Spinal conditions

Question 1

Spinal or intervertebral stenosis - etiology

Answer 1

narrowing of spinal canal or intervertebral forament coupled with hypertrophy of the spinal lamina and ligamentum flavum or facets

Question 2

Spinal or intervertebral stenosis - results in

Answer 2

vascular and/or neural compromise

Question 3

Spinal or intervertebral stenosis - s/s

Answer 3

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

Question 4

Spinal or intervertebral stenosis - clinical tests

Answer 4

bicycle (van Gelderen’s test) will help identify and differentiate it from intermittent claudication

Question 5

Spinal or intervertebral stenosis - PT traction

Answer 5

C spine positioned at 15 of flex to provide optimum opening of intervertebral foramina

Question 6

Spinal or intervertebral stenosis - PT traction - contraindications include

Answer 6

joint hypermobility
pregnancy
RA
down syndrome 
or any other systemic disease that impacts ligamentous laxity

Question 7

Disc conditions - internal disc disruption - most commmon where

Answer 7

lumbar

Question 8

Disc condition - internal disc disruption - s/s

Answer 8

constant deep, achy pain, and inc with mvmnt

No objective neuro findings but pt may have referred pain in LE

Question 9

Posterolateral bulge/herniation - most common observed disc disorder of ____ spine due to

Answer 9

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

Question 10

Posterolateral bulge/herniation - results from

Answer 10

overstretching and/or tearing of annular rings, vertebral endplate and/or ligamentous structures from high compressive forces or rep. microtrauma

Question 11

Posterolateral bulge/herniation - results in

Answer 11

loss of strength
radicular pain
paresthesia
inability to perform ADLs

Question 12

Posterolateral bulge/herniation - PT intervetion

Answer 12

Positional gapping for 10 minutes to inc space within region of space occupying lesion
Traction

Question 13

Posterolateral bulge/herniation - PT intervention - positional gapping - if left posterolateral lumbar herniation is present - have pt

Answer 13

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)

Question 14

Central posterior bulge/herniation - more commonly observed where

Answer 14

cervical spine but can be seen in lumbar

Question 15

Central posterior bulge/herniation - results in

Answer 15

loss of strength
radicular pain
paresthesia
inability to perform ADLs
possible compression of spinal cord - CNS s/s (hyperreflexia, pos babinski)

Question 16

Anterior bulge/herniation

Answer 16

VERY RARE due to structural integrity of anterior IVD

Question 17

Facet joint conditions - DJD results in

Answer 17

bone hypertrophy
capsular fibrosis
hyper or hypomobility of joint
proliferation of synovium

Question 18

Facet joint conditions - DJD s/s

Answer 18

Reduction of mobility of spine
pain
possible impingement of associated nerve root
loss of strength and paresthesias

Question 19

Facet joint conditions - facet entrapment (acute locked back) - caused by

Answer 19

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

Question 20

Facet joint conditions - facet entrapment (acute locked back) - flexion vs. extension

Answer 20

Flexion is most comfortable for patient

Extension increases pain

Question 21

Acceleration/Deceleration injuries of C spine - whiplash - early s/s

Answer 21

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

Question 22

Acceleration/Deceleration injuries of C spine - whiplash - late s/s

Answer 22

Chronic head and neck pain
limitation in flexibility 
TMJ dysfunction
limited tolerance to ADLs
disequilibrium
anxiety and depression

Question 23

Hypermobile spinal segments - due to

Answer 23

insufficient soft tissue control

Question 24

SIJ dysfunction - clinical tests

Answer 24

Gillet's 
Ipsilateral anterior rotation test
Gaenslen's
Long sitting (supine to sit)
Goldthwait's

Question 25

Repetitive/cumulative trauma to back - rep trauma disorders account for what percent of all reported occupational diseases

Answer 25

48%

Question 26

Back tumors - primary tumors include

Answer 26

multiple myeloma 
ewing's sarcoma
malignant lymphoma
chondrosarcoma
osteosarcoma
chondromas

Question 27

Metastatic bone cancer has primary sites in

Answer 27

lungs, prostate, breast, kidney and thyroid

Question 28

Visceral tumors - Esophageal cancer s/s may include

Answer 28

pain radiating to back, pain with swallowing, dysphagia, weight loss

Question 29

Visceral tumors - pancreatic cancer s/s includes

Answer 29

deep, gnawing pain that may radiate from chest to back

Question 30

GI conditions - Acute pancreatitis may manifest itself as

Answer 30

mid epigastric pain radiating through to the back

Question 31

GI conditions - cholecystitis may present with

Answer 31

abrupt, severe abdominal pain and righ tupper quadrant tenderness, nausea, vomiting, and fever

Question 32

Cardiovascular and pulmonary conditions - heart and lung conditions can refer pain to

Answer 32

chest, back, neck, jaw, UE

Question 33

Abdominal aortic aneurysm usually appears as

Answer 33

nonspecific lumbar pain

Question 34

Kidney, bladder, ovary, and uterus disorders can refer pain to

Answer 34

trunk, pelvis, and thighs