Spinal Level Related S/S

Question 1

Discogenic Pain

this is the Sudden onset of lower back pain after gardening over the weekend

Answer 1

• Central, deep, and diffuse pain is a burning/aching sensation
• Pain is referred to proximal limb and or local
• Proximal pain will be worse than distal pain
• Pain is referred through the body, not around
• worse with sitting, flexion based activities.

Question 2

Capsule, ligament, facet joint

non-disc, non-nerve pain

Answer 2

• local presentation of pain is typical; facet joint and muscle can refer pain distally
• may follow typical face based movement limitations
• pain may be referred around the body, not through

Question 3

Lumbar Facet Dysfulction

Answer 3

Facet hypomobility (no movement at all)

• -Felxion=diviation to the hypomobile side
• -Extension= deviation away from the hypomobile side
• -Sidebend and Roatation=will be limited both sides

Facet hypomobility (opening, capsular limitation) (moving but not well at end range)

• -Felxion=diviation to the hypomobile side
• -Extension=normal, no diviation
• -Rotation=Limited to hypomobile side
• -SB= limited away from hypomobile side

Question 4

Nerve and Nerve Root sleeve Pain

Answer 4

Pain Is asymmetrical, superficial, and clearly demarcated
Referred to distal dermatome
Pain may be in Myotome or sclerotome pattern
possible only felt distally, not proximal symptoms
anatomic symptoms common
para-/hypoesthesia common
nerve root not normally pain sensitive, but is if irritated

Question 5

Facet or Rib articulation pain: T/S problem

Answer 5

– Andistinctpainthatrunsalongtherib
– Deeptoscapulaforupperlevelribs
– Runsaroundbody
– Commonlyassociatedwithbreastpain
– Maypresentwithpatternofmovement
restrictions

Question 6

T4 syndrome

Answer 6

T–4 Glovepatternofpaininthehandpossiblyreferringup toelbow
– Non‐dermatomal paininarmorforearm
– Associatedwithprolongedstooping,bending
– Lastsminutestohours
– Forwardheadposture
– Sympatheticsigns;temperture,colorchanges
– MarkedtendernessofT4spinousprocess,ribangle

Question 7

T9 Syndrome (not very common)

Answer 7

– SameExceptgivesastockingpatternintheLE

Question 8

Costochondritis (Titsl’s Syndrome)

Answer 8

Related to trauma; contact or sever coughing
May accompany a thoracic vertebrae or rib movement dysfunction
Pain anteriorly, but may refer posteriorly

Question 9

Spondylolisthesis

Answer 9

Pars defect–anterior slip of vertebral body
NOTE: all spindylo’s are not painful, some are structurally stable
Syndrome:
pain eased with sitting
worsened with standing
worsened with extension

Question 10

Non-correspondence of myotomes and dermatomes

Answer 10

– Therearecertainareasofthebodywheretwo
innervation sitesfromthesamesegmentdonot
correspond.
– Occurssecondarytomigrationofstructuresduring
development
– Examples:
• Posteriorupperthorax:skinT2‐3,RotatorCuffC3‐6,
IntercostalsT1‐3
• Anteriorupperthorax:skinT2‐5,MusclesC5‐T1

Question 11

Syndrome that is contraindication for tx until clearly diagnosed

Answer 11

Increased pain at night
up and out of bed to relieve pain
morning stiffness greater than one hour
generally increased pain after heavy or prolonged exercise
–when these group of symptoms occur, you need to review the hx for sinister problems, and if unstable to reach conclusion, refer.

Question 12

Sacroiliac Joint

Answer 12

Pain from lumbar levels esp. L1 and 2 commonly refers to over the sacral area, also, L5 dysfunction is closely associated with SIJ dysfunction
Always assess SIJ with lumbar region!!!

Question 13

SI Syndrome

Answer 13

Pain with sitting
Pain with unilateral stance and ipsilateral sidebend
Pain with coming from sitting
Diffuse pain can refer down posterior thigh
Pt. C/O
–Hamstring and adductor pulls
–Piriformis syndrome
–Heavy or weak leg that tires easy
–Difficulty stepping up stairs with leg of involved side
–Hypermobile SIJ relapses easily!!!!!