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NMSK1 - physio 1 > spine conditions > Flashcards

spine conditions Flashcards

1
Q

how is lower back pain defined?

A
  • pain and discomfort, localised below the costal margin and above the inferior gluteal folds **with or without **leg pain
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2
Q

define acute LBP

A
  • usually defined as the duration of an episode of low back pain** persisting for less than 6 weeks **
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3
Q

define sub-acute LBP

A
  • episode of low back pain between 6 - 12 weeks
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4
Q

define chronic LBP

A

lower back pain for longer than 12 weeks

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5
Q

what other pain might lower back pain also present with?

A
  • with or without **sciatica/leg pain **
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6
Q

describe the** epidemiology **of LBP

A
  • back pain affects up to 85% of the population at some time in their lives
  • **leading cause of disability **world wide
  • 10-15% proceed to become chronic, high recurrence rates
  • most LBP is classified in non-specific LBP
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7
Q

what are the 3 groups that LBP can be classfied into?

A
  • specific spinal pathology (less than 1%)
  • radicular symptoms (5-10%)
  • non specific low back pain (90-95%)
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8
Q

what are other situations that may cause LBP that arent the classified groups?

A
  • hip pathology
  • referred visceral pain
  • viral syndrome
  • vascular causes
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9
Q

what important mental factor can be associated with lower back pain?

A
  • psychosocial factor - eg fear of movement, catastrophising, stress etc
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10
Q

when is it important to refer a patient with LBP for a medical opinion / ie to see a doctor?

A
  • if there is a** suspicion of serious underlying condition**
  • if the pain meds that the patient is taking arent working well for him
    * if they dont respond or improve after conservative physio treatment for longer than 4-6 weeks
  • if they have** severe or progressive neurological deficit**
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11
Q

what are examples of specific causes of LBP?

ie anything that isnt non specific lbp

A
  • fracture
  • osteoporosis
  • inflammatory rheumatology condition
  • tumour - spine is common site for secondary bony metastases
  • infection
  • cauda equina syndrome
  • structural changes radicular pain
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12
Q

what are red flags?

A
  • clinical findings that increase the level of suspicion that there is a **serious medical condition **presenting as common, non serious, MSK conditions
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13
Q

what are examples of red flags for lower back pain?

A
  • thoracic pain
  • fever
  • unexplained weight loss
  • history of cancer
  • ill health or presence of medical illness
  • bladder or bowel dysfunction
  • progressive neurological deficit, especially bilateral (abnormal neurological function )
  • saddle anaesthesia (altered sensation in perineal area)
  • history of steroid use
  • history of osteoporosis
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14
Q

what is cauda equina syndrome?

NB

A
  • compression and paralysis of nerve roots in the lumbar spinal canal
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15
Q

what are some examples of symptoms of cauda equina syndrome?

A
  • bladder or bowel dysfunction
  • progressive neurological deficit- esp bilateral
  • saddle anaesthesia **- altered sensation in perineal area **
  • disturbed (ataxic gait)- poor coordination of gait
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16
Q

what should you do if you suspect a patient may have cauda equina syndrome?

A
  • you should send them to A&E for further investigation
  • if patient does have CES - then they will get an urgent decompression surgery - otherwise permenant damage will occur
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17
Q

what is degeneration of the spinal column?

A
  • age related change to the spinal column
  • by the age of 50 years, 85-95% of adults show evidence of **degenerative disc disease **at autopsy including disc bulge/ prolapsed disc
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18
Q

what** 2 types of joints in the spine **can suffer from osteoarthritis?

A
  • central intervertebral joints
  • facet joints
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19
Q

what is spondylosis?

A
  • a term used to describe a group of degenerative conditions that affect the intervertebral discs, vertebral bodies and associated joints in the spine
  • eg lumbar or cervical spondylosis
20
Q

if there is osteoporosis of the IV discs and also the facet joint, what is this condition called?

A
  • degenerative disc disease (DDD)
21
Q

what are the clinical features of osteoporosis in the spine?

A
  • LBP that may or may not accompany referred pain in the buttock/leg
  • bilateral or unilateral LBP
  • stiffness - eg in the morning
  • there may or may not be symptoms of nerve root compresion eg P&N’s, numbness, weakness
22
Q

after examining a patient with suspected osteoarthritis in the spine, what can be noticed?

