Sacral, Lumbar and Thoracic joint Pathology 2

Question 1

Primary mechanism of injury in lumbar strain

Answer 1

Movement under a load

Question 2

Pain in lumbar strain

Answer 2

In the lumbar spine, but may refer to the buttocks. May increase with flexion or extension.

Question 3

ROM in lumbar strain

Answer 3

Is limited and pain increases upon stretch or muscular contraction.

Question 4

Neurological tests in lumbar strain

Answer 4

Sensation and reflex tests are all normal.

Question 5

Joint play in lumbar strain

Answer 5

Joints show significant muscle guarding.

Question 6

Mechanism of injury in disc degeneration

Answer 6

Mechanism was some movement.

Question 7

Pain in disc degeneration

Answer 7

Is in the lumbar spine with referral into the posterior leg and foot with extension.

Question 8

ROM in disc degeneration

Answer 8

Is limited and may or may not be painful in any given movement.

Question 9

Myotomes most commonly affected by disc degeneration

Answer 9

L5-S1

Question 10

Tests which are often positive in cases of lumbar disc degeneration

Answer 10

SLR and slump, L5-S1 dermatomes.

Question 11

Trigger point locations

Answer 11

Can be found in muscles, tendons or ligaments.

Question 12

Trigger point theory

Answer 12

Thought to be laid down through repetitive motions, acute injuries and postural patterns.

Question 13

Other more sinister diseases that can mimic back pain

Answer 13

Aortic aneurysms, Paget’s disease, prostate or bone cancer, kidney stones.

Question 14

Annulus fibrosus

Answer 14

20 concentric rings of collagenous fibers. Divided into 3 layers

Question 15

Outer zone of the annulus fibrosus

Answer 15

Fibrocartilage that attaches to the outer aspect of the vertebral body and contains an increased number of cartilage cells.

Question 16

Layers of the annulus fibrosus

Answer 16

Outer, intermediate and inner zones

Question 17

Intermediate zone of the annulus fibrosus

Answer 17

Layer of fibrocartilage

Question 18

Inner zone of the annulus fibrosus

Answer 18

Primarily fibrocartilage with the largest number of cartilage cells.

Question 19

End plate

Answer 19

Attached to the vertebrae and the intervertebral disc. Made of bone and cartilage.

Question 20

Schmorl’s nodules

Answer 20

If the end plate fails, part of the nucleus pulposus moves into the vertebral body.

Question 21

Nucleus pulposus with age

Answer 21

Begins to resemble the annulus fibrosus. Mucopolysaccharides, which act as an incompressible fluid, turn to collagen.

Question 22

Innervation of intervertebral discs

Answer 22

There is no innervation.

Question 23

Disc injury types

Answer 23

Protrusion or bulging, prolapse, extrusion or herniation

Question 24

Protruding or bulging intervertebral disc

Answer 24

The disc bulges posteriorly without any rupture of the annulus fibrosus.

Question 25

Prolapse of the intervertebral disc

Answer 25

Only the outermost fibers of the annulus fibrosus remain intact and contain the nucleus pulposus.

Question 26

Extrusion or herniation of the intervertebral disc

Answer 26

The annulus fibrosus is perforated and discal material moves into the epidural space.

Question 27

Sequestrated disc

Answer 27

Formation of discal fragments from the annulus or nucleus outside of the disc.

Question 28

Degenerative changes of the intervertebral discs

Answer 28

Due to loss of fluid with age. Causes shrinking, tears and cracks in the annulus.

Question 29

Discs which are most susceptible to herniation

Answer 29

Lumbar and cervical

Question 30

Which lumbar vertebrae are most susceptible to herniation?

Answer 30

L4/L5 and L5/S1

Question 31

Which cervical vertebrae are most susceptible to herniation?

Answer 31

C6/C7 and C5/C6

Question 32

Possible referral patterns for mechanical paid

Answer 32

Referred, sclerotomal or radicular

Question 33

Referred pain

Answer 33

The pain originates from a deep visceral structure but is perceived to come from somatic structures that share the same spinal segment

Question 34

Sclerotomal pain referral

Answer 34

Pain is due to the injury of paraspinal muscles, ligaments, facets, joint capsules, discs or dura mater. Usually described as deep and diffuse aching.

Question 35

Sclerotome

Answer 35

The deep connective tissue structures supplied by the same spinal segment.

Question 36

Radicular pain referral pattern

Answer 36

Pain is due to the irritation of a spinal nerve root. Can be sensory or motor.

Question 37

Sensory radicular referral

Answer 37

Due to compression of the dorsal root. The patient experiences sharp pain, numbness and localized tingling.

Question 38

Motor radicular referral

Answer 38

Due to compression of the ventral nerve root. Causes decreased reflexes and strength.