspecific sxs ?

A

No radiation of pain - it stays in lower back

No red flags

Pain better with recumbency - laying down

Normal neuro exam -DTR intact

135
Q

Nonspecific Low Back Pain
 Lumbosacral strain/sprain PE, signs ?

A

Paraspinal muscle spasms (of to the side maybe tender and tight)

Pain reproduced by direct (hurts cause right on the surface)

compression over the area

Pain with forward flexion, or walking uphill

Negative SLR - does not recreate any pain

136
Q

Low Back Pain - Tests: Who to XR/CT/MRI ?

A

– If sxs don’t resolve quickly or worsen

  • If + 70 y.o.
    look for fracture or sign of metastasis
  • If hx of trauma, CA, wt. loss, pain at rest, infxn (red FLAGS)
  • Radiculopathy, IF results will impact tx
    not for sciatica
137
Q

Low Back Pain - Tests: Who to XR/CT/MRI notes ?

A

MRI – assesses neural compromise better than CT

choose MRI over CT cause more information about nerve supply

138
Q

Nonspecific Low Back Pain - Treatment
 ?

A

Tailor it the patient

Goal is early return to functioning

Bed rest has negative impact (not the best thing)
– ↓ muscle bulk and demineralization of bone
- prolongs disability

Avoid prolonged sitting, heavy lifting

Mild analgesics – Tylenol, NSAID’s

Short course of prednisone?
depend on pt. and provider but usually not necessary

Muscle relaxers?
cause drowsiness so no driving

Education, heat or ice , back exercises ( especially abd. exercises so back muscle get a rest), prevention

**3% of muscle bulk every day with bed rest and 6% of bone minerals every 6 weeks **

139
Q

Low Back Pain
 Lumbosacral strain/sprain - prognosis ?

A

Usually self-limited - good news!

50% recover by 2 weeks

90% by 6 weeks - if not then worry about sometime more

25% will have recurrence within a year

**tell them that they are going to get better but it is going to take time for inflammation to go away

if your nice to it it will happen sooner so dont be mean to it **

140
Q

CHRONIC Low Back Pain (>3 months) 
 Treatment ?

A

Acetaminophen – first-line

Spinal manipulation may help mechanical pain

Anticonvulsants (neurontin) if radiculopathy
-Gabapentin

Muscle relaxers - controversial

Opioids–weigh risk/benefit
only severe pain for a short period of time (constipation)

NSAIDs - worry about GI effects and bad for kidneys , take OTC stuff and take it with food

PT/OT - teach strengthening exercise

Exercises, acupuncture, massage - not well studied

Antidepressants -

Benzos - good for spasms

TENS unit? - not proven to be effective even though they still use it quite a bit

**careful in liver disease or on other meds with acetomenophin **

141
Q

CHRONIC low back pain prognosis ?

A

Longer recovery is associated with illness behavior, depression:

  1. Cognitive Behavioral Therapy (CBT) - learn coping mechanisms if longer than 6 weeks
  2. Benzodiazepines -

If pain lasts longer than 6 wks -refer

142
Q

Herniated Nucleus Pulposus 
(HNP) facts ?

A

total of 24 vertebrae

90% at L4-L5 or L5-S1 - were herniated disc mostly occur - cause sharp angle

143
Q

Herniated disc: 90 % of herniations are at ?

A

L4-L5 (dorsiflexors)

L5-S1 (plantar flexors, Achilles)

Causes nerve root
compression

144
Q

HNP ?

A

annulus rupture and it herniates the jelly out of the donut

it is a FB reaction plus the mechanism pressure on the nerve root is causing symptoms and will follow the nerve root or derotomal distribution

145
Q

Herniated Nucleus Pulposus (HNP) pain description ?

A
  • from direct pressure on nerve root
  • from breakdown of nucleus pulposus
  • in a dermatomal distribution
146
Q

HNP -PE ?

A

Straight Leg Raise

Recreates radicular pain (in first 30-70° of raise)

Dorsiflex foot or raise
head for additional
stretch on nerve

  • asymmetric DTR’s
  • motor weakness - push foot out against hand and one might be stronger than the other so look for symmetry
  • sensory deficit
147
Q

HNP dx?

A

MRI

148
Q

HNP tx ?

A

Bedrest x 2 days (no longer), then PT

NO CHIROPRACTIC

ADJUSTMENTS

Muscle relaxers

NSAID’s

Epidural steroids - if recurrent

Surgery - if recurrent

**back to functional as fast as possible **

149
Q

HNP tx surgery ?

A
  • discectomy with fusion or replacement
  • laminectomy

**laminectomy- allows nerve to have enough room

take the herniated disc out and fused vertebraa together maybe a fake disc to keep the space**

150
Q

Sciatica patho ?

A

Inflammation of sciatic nerve – often due to HNP ( forgiven body substance creating the inflammatory reaction)

in the butt, radiative even down to the feet and toes, just below the SI joint with patient on their side flexing their leg and hip - for palpation

151
Q

Sciatica sxs ?

A

Radicular pain – usually below knee(s)

↑ pain with bending, sneezing, coughing

152
Q

Sciatica PE ?

A

+SLR ( straight leg riase- stretch nerve - it is inflammed), pain on palpation over SI joint, sensory changes, ↓Achilles reflex

153
Q

Sciatica tx ?

A

NSAIDs

Patient Evaluation (29 decks)

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