ORTHO- SPINE Flashcards
What is the MC reason Pt visit HCP? BE PREPARED! CAncer infection
1.SKin-CA, infx 2. Jt pain-SLE, CA, OA 3. BACK PAIN- Nerve, CA. 80% LBP, 28% disabled from LBP-largest cause of disability WW
What are the DDX for Mechanical LBP?
- Lumbar strain (70%)-compression, TP 2/2 glutes
- Degenerative disk disease
- Spinal stenosis
- Disk herniation
- Spondylolisthesis
- Compression fracture
- Severe deformity (scoliosis, kyphosis)
What are the visceral MC of LBP?
Neoplasm, Infecion, Dissecting Aortic Aneurysm, Pancreatitis, Cholecystitis, Ankylosing spondylitis, Paget, Prostatitis, Gastric ulcer, Nephrolithiasis, PID, Intermittent claudication-vascular
What MC LBP etiology is self limiting, assoc. w/ heavy lifting, twisting, or sudden deceleration injuries; usually non-radiating
Muscle strain-Assess dehydration, TP, Hip jt assess, Leg length, Glute strength, Breath, Anxiety
What MC LBP etiology develops slowly but acute event triggers disk rupture, tear, or herniation resulting discogenic back pain, may also have sciatica
Degenerative Disk Disease
What MC etiology result from compression or flexion injuries and consist of anterior wedging; severe injury “burst” fracture with involvement of vertebral body and posterior elements; vertebral chip fracture caused by fall from a height- L5 most common**
Fracture spine
What are some important Q/A to ask with LBP?
a. Sudden or gradual
b. Location, pattern, intensity, and duration
c. What makes it worse? Does it feel better with activity or with rest?
d. Leg/arm pain, weakness, or numbness? Problems walking?
e. Bowel/bladder problems?
f. Hx of back pain: congenital spine problems, previous episodes of low back pain, previous back injuries
g. Is this a work-related injury? Any legal action related to your back pain?
h. Smoking, drinking, drug use, arthritis, cancer, malabsorption, arthritis, weight loss, fever
What is PE work with LBP?
- Asses body type and habit- lean to one side, Leg length, Breath 2. Gait 3. AROM 4. AP of SP tender 5. Above and below level 6. Organs, Wt loss, Fatigue 7. SLR 8 Strength- Hip and Core, UE, Neck 9. Sensation- Head to toe 10. Reflex Head to toe- patella, Achilles- Clonus?
What is test when Pt relaxe their hand and lift their hand from their middle finger and you flick their middle finger – Positive all the other fingers will move like a jellyfish, Flexion of Index finger and ADD of thumb
Hoffman’s Reflex/Test- check integrity of UMN (corticospinal) cervical radiculopathy
What is Grade of strength if pt cannot overcome gravity?
2/5. 0- flaccid, 1/ flicker, 3/ can’t overcaome resistance 4/ weaker than normal
What condition is often found in school or family notice should asymmetry?
Scoliosis- Rib hump when Pt flexes spine, Waist and Shoulder Asymmetric
What is work up for Scoliosis?
DX- 36in(3ft) AP XR - Lateral curver >10deg Cobb angle. Lateral for Kyphosis. Annual until skeletally mature. TX-PT refer Spine surgeon or neuro. Bracing >25 deg curve
What is the MCC of chronic lumbar disk pain and leg pain?
Disk degeneration L4-L5, L5-S1. Post op alway check Toe EXt strength L5 integrity
Who are are risk?
Obese, sedentary, lifters, smoking, alcohol (dries out faster), Drivers-sit bulge, posture, compression
What is the pathology of degeneration of disk?
Inne nucleus pulposus surround y annulus fibrosus- disk protrude posteriorly 1. L/2 central stenosis- narrowing of spinal cord canal, radiates down leg. Push through DAP layers of spinal cord compressing nerves. 2. Also posterolateral-easy space to fill. Intervertebral space decrease dehydrates, which cause foraminal stenosis compressing on spinal nerve roots exiting
What are the benefits of the disk?
Shock absorbers for axial forces (opp of sitting) 2. Pivot point for movement
What are significant history question regarding disk injury?
- Pain 2. sudden or gradual with event ie. lifting 3. **Acute disk cause MORE LEG PAIN 4. Degeneration MORE BACK PAIN 4. Leg pain numb or paraesthesia, weak
What is prognosis of herniated nucleus propulsus?
**Herniation often self limiting 90% w/in 6wk. Denervation will worse over months to years
What are some significant PE finding on disk exam?
- Pain w/ ROM -AROM first 2. Blunted Patellar L3-4, Achilles Reflex L5-S1 Grade 1+, DM poor 3. +SLR Radiculopathy of disk 4. Myotomes - weak DF L4-5, (Common Fib L4-S2), Weak PF L5-S1, weak Great toe FLX L5-S1
What is concern IF pt c/o saddle anesthesia, reduced rectal tone reflex, bowel bladder incontinence?
Cauda equina-surgical evaluation ASAP- Spontaneous or Trauma
What is work up for Disk pathology?
1 MRI** MC L4-L5, L5-S1- Central, lateral, bulge, extruded disk fragment. Deneration-modic vertebbral endplates, inflammtin of arthiris. IF UNABLE to get MRI- CT Myelogram
What is the ideal TX for Disk pathology?
- 6-8wk recovery, RICE, no lifting or repetitive behind 2. NSAIDs, prednison, narcotics, CNS depressants-for sleep 3. PT INC ROM prevention, core MSK 4. Nerve pain stabilizers-gabapentin, pregabalin 5. CS inj for neurogenic pain-sciatica
What do you do if Pt has new onset or progressive weakness or incapacitating pain beyond 6 weeks?
Refer to spine surgeon- MRI microdiscectomy for disk herniations or lumbar fusion for degenerative disk disease.
What are indicators of cervical disk problem?
Neck pain, +/- HA 2. Radicular pain and paresthesia 3. Weakness
