Sacral, Lumbar and Thoracic joint Pathology 2 Flashcards
Primary mechanism of injury in lumbar strain
Movement under a load
Pain in lumbar strain
In the lumbar spine, but may refer to the buttocks. May increase with flexion or extension.
ROM in lumbar strain
Is limited and pain increases upon stretch or muscular contraction.
Neurological tests in lumbar strain
Sensation and reflex tests are all normal.
Joint play in lumbar strain
Joints show significant muscle guarding.
Mechanism of injury in disc degeneration
Mechanism was some movement.
Pain in disc degeneration
Is in the lumbar spine with referral into the posterior leg and foot with extension.
ROM in disc degeneration
Is limited and may or may not be painful in any given movement.
Myotomes most commonly affected by disc degeneration
L5-S1
Tests which are often positive in cases of lumbar disc degeneration
SLR and slump, L5-S1 dermatomes.
Trigger point locations
Can be found in muscles, tendons or ligaments.
Trigger point theory
Thought to be laid down through repetitive motions, acute injuries and postural patterns.
Other more sinister diseases that can mimic back pain
Aortic aneurysms, Paget’s disease, prostate or bone cancer, kidney stones.
Annulus fibrosus
20 concentric rings of collagenous fibers. Divided into 3 layers
Outer zone of the annulus fibrosus
Fibrocartilage that attaches to the outer aspect of the vertebral body and contains an increased number of cartilage cells.
Layers of the annulus fibrosus
Outer, intermediate and inner zones
Intermediate zone of the annulus fibrosus
Layer of fibrocartilage
Inner zone of the annulus fibrosus
Primarily fibrocartilage with the largest number of cartilage cells.
End plate
Attached to the vertebrae and the intervertebral disc. Made of bone and cartilage.
Schmorl’s nodules
If the end plate fails, part of the nucleus pulposus moves into the vertebral body.
Nucleus pulposus with age
Begins to resemble the annulus fibrosus. Mucopolysaccharides, which act as an incompressible fluid, turn to collagen.
Innervation of intervertebral discs
There is no innervation.
Disc injury types
Protrusion or bulging, prolapse, extrusion or herniation
Protruding or bulging intervertebral disc
The disc bulges posteriorly without any rupture of the annulus fibrosus.
Prolapse of the intervertebral disc
Only the outermost fibers of the annulus fibrosus remain intact and contain the nucleus pulposus.
Extrusion or herniation of the intervertebral disc
The annulus fibrosus is perforated and discal material moves into the epidural space.
Sequestrated disc
Formation of discal fragments from the annulus or nucleus outside of the disc.
Degenerative changes of the intervertebral discs
Due to loss of fluid with age. Causes shrinking, tears and cracks in the annulus.
Discs which are most susceptible to herniation
Lumbar and cervical
Which lumbar vertebrae are most susceptible to herniation?
L4/L5 and L5/S1
Which cervical vertebrae are most susceptible to herniation?
C6/C7 and C5/C6
Possible referral patterns for mechanical paid
Referred, sclerotomal or radicular
Referred pain
The pain originates from a deep visceral structure but is perceived to come from somatic structures that share the same spinal segment
Sclerotomal pain referral
Pain is due to the injury of paraspinal muscles, ligaments, facets, joint capsules, discs or dura mater. Usually described as deep and diffuse aching.
Sclerotome
The deep connective tissue structures supplied by the same spinal segment.
Radicular pain referral pattern
Pain is due to the irritation of a spinal nerve root. Can be sensory or motor.
Sensory radicular referral
Due to compression of the dorsal root. The patient experiences sharp pain, numbness and localized tingling.
Motor radicular referral
Due to compression of the ventral nerve root. Causes decreased reflexes and strength.
