MSK lumbar spine pathologies/anatomy Flashcards
What are some major red flag questions that should be asked when it comes to the lumbar spine
Constant progressive night pain
saddle anesthesia
Bowel or bladder incontinence or retention
history of cancer/unexplained weight loss (5% over 6 months)
history of intravenous drug use
systemic illness or infection
What is cauda equina syndrome
compression of 20 nerve roots that originate from the bottom of the spinal cord and travel down to their respective roots
the compression can cause a variety of issues, and is very serious
What are some things to look out for with cauda equina syndrome
changes in urinary function/bowel incontinence
saddle sensory disturbance
Erectile dysfunction
unilateral or bilateral radicular pain
new motor weakness
sexual dysfunction
common with those 50+ and obese
What would the physical examination look like for suspected CES
full neurological assessment
sensation to light touch and pinprick throughout the saddle region, including buttocks, inner thighs, and perianal region
What should you do if CES is suspected
send for emergency MRI
send to doctor asap
What population is most at risk for vertebral fractures
women who are above the age of 50, with 70% of these cases going undiagnosed
WHat are the high evidence risk factors for vertebral fractures
history of osteoporosis
steroid use
severe trauma
female
older than 50
history of spinal fractures
WHat are the high evidence risk factors for vertebral fractures for young populations
excessive alc consumption
vitamin d deficiency
rheumatoid arthritis
diabetes
smoking
eating disorders
What are some objective indicators of vertebral fractures
localized tenderness of spinous processes
contusion or abrasion of spine
What is the biggest risk factors for spinal malignancy
previous history of cancer - always ask
unexplained weight loss (5% over 6 months)
What is the subjective triad for spinal infections
spinal pain with linear progression/limited ROM
worsening neurological symptoms
Fever (sepsis)
What are the 3 main functions of the lumbar spine
bear body weight
shock absorption
absorb stress of lifting/carrying
What are the movements of the vertebral column
flexion/extension in sagittal plane around frontal axis
lateral flexion in frontal plane around sagittal axis
rotation in transverse plane around vertical axis
what are the 2 main articulations in the lumbar vertical column
vertebral bodies and IV disks (cartilagenous and anterior)
z-joints (synovial and posterior, facilitate lumbar movement)
What is revels criteria
criteria for diagnosing z-joint dysfunction
older than 65
pain relief by recumbant position
no increase in pain due to cough or flexion
increase in pain with sitting, hyperextension, and rotation
pain is localized and unilateral, eased with flexion
decreased ROM and increased stiffness over joint
What are the 6 ligaments of the spine that you should know
anterior longitudinal ligament - runs anterior
posterior longitudinal ligament - runs posterior
ligamentum flavum - runs between lamina of adjacent vertebrae
supraspinous ligament - connects tips of spinous processes
interspinousligament - between spinous processes
intertransverse ligament - between transverse processes
What are the components of the IV disk
nucleus pulposus - centrally
annulus fibrosus - surrounds nucleus pulposus, fibrocartilagenous, weak posteriorly due to less density in the posterior regions
cartilage end plates - between disk and vertebral body
What happens to the IV disk as you age
increased collagen, loss of disk height, spondylosis starts to occur
What is a disk herniation
aging of annulus and nucleus
can lead to cracks in annulus and herniation of nucleus
thinning of disk and osteophyte formation on adjoining body - spondylosis
pain with coughing sneezing, straining, and feeling of coldness in legs alongside pain distribution
SLR and slump test have high sensitivity but low specificity
require imaging for confirmation
