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MSPT II > The Lumbar Spine > Flashcards

The Lumbar Spine Flashcards

1
Q

Up to ___% of all people experience LBP at some point in their lifetime.

A

80%

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2
Q

List 7 questions to ask a patient experiencing LBP.

A
  1. Has the patient experienced low back pain in the past? If so, was it the same type of LBP that the patient is currently experiencing?
  2. What was the result of intervention for any previous incidences of back pain?
  3. How did the injury occur? Lifting? Insidious onset?
  4. What is the patient’s occupation? Is the patient currently working?
  5. Where is the pain located?
  6. Is the pain constant or intermittent?
  7. Is the patient experiencing sxs of numbness/tingling or problems with bowel/ bladder?
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3
Q

Pain radiating below the ____ is an indication that there could be a disc injury

A

KNEE

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4
Q

Radiating pain that is greater in the buttock and/or leg than in the low back is also an indication of a _____.

A

Disc herniation

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5
Q

List 5 common medical diagnoses that can cause LPB (red flags).

A
  1. Spinal fractures
  2. Spinal infection
  3. Neoplasm
  4. Cauda Equina Syndrome
  5. Ankylosing Spondylitis
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6
Q

List 2 indications that may suggest the presence of a fracture.

A
  1. History of trauma

2. Point tenderness over the area of the fracture

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7
Q

Compression fractures are common in patients with _____ and with a history of ______.

A

Osteoporosis (age >50, Asian/Caucasian, female)

History of steroid use

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8
Q

List 3 risk factors for neoplasms.

A
  1. Hx of cancer
  2. Cancers that metastasize to the spine (breast, lung, prostate)
  3. Age > 50 years
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9
Q

List 5 signs and symptoms of neoplasm.

A
  1. Unexplained weight loss
  2. Constant pain
  3. No relief with bed rest
  4. Night pain
  5. Symptoms do not improve with PT
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10
Q

List 4 characteristics of cauda equina syndrome.

A
  1. MEDICAL EMERGENCY
  2. Saddle anesthesia
  3. Recent onset of bladder dysfunction
  4. Progressive lower extremity symptoms
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11
Q

List 5 characteristics of ankylosing spondylitis.

A
  1. Male gender
  2. Age < 35 years
  3. Night pain
  4. Morning stiffness
  5. Reduction in symptoms with exercise and activity
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12
Q

List 4 risk factors for spinal infection.

A

History of

  1. Recent bacterial infection
  2. Recent spinal surgery
  3. IV drug abuse
  4. Immunosuppression
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13
Q

List 3 characteristics of a spinal infection.

A
  1. Fever
  2. Deep constant pain
  3. Spinal rigidity
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14
Q

List 4 things to observe, in addition to the usual items, in patients with back pain.

A
  1. Posture
  2. Gait
  3. Willingness to move (transfer out of chair)
  4. Inconsistent movement patterns
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15
Q

List 3 things to palpate when examining patients with low back pain.

A
  1. Soft tissue integrity
  2. Bony landmarks in lumbar spine and SI joint
  3. Bony landmarks in the pelvis and LE for leg length discrepancy
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16
Q

Tightness in what 7 muscle groups can contribute to back problems?

A
  1. Gastrocsoleus
  2. Quadriceps
  3. Hamstrings
  4. Hip flexors
  5. Glut maximus
  6. Hip adductors
  7. Hip rotators
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17
Q

Most of the motion in the lumbar spine in to forward bending occurs at ____ and _____, and only a small amount of ____ occurs in the lumbar spine.

A

L4-L5 and L5-S1

Small amount of ROTATION at the lumbar spine

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18
Q

How is range of motion into forward bending measured at the lumbar spine? Normal values?

A
  1. With the patient in a neutral position, put one end of the tape measure on T12, and stretch the tape measure down the lumbar spine to S1.
  2. Instruct the patient to bend forward as far as possible before pain.
  3. Normal: 5cm difference
  4. Abnormal: Less than 3cm
19
Q

Strength of the ____, ____ and _____ should be assessed in patients with back pain.

A

Abdominals
Back extensors
LE muscles

20
Q

______ testing is not performed in the lumbar spine because it is difficult to eliminate motion in joints.

A

Resistive Isometric Testing

21
Q

L5 nerve root is usually affected by the ____, and the S1 nerve root is usually affected by the ____ disc.

A

L5 nerve root = L4/5 disc

S1 nerve root = L5/S1 disc

22
Q

Spondylosis is _____ at the lumbar spine, and it includes _____ disease and _____.

A

Osteoarthritis
Degenerative disc disease
Stenosis

23
Q

What is the prevalence, etiology, and prognosis of lumbar radiculopathy? What segments are more most commonly effected?

