Spine Conditions Flashcards
lumbar disc pathology
1. types of pathology
2. symptoms
- bulging is even flow out along the entire circumference, herniation is localized bulge which can lead to neurological compromise since commonly bulges posterolateral and puts pressure on nerve (post longitudinal lig and ant longitudinal lig prevent it spilling on front and back)
- acute (often with neurodegen) or chronic central LBP that may radiate to buttocks/legs, potential for radiculopathy (spinal nerve issue), sciatica, or foot drop (nerve supplying DF compromised)
cause of lumbar disc pathology
degeneration of disc causes annulus fibres become weaker, unable to tolerate rotation, flexion, or ext forces as well, harder to contain the dehydrated nucleus, disc height decreases and spills outwards so that it does not align with body, commonly affects L4-5 and L5-S1 since they bear the most weight
lumbar disc pathology
1. aggravates
2. alleviate
- flexion, esp when sitting, lat flex to opposite side opens herniation, Valsalva (forced expiration against closed glottis), can be with sneeze or cough
- extension (standing) and decreasing compression load by lying down
ZA (facet) joint arthropathy
1. causes
2. symptoms
3. aggravates
4. alleviates
- acutely caused by trauma, chronically due to OA changes
- unilateral point specific pain deep to paraspinal, <1 inch of midline
- ZA joint limits ant translation of the sup vertebrae during ext and rotation; thus aggravated by extension and rotation
- flexion, sitting and lying down
SI joint dysfunction
1. causes and overview of SIJ
2. symptoms
3. aggravates
4. alleviates
1.SIJ is a tough joint with limited motion which takes load from leg to the spine; falls, pregnancy (opens SIJ to make space for fetus), MVA, and OA (no synovial membrane)
2. unilateral pain below the belt line, near PSIS which can radiate into the gluteal region through the piriformis
3. asymmetrical motion causes single load through pelvis such as single leg stance, split stance, or stairs
4. symmetry, less load through one joint, reduced lower extremity loading
whiplash associated disorders
1. causes
2. symptoms
3. considerations
- acute acceleration-deceleration mechanism of head and neck via collision, head and cervical tissues absorbs E of impact to stop motion
- no definitive tissue source of problems, usually no evidence in imaging but causes neurological changes, symptoms may have a 24-hour delay, neck pain and stiffness
- with all WAD check for concussion and X-ray for vertebral fracture
serious pathologies for low back pain and associated red flags
- fractures: trauma and age >50
- malignancy: cancer, unexplained weight loss, pain awakening from sleep, and age > 50
- infection: fever, chills, pain awakening from sleep, and persistent sweating at night
- cauda equina syndrome: recent loss of bowel or bladder control
cauda equina syndrome
large lesion in the lumbosacral canal due to compression; requires immediate surgical treatment, if not lead to lower extremity pain, weakness, or numbness, saddle anesthesia (loss of sensation in the perineum, buttocks, and posteromedial thigh), and impaired bladder or bowel control
vertebra-basilar insufficiency
inadequate blood flow through the posterior vertebral arteries forming the basilar artery causing vertigo, dizziness, loss of vision, paresthesia, confusion, headache, ataxia, and incontinence; vertebral arteries run through foramen of transverese processes of cervical spine so VBI can also occur with inj to cervical spine
stroke symptoms
sudden numbness or weakness of face, arm, or leg, especially on one side of the body, sudden confusion or trouble speaking, sudden trouble seeing in one or both eyes, sudden trouble walking or loss of balance, and sudden severe headache with no known cause
what is a red flag for spine pain?
any symptom or condition that may indicate a serious pathology for patients with spine pain
idiopathic neck pain
1. overview
2. aggravates
3. suggested factors
- diagnosis of exclusion, no clear tissue or mechanism, painful in shoulders, upper back, headache, perceived high muscle tension possibly with associated ROM deficits esp in upper traps, levator scapulae, and suboccipitals
- prolonged static posture or specific repeated activities
- environment, posture, stress, and lifestyle
broader signs and symptoms of spine conditions
- radiculopathy due to compromisation or other issue with sensory and motor dysfunction affecting dermatomes and myotomes (weakened muscles due to to lack of neural recruitment)
- sciatica pain along sciatic nerve posterior thigh to calf
- headache can be caused by pain signals from neck dysfunction can be mapped to the head in a cervicogenic headache
broader movement impairments of spine conditions
- consider the next segment of the kinetic chain of the spine, lumbar consider hip, cervical consider shoulder complex, thoracic consider both
- transitions may be difficult
- lumbar consider gait and head turn for cervical
- balance with both but particular interest in cervical since there are high amounts of proprioceptors that are affected which manifests as issue with balance
Cervical spine ROM values
- Flexion 60(10)
- Extension 70(10)
- Side flexion 40(10)
- Rotation 80(10)
Thoracic spine ROM values
- Flexion 20(5)
- Extension 10(5)
- Side flex 25(5)
- Rotation 45(10)
Lumbar ROM values
- Flexion 55(10)
- Extension 25(10)
- Side flexion 20(5)
- Rotation 15(5)
Spinal nerve L2-S2 myotomes
- L2 hip flexion
- L3 knee extension
- L4 dorsiflexion
- L5 hallux extension
- S1 ankle plantar flexion
- S2 knee flexion
Spinal nerve C5-T1 myotomes
- C5 shoulder abduction
- C6 elbow flexion, wrist ext
- C7 elbow ext, wrist flex
- C8 finger flexion
- T1 thumb and finger abduction
