Neck and LBP Flashcards
myelopathy signs (2)
hyperactive reflexes (clonus), spasticity weakness, muscle atrophy
myelopathy affects?
upper motor neurons (CNS, brain, spinal cord)
radiculopathy affects what?
lower motor neurons (after the nerve leaves the spinal cord)
signs of radiculopathy (2)
hypoactive reflexes, flaccidity
weakness, muscle atrophy, fasiculations
rapid deceleration injury w/ hyperextension of the neck, followed by flexion can cause?
cervical strain/sprain
strain =
muscle-tendon injury
sprain =
ligamentous injury
gradual onset of neck stiffness & soreness, muscle tightness, headache starting at the back of the skull, shoulder pain
cervical strain/sprain
acute onset of pain in lower back w/ identifiable event (lifting, twisting)
pain increases w/ activity and is improved w/ rest
lumbar strain/sprain
in lower back: decreased ROM due to pain, tender to palpation, muscle spasm, normal neuro exam
lumbar strain/sprain
Treatment for both cervical and lumbar strain/sprains (3)
limit activities (bed rest no more than 48 h), local ice/heat, massage = 48h “therapeutic trial”
NSAIDs, muscle relaxants, analgesics for 48-72h around the clock
PT, education
majority of strains/sprains recover within?
4 weeks
degenerative disk disease and hypertrophy of ligamentum flavum & facets in the cervical vertebrae
Cervical spondylosis
A disorder with variable clinical presentations:
one level w/ variable radicular symptoms- neck tenderness &/or muscle spasm
multiple levels with bilateral symptoms
signs consistent with myelopathy
Cervical spondylosis
Cervical spondylosis most commonly affects? (3)
C4-5
C5-6
C6-7
where is herniated lumbar disk disease most common?
L4-5
L5-S1
presents w/ symptoms consistent w/ L5 or S1 radiculopathy
Herniated lumbar disk disease
Sciatica is a symptomatic hallmark of what?
Herniated lumbar disk disease
Treatments of both Cervical Spondylosis and Herniated Lumbar Disk Disease (3)
NSAIDs, analgesics
muscle relaxants
PT, bed rest
urinary retention, bilateral lower extremity weakness, “saddle anesthesia”, anal wink
Cauda Equina syndrome
pathology of cauda equina syndrome
massive midline herniation due to trauma or metastatic disease
treatment of cauda equina syndrome
based on etiology:
herniation = surgical decompression
metastatic disease = oncology consult, radiation therapy
defect in the pars interarticularis, seen mostly on kids and teens
Spondylolysis
“a collar on the scottie dog” on x-ray indicates?
Spondylolysis
Spondylolysis results from?
repetitive hyperextension stress: gymnasts, divers, athletes
Spondylolysis treatments?
rest & NSAIDs for LBP only
anterior displacement of one vertebrae on another. Associated w/ degenerative disk disease
Spondylolisthesis
where is spondylolithesis most common? (2)
L4-L5
L5-S1
back pain, worsened by bending, lifting, twisting
“step off” of spinous processes on exam
Spondylolithesis
Spondylolisthesis treatment
NSAIDs, rest, conservative exercise
condition that narrows the neural foramen, compressing spinal cord & or nerve roots
Lumbar spinal stenosis
combination of degenerative disk disease & hypertrophy of ligamentum flavum & facets in lower back
Lumbar spinal stenosis
progressive low back and bilateral leg pain that is worsened by standing &/or walking, improved by leaning forward or laying down
Lumbar spinal stenosis
treatment of lumbar spinal stenosis? (4)
NSAIDs
PT to retain ROM
Refer to pain management for epidural steroid injections
Surgery for intractable pain or neuro deficits
night pain that is dull, progressive, persistent, worse w/ recumbency
pt w/ hx of malignancy
Spinal tumor
new LBP in a patient w/ hx of malignancy is what until proven otherwise?
metastasis
what bone condition is associated with invasive procedures, drug abusers, diabetics, and the immunosuppressed?
Osteomyelitis/bone infection
back pain, malaise, fever, sepsis, wound drainage, elevated ESR indicate?
spinal infection
treatment of spinal infection? (2)
antibiotics
surgical drainage