A
  • reduced spinal ROM
  • stiffness on accessory glides of spinal vertebrae
  • may or may not be signs of nerve root compression
23
Q

what can be seen on x ray with osteoarthritis of the spine?

A
  • narrowing intervertebral disc space
  • osteophyte formation - ‘spurs’
  • narrowing of inter vertebral foramen
24
Q

how does** spinal stenosis** occur?

A
  • spinal stenosis happens when the space inside the spinal canal is too small
  • this puts pressure on the spinal cord and or the nerves
25
Q

at what age can spinal stenosis occur?

A

over the age of 50 years old

26
Q

what are the** signs/symptoms** of spinal stenosis?

A
  • flexed spinal posture
  • limited spinal extension
  • pain & symptoms worsen with extension and are better/relieved with flexion
  • treadmill test may reproduce leg symptoms
27
Q

what are the 3 options for surgery for spinal stenosis?

A
  • spinal decompression
  • laminectomy
  • urgent decompression surgery if cauda equina syndrome
28
Q

what is spondylolisthesis?

A
  • the slippage one 1 vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms of pain
29
Q

what are the causes of spondyloisthesis?

A
  • traumatic spondylolisthesis - L5/S1 - most common
  • degenerative changes - L4/L5 - more common
  • graded I-IV in severity, with IV being the worst
30
Q

what is spondylolysis?

A
  • a condition involing a bony defect or stress fracture in the pars interarticularis
  • can be unilateral or bilateral
  • may predispose to slip - spondylothesis
  • can be congenital or acquired
31
Q

what kind of activities is spondylolysis associated with?

A
  • associated with hyperextension activities eg gymnastics, high jump and throwing sports
32
Q

what are clinical features of spondylolysis?

A
  • may be asymptomatic if grade I
  • may present with unilateral LBP and +/- buttock pain
  • pain worsens with extension movements like walking
  • rest usually relieves the symptoms
  • localised tenderness
  • localised protective muscle spasm
33
Q

what are clinical features of spondyloisthesis?

hint: similiar to spondylolysis symptoms

A
  • patients have low back pain
  • pain is made worse by extension movements
  • pain decreases as the patient goes into a flexed posture
  • localised tenderness
34
Q

what does the treatment for grade I-II spondylolisthesis involve?

A
  • relative rest from aggregating movements & activities
  • exercise
  • no manual therapy at level of slip
  • anti-lordotic brace
35
Q

what does the treatment for a grade III-IV for spondylolisthesis involve?

A
  • no contact sport
  • same as grade I&II
  • may require spinal fusion (fusion of 2 or more unstable vertebrae into 1 to relieve pain)
36
Q

what is lumbrosacral radiculopathy?

A
  • disorder that causes pain in the lower back and radiates down the back of the thigh into the leg (sciatica)
  • very common cause of back pain
  • patient will present with symptoms related to nerve root compression or irritation to a nerve
37
Q

what is sciatica?

A
  • pain going down the leg from the lower back
38
Q

where do the lumbar nerve roots exit the spinal column?

A
  • **below **the corresponding vertebra
39
Q

what are examples of pathologies can cause radicular back pain?

A
  • disc prolapse or herniation
  • OA
  • stenosis in older patient
40
Q

what is a prolapsed intervertebral disc?

example of cause for radicular back pain

A
  • protrusion of nucleus pulposus through the outer layer - annulus fibrosis
  • varying degrees of severity
41
Q

what discs are most common for prolapsed intervertebral discs?

A
  • l5/S1
  • L4/L5
42
Q

in which direction does the nucleus protrude?

A

posterolaterally or posteriorly

43
Q

what are the symptoms of radiculopathy related to disc pathology?

A
  • age 20-50 years
  • males > females
  • trivial event involing flexion and possibly +/- rotation
  • acute severe pain, unable to move
  • pain - central or unilateral LBP, may have buttock pain, may have leg pain
  • aggravated by coughing, sneezing, flexion movements and positions eg sitting, driving etc
  • eased by **lying and short periods of walking **
44
Q

what is the ASIA scale?

A
  • the american spinal injury association impairment scale
  • describes a patients functional impairment as a result of a spinal cord injury
45
Q

describe** non specific lower back pain**

A
  • lower back pain that is not due to a recogniziable, known specific pathology
  • several structures in the back including joints, discs and connective tissues may contribute to symptoms

NMSK1 - physio 1 (36 decks)

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