MSK - the lumbar spine Flashcards
Name the 5 regions of the vertebral column
Cervical spine C1-C7 Thoracic spine T1-T12 Lumbar spine L1-L5 Sacrum S1-S5 Coccyx
Name and describe 5 common postural types
Kyphosis: increased anterior lumbar curve from neutral giving a hunched over posture with a depressed chest
Lordosis: increased posterior thoracic curve from neutral, giving a posture in which the stomach and head are pushed forward
Sway back: an increase in the posterior tilt of the pelvis and the trunk, leaning backward with the upper body
Flat back: very little or no lumbar curve is present, due to the position of the hip it can be difficult to fully straighten the knees when standing
Scoliosis: lateral spinal curvature often accompanied by vertebral rotation
What can changes in posture be a result of?
pregnancy
obesity
hypo/hypermobility
Describe what cauda equina syndrome is and the symptoms that can occur
CES is a rare condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged.
Characterised by these red-flag symptoms:
- severe low back pain
- sciatica
- saddle and/or genital sensory dysfunction
- bladder and bowel dysfunction
- gait disturbances
Describe what radiculopathy is and what radiculitis is
Radiculopathy: Commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly
Radiculitis: is pain “radiated” along the dermatome due to inflammation or other irritation of the nerve root
Name and describe the 4 pain mechanisms
- Nociceptive pain: the pain from physical damage or potential damage to the body
2, Inflammatory pain: increased sensitivity due to the inflammatory response associated with tissue damage - Neuropathic pain: pain caused by damage or disease affecting the nervous system
- Central sensitisation: a condition of the nervous system that is associated with the development and maintenance of chronic pain.
Explain what yellow flags are and give some examples
Psychological risk factors
- depression
- anxiety
- fear-avoidance beliefs
- catastrophising
- illness-belief
What should motivational interviewing involve?
OARS: Open-ended questions Affirmation Reflection Summarise
What should the observation of an objective assessment of the lumbar spine include?
Weight-bearing
Spinal posture
Muscle tome and bulk
General condition
What should the ROM of an objective assessment of the lumbar spine include?
LSp flexion and extension
LSp side flexion
check irritability
What should the functional tests of an objective assessment of the lumbar spine include?
Sit to stand
Single leg stand
Turn over on bed/plinth
Gait
As a general rule, when should a neurological assessment be undertaken?
A neurological assessment is indicated if the patient has symptoms below the level of the buttock crease. Symptoms include: - pain - altered sensation - weakness
Name and describe the neurological testing you would undertake for the lumbar spine
Dermatomes - comparison of light touch with tissue Myotomes - apply resistance to assess power - L2 = hip flexion - L3 = hip extension - L4 = ankle dorsiflexion - L5 = hallux extension (big toe extension) - S1 = calf pflex (calf raises) - S2 = knee flexion Reflexes - L3/4 = patella tendon - L5/S1 = achilles tendon
Explain how pain at different degrees of a straight leg raise suggest different things
30-70 degrees suggest lumbar disc herniation
<30degrees suggest gluteal abscess
>70degrees suggests tight hamstrings, gluteus maximus or hip capsule
What can a slump test tell you about a patient?
The Slump Test is a neural tension test used to detect neural tissue sensitivity
If extending the knee causes pain, extend the neck to neutral. Still unable to extend knee = +ve test
If extending the knee does not cause pain, actively dorsiflex the ankle. If this causes pain, lift head. If pain decreases = +ve test
