Spinal conditions Flashcards
Spinal or intervertebral stenosis - etiology
narrowing of spinal canal or intervertebral forament coupled with hypertrophy of the spinal lamina and ligamentum flavum or facets
Spinal or intervertebral stenosis - results in
vascular and/or neural compromise
Spinal or intervertebral stenosis - s/s
Bilateral pain and paresthesia in back, buttock, thigh, calves and feet
Pain dec with flex, inc with ext
Pain inc with walking
Pain relieved with rest
Spinal or intervertebral stenosis - clinical tests
bicycle (van Gelderen’s test) will help identify and differentiate it from intermittent claudication
Spinal or intervertebral stenosis - PT traction
C spine positioned at 15 of flex to provide optimum opening of intervertebral foramina
Spinal or intervertebral stenosis - PT traction - contraindications include
joint hypermobility pregnancy RA down syndrome or any other systemic disease that impacts ligamentous laxity
Disc conditions - internal disc disruption - most commmon where
lumbar
Disc condition - internal disc disruption - s/s
constant deep, achy pain, and inc with mvmnt
No objective neuro findings but pt may have referred pain in LE
Posterolateral bulge/herniation - most common observed disc disorder of ____ spine due to
Lumbar
Post disc is narrower in height than anterior
Post longitudinal lig is not as strong and only centrally located in lumbar spine
Post lamellae of annulus are thinner
Posterolateral bulge/herniation - results from
overstretching and/or tearing of annular rings, vertebral endplate and/or ligamentous structures from high compressive forces or rep. microtrauma
Posterolateral bulge/herniation - results in
loss of strength
radicular pain
paresthesia
inability to perform ADLs
Posterolateral bulge/herniation - PT intervetion
Positional gapping for 10 minutes to inc space within region of space occupying lesion
Traction
Posterolateral bulge/herniation - PT intervention - positional gapping - if left posterolateral lumbar herniation is present - have pt
sidelying on R side with pillow under R trunk to accentuate R sidebending
Flex both hips and knees
Rotate trunk to left (or pelvis to R)
Central posterior bulge/herniation - more commonly observed where
cervical spine but can be seen in lumbar
Central posterior bulge/herniation - results in
loss of strength radicular pain paresthesia inability to perform ADLs possible compression of spinal cord - CNS s/s (hyperreflexia, pos babinski)
Anterior bulge/herniation
VERY RARE due to structural integrity of anterior IVD
Facet joint conditions - DJD results in
bone hypertrophy
capsular fibrosis
hyper or hypomobility of joint
proliferation of synovium
Facet joint conditions - DJD s/s
Reduction of mobility of spine
pain
possible impingement of associated nerve root
loss of strength and paresthesias
Facet joint conditions - facet entrapment (acute locked back) - caused by
abnormal movement of fibroadipose meniscoid in facet during extension
meniscoid does not properly reenter joint cavity and bunches up, becoming a space occupying lesion which distends capsule and causes pain
Facet joint conditions - facet entrapment (acute locked back) - flexion vs. extension
Flexion is most comfortable for patient
Extension increases pain
Acceleration/Deceleration injuries of C spine - whiplash - early s/s
HA, neck pain, limited flexibility, reversal of lower cervical lordosis and dec of upper cervical kyphosis, vertigo, changes in vision and hearing, irritability to noise/light, difficulty swallowing
Acceleration/Deceleration injuries of C spine - whiplash - late s/s
Chronic head and neck pain limitation in flexibility TMJ dysfunction limited tolerance to ADLs disequilibrium anxiety and depression
Hypermobile spinal segments - due to
insufficient soft tissue control
SIJ dysfunction - clinical tests
Gillet's Ipsilateral anterior rotation test Gaenslen's Long sitting (supine to sit) Goldthwait's
Repetitive/cumulative trauma to back - rep trauma disorders account for what percent of all reported occupational diseases
48%
Back tumors - primary tumors include
multiple myeloma ewing's sarcoma malignant lymphoma chondrosarcoma osteosarcoma chondromas
Metastatic bone cancer has primary sites in
lungs, prostate, breast, kidney and thyroid
Visceral tumors - Esophageal cancer s/s may include
pain radiating to back, pain with swallowing, dysphagia, weight loss
Visceral tumors - pancreatic cancer s/s includes
deep, gnawing pain that may radiate from chest to back
GI conditions - Acute pancreatitis may manifest itself as
mid epigastric pain radiating through to the back
GI conditions - cholecystitis may present with
abrupt, severe abdominal pain and righ tupper quadrant tenderness, nausea, vomiting, and fever
Cardiovascular and pulmonary conditions - heart and lung conditions can refer pain to
chest, back, neck, jaw, UE
Abdominal aortic aneurysm usually appears as
nonspecific lumbar pain
Kidney, bladder, ovary, and uterus disorders can refer pain to
trunk, pelvis, and thighs
