MSK 6

Question 1

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

Answer 1

nerve root impingement

Question 2

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

Answer 2

last

Question 3

What are the 5 Waddell’s Signs?

Answer 3

• 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

Question 4

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

Answer 4

Iliopsoas → hip flexion

Question 5

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

Answer 5

Quadriceps, adductors → knee extension, hip adduction

Question 6

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

Answer 6

Tibialis anterior → ankle dorsiflexion

Question 7

Nerve root L5 is affiliated with what muscle and action?

Answer 7

Extensor hallucis longus → great toe extension

Question 8

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

Answer 8

Peroneal longus/brevis → ankle eversion

Question 9

Nerve root S1 is affiliated with what muscle and action?

Answer 9

Gastrocsoleus → ankle plantarflexion

Question 10

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

Answer 10

MRI

Question 11

What are 5 tx recommendations for low back pain?

Answer 11

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

Question 12

What are 6 surgical indications for low back pain tx?

Answer 12

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

Question 13

What is considered a true orthopedic emergency?

Answer 13

Cauda equina syndrome

Question 14

What nerve roots are most often affected in HNP?

Answer 14

L4-5, L5-S1

Question 15

What is HNP?

Answer 15

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

Question 16

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

Answer 16

severe herniation

Question 17

Why is an MRI used in HNP?

Answer 17

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

Question 18

When should cauda equina syndrome be ruled out?

Answer 18

If pt ℅ perianal numbness or bowel or bladder incontinence

Question 19

What is spinal stenosis?

Answer 19

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

Question 20

What are 4 causes of spinal stenosis?

Answer 20

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

Question 21

What makes pain worse and better with spinal stenosis?

Answer 21

Worse w/back extension and relieved by leaning forward

Question 22

What is a better tx route for spinal stenosis?

Answer 22

Surgery > conservative tx (found in randomized trials)

Question 23

What happens in spinal decompression?

Answer 23

Widening of the spinal canal

Question 24

What happens in nerve root decompression?

Answer 24

freeing a single nerve

Question 25

What happens in spinal fusion?

Answer 25

Joining the vertebra to eliminate motion and diminish pain from the arthritic joints

Question 26

What are vertebral fractures?

Answer 26

Osteoporotic fxs occurring from fall at standing height or less

Question 27

What are the 2 most common sites of vertebral fractures?

Answer 27

T7-T8 and T12-L1

Question 28

What are 4 etiologies of spinal instability in vertebral compression fxs?

Answer 28

(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

Question 29

Approximately how much height loss does each complete compression fx cause?

Answer 29

1 cm or more

Question 30

A loss of >4 cm of height is associated with what?

Answer 30

15 degrees of kyphosis

Question 31

What is a wall-occiput test used to detect?

Answer 31

Occult thoracic vertebral fxs

Question 32

What is a positive result on a wall-occiput test?

Answer 32

Unable to touch wall w/the occiput when standing with back and heels against wall

Question 33

What are 3 types of compression fxs osteoporosis may lead to?

Answer 33

(1) wedge fxs
(2) biconcave or “codfish” deformities
(3) compression fxs

Question 34

What type of x-ray view do you order for vertebral compression fxs?

Answer 34

Plain x-ray of thoracolumbar spine

Question 35

What are 2 radiographic characteristics of vertebral compression fxs?

Answer 35

(1) anterior wedging w/vertebral collapse

(2) vertebral end-plate irregularity

Question 36

What is a CT helpful for with vertebral compression fx dx?

Answer 36

determining potential instability of a wedge fx

Question 37

What 2 things are MRI/bone scans useful for with vertebral compression fx dx?

Answer 37

(1) assessing acuity of the fx

(2) if there is an underlying malignancy

Question 38

What is kyphoplasty and how is it performed?

Answer 38

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