A
  1. Prevalence: ~5% of all patients with low back pain
  2. Etiology: more common among patients aged < 55
  3. Prognosis favorable, recovery could take longer than simple nonspecific LBP
  4. Most common at L4/L5 and L5/S1
24
Q

List 5 signs and symptoms of lumbar radiculopathy.

A
  1. Pain radiating below the knee
  2. Pain that is worse in the buttocks and/or leg than in the low back
  3. Pain that is worse with sitting than most other positions (causes posterior migration of disk)
  4. Nerve root signs (sensory deficits, motor deficits, deep tendon reflex changes) that are consistent with one nerve root level
  5. Positive SLR, with pain limiting range to no more than approximately 40 degrees of hip flexion
25
Q

List 3 interventions used to treat lumbar radiculopathy.

A
  1. Extension exercises
  2. Activity regulation
  3. Maintaining a lordosis with ADLs
26
Q

What is the difference between spondylosis and spondylolisthesis?

A
  1. Spondylosis: presence of a fracture in the pars intraarticularis.
  2. Spondylolisthesis: presence of a vertebra that has slipped forward due to the presence of bilateral fractures in the pars intraarticularis.
27
Q

List 2 possible causes of spondylosis and spondylolisthesis.

A
  1. Failure of the neural arch (surrounding the spinal cord) at the pars intraarticularis to unite during growth (more common)
  2. Fracture of the pars intraarticularis.
28
Q

What are 2 onsets of pain for spondylosis and spondylolisthesis?

A
  1. Sudden quick movement into extension

2. Repetitive movements into extension

29
Q

What kinds of pain should be monitored for in patients with spondylosis and spondylolisthesis? (2)

A
  1. Pain with positions/ activities that entail extension (increases tendency for vertebra to slip anteriorly)
  2. Pain is better with positions that entail flexion
30
Q

The presence of a _____ on X-ray is a sign of the presence of a fracture

A

‘Scotty dog collar’

31
Q

List the 4 grades of slippage as determined by an xray for spondylosis and spondylolisthesis.

A
  1. Grade I if up to 1/4 of the vertebral body has slipped forward in relation to the vertebral body below
  2. Grade II if up to 1/2 of the vertebral body has slipped forward in relation to the vertebral body below
  3. Grade III if up to 3/4 of the vertebral body has slipped forward in relation to the vertebral body below
  4. Grade IV if more than 3/4 of the vertebral body has slipped forward in relation to the vertebral body below
32
Q

How is spondylosis/OA of the spine diagnosed?

A

via X-ray and MRI

33
Q

___ exercises and ___ mobilization have been shown to reduce symptoms in patients with spondylosis/OA.

A

Stabilization exercises

Hip Mobilizations

34
Q

What is the cause of spinal stenosis?

A

Bony encroachment into the spinal canal (central stenosis) and/or intervertebral foramen (lateral stenosis) secondary to degenerative changes

35
Q

Stenosis is characterized by a pain pattern in which symptoms increase with ___ and decrease with ____.

A

Increases with extension

Decreases with flexion

36
Q

List 2 symptoms that stenosis can cause.

A
  1. Sxs attributable to a nerve root compression

2. Neurogenic claudication sxs (nerve root ischemia causing poorly localized leg pain, parasthesia and cramping)

37
Q

Stenosis pain can be described as resembling ____ pain, and often increases with ____.

A

Ischemic pain

Walking

38
Q

How can one distinguish between spinal stenosis and LE claudication? (3)

A
  1. Place patient on stationary bike
  2. If sxs increase with biking- intermittenet claudication
  3. If sxs remain the same = stenosis
39
Q

What are 5 diagnosis criteria for spinal stenosis?

A

4/5 must be positive:

  1. Bilateral symptoms
  2. Leg pain greater than back pain
  3. Pain during walking/standing
  4. Pain relief when sitting
  5. Age > 48 years
40
Q

What is ankylosing spondylitis? (3)

A
  1. Rheumatic, sero-negative condition
  2. Characterized by ossification of spinal ligaments and joint capsules
  3. Spinal mobility gradually decreases over time
41
Q

Patients with signs of _____ and _____ or a positive _____are likely to benefit from lumbar traction.

A
  1. Nerve root compression
  2. Peripheralization of sxs
  3. Positive crossed leg raise test
42
Q

List 4 advantages of using lumbar bracing.

A
  1. Controls lordotic positioning
  2. Reminds patient to maintain lordosis
  3. Reduces stress on spine by increase intra-abdominal pressure
  4. Reduces stress on the spine by decreasing lever arm created by abdomen to bring abdominal contents towards the spine
43
Q

List 3 disadvantages of using lumbar bracing.

A
  1. Atrophy of trunk muscles
  2. Skin breakdown
  3. Cosmetic issues

MSPT II (13 decks)

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