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
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)
3
Q
what is the majority of back pain due to?
A
mechanical dysfunction
4
Q
lumbar spine is frequent site of:
A
- strain
- pain
- disability
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
6
Q
lumbar herniated disc
A
- may compress lumbar spinal nerve
- may tear the annular ligament
7
Q
mechanical etiologies of low back pain
A
- arthritis
- spondylosis/ spondylolysis/ spondylolisthesis
- degenerative disc dz
- somatic dysfunction
8
Q
non-mechanical etiologies of low back pain
A
- viscerogenic
- vasculogenic
- infection
- tumors
- metabolic
- rheumatologic
9
Q
what are examples of viscerogenic etiologies?
A
- renal colic
- endometriosis
10
Q
what are examples of vasculogenic etiologies?
A
-abdominal aortic aneurysm
11
Q
what are examples of infection etiologies?
A
- osteomyelitis
- diskitis
12
Q
what are examples of tumor etiologies?
A
- primary–>myeloma
- metastatic
- breast
- prostate
- lung
- kidney
13
Q
what are examples of metabolic etiologies?
A
-osteoporosis
14
Q
what are examples of rheumatologic etiologies?
A
rheumatoid arthritis
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
16
Q
what are caudal equina symptoms?
A
- saddle anesthesia
- new onset bladder/bowel dysfunction
- severe or rapidly progressive neurological symptoms
17
Q
what are constitutional symptoms?
A
- fever
- chills
- unexplained weight loss
- recent bacterial infection
- IV drug abuse
- immune suppression
- severe nighttime pain
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
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
how do we figure out the problem with back?
- a thorough H&P
| - especially ROS for red flags
26
parts of lumbar spine examination
- 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
physiologic barrier
active ROM
28
anatomic barrier
passive ROM
| -doctor pushes pt to this point
29
pathologic barrier
- less than physiologic
- this is where complaint lies
- physiologic-pathologic=motion lost
30
mechanics of lumbar spine
- follows type I mechanics in neutral
- follows type II mechanics in non-neutral
- lumbar SP and TPs are at the same level!
31
type I mechanics
- TONGO
- predominantly in neutral spine
- SB and rotation occur in opposite directions
32
what maintains type I mechanics?
-long restrictor muscles
33
type II mechanics
- predominantly in F or E of spine
- rotation and SB occur in same direction
- rotation occurs first
34
what maintains type II mechanics?
- intertransversarii
- multifidus
- rotatores
35
if motion is roughly the same in both in F and E...
its neutral dysfcn
| -type I mechanics
36
if motion is more restricted in F or E...
F or E dysfcn
| -type II mechanics
37
lumbosacral mechanics
- sacrum and lumbar spine move in opposite directions
- lumbar F-->sacral E
- lumbar E-->sacral F
38
dermatome referred pain
from irritation of S1 nerve root
39
sclerotomal referred pain
-from irritation of L4-5 facet joint and/or capsule
OR
-sacroiliac joint and/or sacroiliac ligaments
40
myotomal referred pain
-gluteus minimus muscle (posteriorly and anteriorly)
OR
-piriformis in full blown piriformis
41
viscerosomatic reflexes
- 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
Chapman's Reflexes
- 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
anterior points of Chapman's Reflexes
- periumbilical--adrenal, kidney, bladder
- 5th ICS--stomach (left), liver (R)
- 6th ICS--stomach (L), liver/gallbladder (R)
- 7th ICS--spleen (L), pancreas (R)
44
posterior points of Chapman's Reflexes
- kidney
- bladder
- urethra
- uterus
- colon
- pelvic organs
45
management of low back pain
- address the cause
- use OMT to address mechanical causes and help in visceral causes
- medical management
- NSAIDS
- muscle relaxants
- tricyclic antidepressants
- narcotics
- surgery
46
what can healthcare providers do about prescribing narcotics?
- 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
