Pathoanatomical Conditions

Question 1

Tell me about Spondylosis

Answer 1

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

Question 2

Tell me about Spondylolysis

Answer 2

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

Question 3

Tell me about Spondylolisthesis

Answer 3

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

Question 4

Tell me about disc herniations

Answer 4

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

Question 5

Tell me about spinal stenosis

Answer 5

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

Question 6

What test is most common to diagnoses sciatica + lumbar herniation?

Answer 6

SLR test

Question 7

What range of hip motion indicates a positive test on the SLR test?

Answer 7

30-70 degrees
*greater than 70 degrees likely indicates hip joint pain

Question 8

Does the SLR test help rule in or out?

Answer 8

RULES IN (more specific)

Question 9

Tell me about a positive crossed SLR test?

Answer 9

increased pain when raising the good leg
** this happens in about 97% of patients

Question 10

Is the slump test helpful at ruling in or out?

Answer 10

RULES OUT (more sensitive)

Question 11

What are the testing positions for the normal SLR test (sciatic + tibial)

Answer 11

Hip flexion + abduction
Knee extension
Ankle DF

Question 12

What is the SLR test for tibial nerve?

Answer 12

Hip flexion
Knee extension
Ankle DF
Foot Eversion
Toe Extension

** TED-E

Question 13

What is the SLR test for sural nerve?

Answer 13

Hip flexion
Knee extension
Ankle DF
Foot inversion

**SIDW

Question 14

What is the SLR test for the common fibular (peroneal nerve)?

Answer 14

Hip flexion, IR
Knee extension
Ankle PF
Foot inversion

**PIP

Question 15

Tell me about Ankylosing Spondylitis

Answer 15

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)

Question 16

What is the Berlin Criteria to ID inflammatory Back Pain?

Answer 16

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

Question 17

What is the CPR to ID inflammatory back pain?

Answer 17

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

Question 18

What are the lab values you would expect to be elevated with Ankylosing Spondylitis?

Answer 18

ESR, CRP, HLA B27 present

Question 19

What chest expansion measurement is very specific to AS?

Answer 19

chest expansion less than 2.5 cm
* should be 5 or more

Question 20

What interventions are most recommended for AS?

Answer 20

extension/mobility exercises
cardiovascular and strengthening exercises
high intensity exercises

Question 21

Intermittent Claudication

Answer 21

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

Question 22

Neurological Claudication

Answer 22

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