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MPT1 > Spine Three - starts with disc strain/bulge > Flashcards

Spine Three - starts with disc strain/bulge Flashcards

1
Q

what structures are involved with a disc strain or bulge

A

nucleus pulposus
annulus fibrosis

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2
Q

what does the nucleus pulposus and annulus fibrosis do?

A

adapts to pressure secondary to movement (hydrostasis)

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3
Q

aging process ________ solubility

A

decreases

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4
Q

what happens to the pressure around the nucleus as you age?

A
  • more fibrous
  • becomes uneven as you age (30-50 highest risk)
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5
Q

why are you less likely to have a disc strain or bulge in you 50-60s?

A

b/c about that time the annulus and NP become homogenous

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6
Q

herniated nucleus pulposus (HNP)

A

stretching and/or tearing of annulus fibrosis

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7
Q

what age is HNP most common in? what level do 90% of them happen at?

A

20-45
L4/5 and L5/S1

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8
Q

McKenzie theory

A
  • prolonged or repeated flexion cause posterior and possible lateral movement of NP
  • NP migrates towards innervated outer AF
  • pain peripheralizes as nerve is compromised
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9
Q

what part of the AF is innervated?

A

outer 1/3

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10
Q

what does repeated stress/strain cause in the annulus

A

fissures in posterior and posterior lateral annulus

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11
Q

herniation stage 1

A
  • slight posterior lateral protrusion
  • small fissure in annulus
  • asymptomatic
  • easily managed with proper mechanics (but we probs won’t see patients at this level because they don’t have symptoms)
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12
Q

Herniation stage 2

A
  • protrusion to outer annulus
  • increase in fissuring
  • no nerve root involvement
  • may present with lateral shift (usually away from the pain)
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13
Q

Herniation stage 3

A
  • prolapse
  • outer annulus is intact but putting pressure on spinal nerve/cord
  • referred pain into extremities
    *** this is where it can become radicular, monitor patient for neuro changes
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14
Q

Herniation stage 4

A
  • extrusion or requestration
  • no annulus containment
  • neurologic and motor changes
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15
Q

extrusion

A

disc is all the way out but not broken free

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16
Q

sequestration

A

disc has completely broken free

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17
Q

can a herniated disc go back in?

A

it depends on the stage
early = maybe
later - no

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18
Q

subjective findings with HNP

A
  • increased pain with prolonged sitting, bending and twisting
  • increased pain with coughing, sneezing, laughing
  • increased pain with flexion activites and standing after prolonged periods of sitting
  • decreased pain with standing, walking, and movement
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19
Q

objective findings for HNP

A
  • slumped posture and decreased lordosis
  • possible lateral shift
  • neuro signs
  • tender to palpate
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20
Q

special tests for HNP

A
  • slump, straight leg raise, femoral
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21
Q

If HNP is acute, what kind of posture will you see

A

very erect (guarding

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22
Q

spondylolithesis

A

forward displacement of vertebra caused by defect in pars interarticularis

23
Q

what can cause a defect in the pars interarticularis?

A
  • fracture or elongation of vertebral arch
  • facet shape or orientation
24
Q

Tor F: spondylolysis can lead to spondylolisthesis

A

T

25
Q

how do you grade spondylolisthesis

A

line is drawn on the anterior aspect to measure how far forward superior vertebra is on inferior vertebra

26
Q

what are the grades of spondylolisthesis

A

1-4
1-2 are usually responsive to treatment
3-4 usually need surgery

27
Q

2 types of spondylolisthesis

A

isthmic and degenerative

28
Q

is antero or retro spondylolisthesis more common

A

antero

29
Q

isthmic spondylolisthesis

A
  • fatigue fracture
  • stretching of pars interarticularis
  • due to repeated extension with rotation
  • common in volleyball, baseball, and gymnasts
30
Q

t or f: in isthmic spondylolisthesis you may palpate a step higher than the actual problem

A

T b/c it will drop when it moves anterior

31
Q

degenerative spondylolisthesis

A
  • wearing out of asymmetry of facet planes
  • caused by obesity or arthritis
  • entire cephalad vertebra slips forward
  • step is at level of slipw
32
Q

where is degenerative spondylolisthesis most common

A

L4/5 > L5/S1

33
Q

subjective findings with spondylolisthesis

A
  • general LBP
  • subsides with rest
  • difficulty/pain with forward bending
  • increased pain with excessive movement or physical activity
  • increased muscle tone with standing
34
Q

objective findings with spondylolisthesis

A
  • hypermobile with passive accessory testing
  • excessive lordosis
35
Q

t or f: there is a direct relationship of displacement with amount of pain

A

false

36
Q

x-ray views for spondylolisthesis

A

oblique and lateral
oblique = scotty dog with collar sign

37
Q

what other imaging can you get with spondylolisthesis

A

bone scan - used in young people with acute onset
MRI - movement between bone and endplates, may be indicated if there are bowel/bladder symptoms

38
Q

what kind of image shows lumbarization or sacralization

A

AP plain film

39
Q

lumbarization

A

6 lumbar vertebra

40
Q

sacralization

A

4 lumbar vertebra

41
Q

common causes of SIJ injuries

A
  • combo of flexion with rotation
  • fall or trauma
  • pregnancy
  • leg length difference
  • weak glute med
42
Q

subjective findings with SIJ pathology

A
  • morning stiffness that gets better with weight baring
  • sharp/dull/achy, throbbing
  • unilateral pain localized to sij
  • pain with walking and climbing stairs
  • pain with prolonged posture or standing on affected side
43
Q

t or f: if it is a true SIJ problem you should be able to clear the lumbar spine

A

true

44
Q

t or f: people with SIJ problems usually have neurological signs

A

F: but they may have referred pain down the leg

45
Q

possible non mechanical causes of SIJ pathology

A

psoriatic arthritis
infection
tumors

46
Q

objective findings with SIJ pathology

A
  • posture (stance shift to one side)
  • able to clear lumbar
  • spine and hip
  • pelvic mobility
  • leg length difference
  • provocation clusters
47
Q

if someone has a hypermobile SIJ what muscle is most likely weak

A

glutes
* also check hamstrings, quads, and hip rotators

48
Q

anterior pelvic rotation palpation findings

A

ASIS is low
PSIS high
long medial malleolus

49
Q

posterior pelvic rotation palpation findings

A

ASIS high
PSIS low
short medial malleolus

50
Q

possible causes of superior innominate upslip

A

landing hard with knee extended
stepping off curb
landing on ischial tuberosity
tight QL

51
Q

palpation findings with superior innominate upslip

A

ASIS and PSIS superior
short medial malleolus

52
Q

what xray view is best for SIJ

A

anterior posterior

53
Q

what is the gold standard imaging for SIJ

A

injection under fluoroscopy

MPT1 (10 decks)

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