MSK 6 Flashcards

1
Q

What is suspected if there is radiation of low back pain to LEs (esp. past knee)?

A

nerve root impingement

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2
Q

When do you do the maneuvers most likely to cause pain?

A

last

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3
Q

What are the 5 Waddell’s Signs?

A
  • Tenderness: superficial-pain w/light touch to skin
  • Stimulation: pain w/light axial compression on skull, pain w/light twisting of pelvis
  • Distraction: no pain w/distracted SLR
  • Regional nonatomic or inconsistent motor/sensory findings during entire exam
  • Overreaction noted at any time during exam
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4
Q

Nerve roots L1,2 are affiliated with what muscle and action?

A

Iliopsoas → hip flexion

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5
Q

Nerve roots L3,4 are affiliated with what muscle and action?

A

Quadriceps, adductors → knee extension, hip adduction

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6
Q

Nerve roots L4,5 are affiliated with what muscle and action?

A

Tibialis anterior → ankle dorsiflexion

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7
Q

Nerve root L5 is affiliated with what muscle and action?

A

Extensor hallucis longus → great toe extension

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8
Q

Nerve roots L5,S1 are affiliated with what muscle and action?

A

Peroneal longus/brevis → ankle eversion

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9
Q

Nerve root S1 is affiliated with what muscle and action?

A

Gastrocsoleus → ankle plantarflexion

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10
Q

What is the study of choice in eval of sx not responding to conservative tx or in presence of red flags of serious conditions?

A

MRI

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11
Q

What are 5 tx recommendations for low back pain?

A

(1) pain control-min narcs
(2) PT
(3) light activity-don’t recommend bed rest (4) epidural steroid injections
(5) surgery

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12
Q

What are 6 surgical indications for low back pain tx?

A

(1) cauda equina syndrome
(2) herniated nucleus pulposus not responding to conservative tx
(3) spinal stenosis
(4) cancer
(5) infection
(6) severe spinal deformity

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13
Q

What is considered a true orthopedic emergency?

A

Cauda equina syndrome

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14
Q

What nerve roots are most often affected in HNP?

A

L4-5, L5-S1

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15
Q

What is HNP?

A

Displacement of intervertebral disc material beyond the normal confines of the disc

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16
Q

If there is (+) straight leg raise on contralateral side w/HNP, what does that indicate?

A

severe herniation

17
Q

Why is an MRI used in HNP?

A

It’s the best method to assess the level and morphology of a herniation (done for intervention purposes)

18
Q

When should cauda equina syndrome be ruled out?

A

If pt ℅ perianal numbness or bowel or bladder incontinence

19
Q

What is spinal stenosis?

A

Narrowing of the spinal canal which occurs mostly in older/elderly pts

20
Q

What are 4 causes of spinal stenosis?

A

(1) osteoarthritis in the lumbar spine
(2) HNP compression of neural structures
(3) hypertrophy of the ligamentum flavum
(4) congenital

21
Q

What makes pain worse and better with spinal stenosis?

A

Worse w/back extension and relieved by leaning forward

22
Q

What is a better tx route for spinal stenosis?

A

Surgery > conservative tx (found in randomized trials)

23
Q

What happens in spinal decompression?

A

Widening of the spinal canal

24
Q

What happens in nerve root decompression?

A

freeing a single nerve

25
What happens in spinal fusion?
Joining the vertebra to eliminate motion and diminish pain from the arthritic joints
26
What are vertebral fractures?
Osteoporotic fxs occurring from fall at standing height or less
27
What are the 2 most common sites of vertebral fractures?
T7-T8 and T12-L1
28
What are 4 etiologies of spinal instability in vertebral compression fxs?
(1) severe compression (>50% of vertebral height) (2) significant fx kyphosis (>30 deg) (3) rotational component to the injury (4) compression fxs at multiple heights
29
Approximately how much height loss does each complete compression fx cause?
1 cm or more
30
A loss of >4 cm of height is associated with what?
15 degrees of kyphosis
31
What is a wall-occiput test used to detect?
Occult thoracic vertebral fxs
32
What is a positive result on a wall-occiput test?
Unable to touch wall w/the occiput when standing with back and heels against wall
33
What are 3 types of compression fxs osteoporosis may lead to?
(1) wedge fxs (2) biconcave or “codfish” deformities (3) compression fxs
34
What type of x-ray view do you order for vertebral compression fxs?
Plain x-ray of thoracolumbar spine
35
What are 2 radiographic characteristics of vertebral compression fxs?
(1) anterior wedging w/vertebral collapse | (2) vertebral end-plate irregularity
36
What is a CT helpful for with vertebral compression fx dx?
determining potential instability of a wedge fx
37
What 2 things are MRI/bone scans useful for with vertebral compression fx dx?
(1) assessing acuity of the fx | (2) if there is an underlying malignancy
38
What is kyphoplasty and how is it performed?
Vertebral augmentation procedure involving percutaneous injection of bone cement under fluoro into fxed vertebra→ inflatable bone tamps placed into fxed vertebral body to create low pressure cavity in which bone cement is placed to reduce the fx