Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Osteopathic Skills--Lexie > TEST 3: Lumbar Spine SD Dx > Flashcards

TEST 3: Lumbar Spine SD Dx Flashcards

1
Q

incidence of low back pain

A
  • 85% of general public have low back pain
  • in 35% of adolescent athletes
  • overuse injuries are prone to recurrence
  • 27% of back pain in adults is due to MSK strains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are some general considerations to remember when treating pts with low back pain?

A
  • it is the number #2 reason its go to the doctor
  • majority of causes do not require surgical intervention
  • massive financial burden (cost of tx, expense of lost work, legal costs)
  • emotional burden (inc stress, depression)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the majority of back pain due to?

A

mechanical dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

lumbar spine is frequent site of:

A
  • strain
  • pain
  • disability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

anatomy of lumbar spine

A
  • vertebrae are built to support heavy loads
  • allows for flexion/extension
  • less SB and rotation due to sagittal orientation of facets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

lumbar herniated disc

A
  • may compress lumbar spinal nerve

- may tear the annular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mechanical etiologies of low back pain

A
  • arthritis
  • spondylosis/ spondylolysis/ spondylolisthesis
  • degenerative disc dz
  • somatic dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

non-mechanical etiologies of low back pain

A
  • viscerogenic
  • vasculogenic
  • infection
  • tumors
  • metabolic
  • rheumatologic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are examples of viscerogenic etiologies?

A
  • renal colic

- endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are examples of vasculogenic etiologies?

A

-abdominal aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are examples of infection etiologies?

A
  • osteomyelitis

- diskitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are examples of tumor etiologies?

A
  • primary–>myeloma
  • metastatic
    • breast
    • prostate
    • lung
    • kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are examples of metabolic etiologies?

A

-osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are examples of rheumatologic etiologies?

A

rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some red flags in low back pain?

A
  • major trauma mechanism
  • great than 50 yo or less than 20 yo
  • history of cancer
  • cauda equina symptoms
  • consititutional symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are caudal equina symptoms?

A
  • saddle anesthesia
  • new onset bladder/bowel dysfunction
  • severe or rapidly progressive neurological symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are constitutional symptoms?

A
  • fever
  • chills
  • unexplained weight loss
  • recent bacterial infection
  • IV drug abuse
  • immune suppression
  • severe nighttime pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

spina bifida

A
  • example of mechanical etiology
  • spinous process is formed from laminae
    • failure of fusion–?spina bifida
  • neural tube defects–>decreased incidence with folate supplementation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

spina bifida occulata

A
  • congenital
  • common at L5-S1
  • asymptomatic
  • may have patch of coarse hair over site
  • may have dimple or birthmark
  • small split in vertebra
  • no spinal cord protrusion
  • usually found on radiograph
20
Q

spina bifida meningocele

A

-meninges force out b/w vertebral spaces

21
Q

spina bifida myelomeningocele

A
  • most common type

- unfused portion of the spinal column allows spinal cord to protrude thru an opening

22
Q

spinal stenosis

A
  • spinal canal contains conus medullaris, hilum terminal, and caudal equina
    • cord terminates at L1-2
  • diameter can become compromised–>stenotic
    • also normally decreases with age
23
Q

causes of comprising diameter with spinal stenosis

A
  • hypertrophy of posterior longitudinal ligament
  • thickening of ligaments flavor
  • osteoarthritis
  • exostoses
  • osteophytes
  • tumors
  • disc rupture
24
Q

cauda equina syndrome

A
  • multiple etiologies:
    • infection/inflammation
    • herniated disc
    • metastasis
    • spinal stenosis
      - all place pressure on caudal equina
  • causes:
    • pain, numbness, or tingling in low back/lower extremity
    • progressive weakness and paralysis of lower extremity
    • bladder and bowel incontinence, sexual dysfunction
  • often a surgical emergency
25
Q

how do we figure out the problem with back?

A
  • a thorough H&P

- especially ROS for red flags

26
Q

parts of lumbar spine examination

A
  • observation
  • palpation
  • motion testing
  • meuromuscular exam–strength & sensation
  • vascular assessment
  1. ROM–pt seated/standing
  2. screen with fingers
    - TART, hip drop test for lumbar SD
    - hone in on these areas for further examination
  3. pt in prone
    • induce anterior force on R TP and induce L rotation
    • repeat for L inducing R rotation
    • repeat in F and E
27
Q

physiologic barrier

A

active ROM

28
Q

anatomic barrier

A

passive ROM

-doctor pushes pt to this point

29
Q

pathologic barrier

A
  • less than physiologic
  • this is where complaint lies
  • physiologic-pathologic=motion lost
30
Q

mechanics of lumbar spine

A
  • follows type I mechanics in neutral
  • follows type II mechanics in non-neutral
  • lumbar SP and TPs are at the same level!
31
Q

type I mechanics

A
  • TONGO
  • predominantly in neutral spine
  • SB and rotation occur in opposite directions
32
Q

what maintains type I mechanics?

A

-long restrictor muscles

33
Q

type II mechanics

A
  • predominantly in F or E of spine
  • rotation and SB occur in same direction
  • rotation occurs first
34
Q

what maintains type II mechanics?

A
  • intertransversarii
  • multifidus
  • rotatores
35
Q

if motion is roughly the same in both in F and E…

A

its neutral dysfcn

-type I mechanics

36
Q

if motion is more restricted in F or E…

A

F or E dysfcn

-type II mechanics

37
Q

lumbosacral mechanics

A
  • sacrum and lumbar spine move in opposite directions
    • lumbar F–>sacral E
    • lumbar E–>sacral F
38
Q

dermatome referred pain

A

from irritation of S1 nerve root

39
Q

sclerotomal referred pain

A

-from irritation of L4-5 facet joint and/or capsule
OR
-sacroiliac joint and/or sacroiliac ligaments

40
Q

myotomal referred pain

A

-gluteus minimus muscle (posteriorly and anteriorly)
OR
-piriformis in full blown piriformis

41
Q

viscerosomatic reflexes

A
  • segmental facilitation
  • visceral organs are innervated by Ns originating in different parts of SC
    • SNS from thoracolumbar
    • PNS from craniosacral
  • dysfunction in these organs can cause palpable SD at the segments
42
Q

Chapman’s Reflexes

A
  • tender point “clues” used for dx of visceral dysfunction
  • anterior and posterior points
  • tender point is palpable as a small smooth firm nodule like a pea
  • good inter examiner reliability and correlates with discharge diagnoses
43
Q

anterior points of Chapman’s Reflexes

A
  • periumbilical–adrenal, kidney, bladder
  • 5th ICS–stomach (left), liver (R)
  • 6th ICS–stomach (L), liver/gallbladder (R)
  • 7th ICS–spleen (L), pancreas (R)
44
Q

posterior points of Chapman’s Reflexes

A
  • kidney
  • bladder
  • urethra
  • uterus
  • colon
  • pelvic organs
45
Q

management of low back pain

A
  • address the cause
  • use OMT to address mechanical causes and help in visceral causes
  • medical management
    • NSAIDS
    • muscle relaxants
    • tricyclic antidepressants
    • narcotics
  • surgery
46
Q

what can healthcare providers do about prescribing narcotics?

A
  • use monitoring programs to ID pts who may be misusing their prescription drugs
  • screening for substance abuse and mental health problems
  • avoid combos of prescription painkillers and sedatives unless there is a specific medical indication
  • prescribe lowest effective dose and only quantity needed
  • talk to pts about risks and benefits of pain tx options

Osteopathic Skills--Lexie (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions