Pathoanatomical Conditions Flashcards
Tell me about Spondylosis
Age >50
basically OA of the spine/degeneration
unilateral back
extension, standing makes it worse
sitting, bending makes it better
SLR test is negative
X-ray will ID
Tell me about Spondylolysis
basically a pars fracture
ages 15-20 (think gymnast)
Back pain
Extension, sidebending, bending makes it worse
Sitting makes it better
Negative SLR test
Oblique view on x-ray helps ID
Tell me about Spondylolisthesis
Age 20
B fracture of pars with translation of vertebrae
Back pain
Extension, standing, bending makes it worse
Sitting makes it better
Negative SLR
Lateral view on x-ray helps identify
Tell me about disc herniations
Age 30-50
Back, Leg – unilateral
sitting, bending, ascending stairs, walking uphill makes it worse
extension, standing, descending stairs makes it better
positive SLR test
MRI, CT can ID bulging disc
Tell me about spinal stenosis
Basically narrowing of spinal canal
Age >60
back, leg pain - bilateral
extension, standing makes it worse
sitting, bending makes the pain better
Positive SLR test
Can be ID’d on a CT, MRI, X-ray
What test is most common to diagnoses sciatica + lumbar herniation?
SLR test
What range of hip motion indicates a positive test on the SLR test?
30-70 degrees
*greater than 70 degrees likely indicates hip joint pain
Does the SLR test help rule in or out?
RULES IN (more specific)
Tell me about a positive crossed SLR test?
increased pain when raising the good leg
** this happens in about 97% of patients
Is the slump test helpful at ruling in or out?
RULES OUT (more sensitive)
What are the testing positions for the normal SLR test (sciatic + tibial)
Hip flexion + abduction
Knee extension
Ankle DF
What is the SLR test for tibial nerve?
Hip flexion
Knee extension
Ankle DF
Foot Eversion
Toe Extension
** TED-E
What is the SLR test for sural nerve?
Hip flexion
Knee extension
Ankle DF
Foot inversion
**SIDW
What is the SLR test for the common fibular (peroneal nerve)?
Hip flexion, IR
Knee extension
Ankle PF
Foot inversion
**PIP
Tell me about Ankylosing Spondylitis
chronic inflammatory disease
males under 40
chronic back pain with progressive spinal stiffness
thoracic kyphosis, flattening of lumbar curve
early sign is squaring of vertebral bodies – best seen on a lateral view x-ray
late stage will see. bamboo sign – vertebral body fusion
inflammatory bowel disease
uveitis
also associated with higher risk of CVD (aortic insufficiency, aoritis, angina, pericarditis, cardiac conduction abnormalities)
What is the Berlin Criteria to ID inflammatory Back Pain?
1) morning stiffness >30 minutes
2) improvement in back pain with exercise, but not rest
3) Awakening because of back pain during the 2nd half of the night
4) Alternating buttocks pain
** presence of 2 or more = positive
What is the CPR to ID inflammatory back pain?
1) age at onset (age <40)
2) insidious onset
3) improvement with exercise
4) no improvement with rest
5) pain at night, improves when you get up
** presence of 4 or more = positive
What are the lab values you would expect to be elevated with Ankylosing Spondylitis?
ESR, CRP, HLA B27 present
What chest expansion measurement is very specific to AS?
chest expansion less than 2.5 cm
* should be 5 or more
What interventions are most recommended for AS?
extension/mobility exercises
cardiovascular and strengthening exercises
high intensity exercises
Intermittent Claudication
PVD, CV disease
ABI<1
cramping, tightness in calves, legs
distal->proximal tightness
pain increases with exercising/walking
pain relieved with rest
bicycle test is negative
Intermittent walking program is the best management
Neurological Claudication
spinal stenosis
low back pain, distal symptoms
proximal to distal symptoms
pain increases with extension, standing, walking
pain is relieved by being in a stooped position
bicycle test is positive
positive shopping cart sign
Management: manual therapy, flexion exercises, body weight treadmill training
