Thoracolumbar

Question 1

Straight Leg Raise Test

Answer 1

Pt supine flex with straight keg at the hip joint. Add dorsiflexion to increase dural tension
+ Test: Radicular pain radiating into leg, especially b/w 30-60 degrees.
Indicates: Lumbosacral Radiculopathy or Sciatic Neuropathy
This test has limited accuracy (but high sensitivity!)

Question 2

Straight Leg Raise Atypical Findings

Answer 2

Positive pain at or above 70degrees indicated muscle strain or joint disease
Pain at less that 15degrees that is most prominent laterally could indicate IT band issues

Question 3

Lumbar Radiculopathy Signs and Symptoms

Answer 3

Positive Straight Leg Raise at 30-60 degrees with muscle weakness and dermatomal sensory loss
Usually due to a herniated disc (95% of herniated discs occur at L5-S1)

Question 4

Signs and Symptoms of Sciatic Neuropathy

Answer 4

Pain in lower back shooting down one leg with positive Straight Leg Raise between 30-60 degrees with muscle wasting and weak dorsiflexion
The presence of the last 2 symptoms make a diagnosis of sciatica 5x more likely

Question 5

Contralateral Straight Leg Raise

Answer 5

Straight leg raise test on the contralateral leg (leg without symptoms)
+ Test: presence or worsening of radicular pain in the resting leg (affected leg) especially b/w 30-60 degrees.
Indicates: Lumbosacral Radiculopathy and/or Sciatic Neuropathy
Used to increase specificity of usual Straight Leg Test

Question 6

Forward Bending Test

Answer 6

Have the patient stand straight and bend forward at the hips, allowing the back to curve forward
+ Test: Asymmetry in scapular heights when looking at the patient from behind. (One scapula or side of the back is higher than the other) A scoliometer may be used if the asymmetry appears subtle or to assess the most affected region.
Indicates: Scoliosis

Question 7

Scoliosis

Answer 7

Scoliosis is a congenital defect that usually has an early onset in adolescence (age 10ish) and is characterized by a curve of the spine in the coronal plane.
Most common form is Adolescent Idiopathic Scoliosis

Question 8

Cobb Angle

Answer 8

The Cobb Angle is the angle of curvature if the spine in a coronal plane .
Anything over 10 degrees of Cobb curvature is deemed outside of normal limits and diagnosed as a scoliosis

Question 9

Scoliosis Screening

Answer 9

Scrren for scoliosis with a Forward Bending Test and general examination of symmetry of landmarks.
Unequal shoulders, unequal arm lengths, and asymmetry of hips can all be indicators of potential scoliosis

Question 10

Scoliosis Treatments

Answer 10

~For angles under 30 degrees, especially with younger patients, bracing is usually used 1- Underarm Brace (Boston Brace) 2- Under-chin-extention (Milwalkee Brace)
~For angles from 30-49- surgical intervention is used with spinal fusion, instrumentation, and bone grafting.
~Angles greater that 49 are above surgical threshold and only have a treatment success rate of about 50%

Question 11

Spondylolysis

Answer 11

Stress fx in the pars interarticularis of the vertebral arch. The vast majority occur in the lower lumbar vertebrae
Decapitated Dog appearance on X-ray

Question 12

Spondylolisthesis

Answer 12

Dislocation of the vertebral body anteriorly or posteriorly over another (felt as a ‘step-off’ during physical examination). The can be due to traumatic, degenerative, isthmic, or pathologic issues.

Question 13

Spondylitis

Answer 13

Inflammation of the spinal joints`

Question 14

Spondylosis

Answer 14

Painful degeneration of the intervertebral discs secondary to osteoarthritis (age-related wear)

Question 15

Cauda Equina Syndrome

Answer 15

Spinal nerve root compression in the Cauda Equina as a result of either massive disc protrusion, trauma, or tumor that all result in loss of bladder/bowel function
Clinical Features: Incontinence, lower back pain, Saddle Anesthesia, Bilateral Sciatica and weakness
The is an EMERGENT issue and requires immediate MRI and surgical decompression

Question 16

Spina Bifida

Answer 16

Congenital Malformation (failure of laminae fusion in vertebrae) leading to neural tube defects in the lumbar spine
Spinal Bifida Occulta- asymptomatic, small split in the vertebrae, usually has some tuft of hair or discoloration associated over the defect 
Meningocele- Meninges bulge out of the defect, no neurologic damage
Myelomeningocele- parts of the spinal cord protrude with the meninges, imply very severe neurologic deficits