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POM > POM lower back pain > Flashcards

POM lower back pain Flashcards

1
Q

Risk factors for lower back pain?

A
  1. Heavy lifting, bending/twisting, whole body vibration
  2. Obesity
  3. Arthritis/osteoporosis
  4. Physically inactive
  5. Pregnancy
  6. Age > 30 yrs
  7. Bad posture
  8. Stress or depression
  9. Smoking
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2
Q

HPI:

A

LIQOR AAA; also previous management (meds, therapy, rest, ice/heat)

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3
Q

PMH and FH of lower back pain:

A

PMH: trauma, surgery, chronic illness, skeletal deformities
FH: congenital abnormalities, scoliosis/back problems, arthritis, genetic disorders

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4
Q

SH of someone with LBP?

A
  1. employment
  2. exercise
  3. ADL’s affected?
  4. Weight changes (lose weight)
  5. Nutrition
  6. Height changes
  7. Tobacco, alcohol, drug use
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5
Q

Define the duration and categories of LBP:

A

Acute: 12 wks;

  1. Non-specific LBP
  2. back pain with neurologic involvement
  3. back pain with suspected SERIOUS pathology
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6
Q

Yellow flags for back pain?

A
  1. risk for chronicity
  2. psychological factors
  3. neurologic deficits
  4. intractable pain resistant to conservative treatment
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7
Q

red flags for back pain?

A
  1. age of onset (55)
  2. significant trauma
  3. unexplained weight loss
  4. massive paresis
  5. widespread neurological changes
  6. bowel/bladder dysfunction
  7. excrutiating
  8. UM signs
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8
Q

Which areas in the anatomy can cause pain?

A
  1. bony: vertebral endplate
  2. Ligaments: posteerior longitudinal ligament
  3. Nerves: nerve root, DRG, spinal nerve
  4. Joints: outer third of annulus fibrosus in the intervertebral disc, FACET joint, SI joint
  5. Muscle and skin
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9
Q

A spinal nerve can leave through the

A

intervertebral foramen

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10
Q

Physical examination of back pain involves

A
  1. inspection
  2. ROM
  3. palpation/percussion
  4. strength
  5. Sensasion
  6. DTRs
  7. Special tests
  8. Balance/gait
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11
Q

Inspection involves?

A
  1. For spine, hips, joints, extremities: alignment (e.g. scapula for scoliosis), contour and body part symmetry (also scoliosis), size, gross deformity
  2. Muscles: size, symmetry, fasciculation or spasm
  3. Skin, SC tissue, muscle, joints: color, swelling, masses
  4. Leg length discrepancy
  5. Posture
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12
Q

Where could you percuss once you’ve palpated?

A

Spinous process!!

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13
Q

ROM/strength for LBP? Numerical system?

A
  1. Spinal mobility: lumbar flexion/extension/rotation/lateral bending
  2. Legs: hip flexion/extension/rotation; thigh abd/add; knee flex/ext; ankle dorsiflexion/plantar flexion/eversion/inversion; toes: flexion/extension/add/abd;

Think 0-5, with 0 being no ROM, 3 having ROM but no resistance, and 5 having full resistance and ROM

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14
Q

List some myotomes:

A
  1. Hip flexion (L1, L2)
  2. Knee extension (L3)
  3. ADF (L4)
  4. Great toes extensor (L5)
  5. Plantar flexion (S1)
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15
Q

Some common reflexes:

A
  1. Achilles: gastroc, soleus at S1 and tibial nerve
  2. Babinski: toe extensor at L4-5, S1-2, tibial nerve
  3. Biceps: biceps brachii, C5, musculocutaneous nerve
  4. Barchioradialis: tests muscle of same name, C6, radial nerve
  5. Triceps: triceps brachii, C7, radial nerve
  6. Patellar: quadriceps femoris, L4, femoral nerve
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16
Q

Special tests:

A
  1. SI joint: Yeoman’s, Gaenslen’s test
  2. Tensor Fascia Lata: Ober’s (can’t drop leg), Noble Compression’s test
  3. Neural source: straight leg raise, slump (you flex neck in addition to SLR), femoral nerve stretch
  4. Structural source: lumbar facet grind test (lateral bend with back extended and while standing and there’s pain), supine-to-long sitting, FABER (flexion, abduction, external rotation), Jackson’s one-legged standing hyperextension
17
Q

How can you look at balance/gait?

A
  1. Romberg Test (equilibrium)
  2. Gait
  3. Heel-to-toe walking
18
Q

Some ancillary/radiographic tests for LBP?

A
  1. Labs: use to evaluate inflamm or neoplastic process (CBC, WBC, ESR)
  2. EMG/NCV
  3. Plain films
  4. Bone scans, CTs, MRI, myelography/CT myelography
19
Q

DD for back pain

A
  1. Muscular: lumbar strain
  2. Bone: acute vertebral Fx, spondylolisthesis
  3. Discogenic: herniated nucleus pulposis, degen disc disease, spondylolysis
  4. Nerve: spinal stenosis, radiculopathy
  5. Deformity: scoliosis, Scheuermann’s Disease
  6. SIJ pain/dysfunction
    EMERGENCIES: tumor, infections, Cauda Equina syndrome, acute nerve compressions
20
Q

Treat LBP:

A
  1. Education: information, reassure, advise to resume activity/work
  2. Bed rest: 2 days maybe
  3. Exercises: massage, certain programs
  4. Manipulation
  5. Psychology
  6. Pharmacological: first acetaminophen, second NSAIDs/coxibs, third muscle relaxants, opioids, antidepressants, anticonvulsants
  7. Refer to specialist for ANY of the red flags, severe disability, Cauda Equina

POM (29 decks)

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