MSK 6 Flashcards
What is suspected if there is radiation of low back pain to LEs (esp. past knee)?
nerve root impingement
When do you do the maneuvers most likely to cause pain?
last
What are the 5 Waddell’s Signs?
- 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
Nerve roots L1,2 are affiliated with what muscle and action?
Iliopsoas → hip flexion
Nerve roots L3,4 are affiliated with what muscle and action?
Quadriceps, adductors → knee extension, hip adduction
Nerve roots L4,5 are affiliated with what muscle and action?
Tibialis anterior → ankle dorsiflexion
Nerve root L5 is affiliated with what muscle and action?
Extensor hallucis longus → great toe extension
Nerve roots L5,S1 are affiliated with what muscle and action?
Peroneal longus/brevis → ankle eversion
Nerve root S1 is affiliated with what muscle and action?
Gastrocsoleus → ankle plantarflexion
What is the study of choice in eval of sx not responding to conservative tx or in presence of red flags of serious conditions?
MRI
What are 5 tx recommendations for low back pain?
(1) pain control-min narcs
(2) PT
(3) light activity-don’t recommend bed rest (4) epidural steroid injections
(5) surgery
What are 6 surgical indications for low back pain tx?
(1) cauda equina syndrome
(2) herniated nucleus pulposus not responding to conservative tx
(3) spinal stenosis
(4) cancer
(5) infection
(6) severe spinal deformity
What is considered a true orthopedic emergency?
Cauda equina syndrome
What nerve roots are most often affected in HNP?
L4-5, L5-S1
What is HNP?
Displacement of intervertebral disc material beyond the normal confines of the disc
If there is (+) straight leg raise on contralateral side w/HNP, what does that indicate?
severe herniation
Why is an MRI used in HNP?
It’s the best method to assess the level and morphology of a herniation (done for intervention purposes)
When should cauda equina syndrome be ruled out?
If pt ℅ perianal numbness or bowel or bladder incontinence
What is spinal stenosis?
Narrowing of the spinal canal which occurs mostly in older/elderly pts
What are 4 causes of spinal stenosis?
(1) osteoarthritis in the lumbar spine
(2) HNP compression of neural structures
(3) hypertrophy of the ligamentum flavum
(4) congenital
What makes pain worse and better with spinal stenosis?
Worse w/back extension and relieved by leaning forward
What is a better tx route for spinal stenosis?
Surgery > conservative tx (found in randomized trials)
What happens in spinal decompression?
Widening of the spinal canal
What happens in nerve root decompression?
freeing a single nerve
