Thoracolumbar Complaint Flashcards
Scoliosis
most often idiopathic-mostly in adolescent girls
curvature of the spine in the CORONAL PLANE
Compensatory scoliosis
occurs w/ torticollis, thoracoplasty, congenital dislocation of hip & shortened lower limb
Structural scoliosis
congenital deformities & paralysis of back or ab muscles
Minor functional scoliosis
forms a single lateral curve (convexity to right)
Epidemiology of scoliosis
if Cobb angle >10=3%
males & females equally affected
risk of curve progression is 10x higher for females
Adult Scoliosis
develop “de novo” degenerative scoliosis
can be progression from earlier onset scoliosis
secondary to another condition
Adult spinal deformity
encompasses scoliosis, kyphosis, lordosis, & spondylolisthesis (all lead to imbalance of structural support of spinal column)
Screening during PE
Differences in height of shoulders or scapulae
Asymmetry of waistline
Asymmetry in distance that arms hang from trunk
Head shifted to 1 side & not centered over sacrum
Forward Bending test
looking for scoliosis…observe posteriorly for accentuation or improvement of spinal curve (functional curves will improve w/ side bending)
What is the scoliometer?
run it along the pt spine when pt is forward bending
look if side of scoliometer deviates to R or L
Treatment for scoliosis
consider risk of progression & symptoms
bracing (depends on Cobb angle, deformity, risk of progression)
surgery
Surgery for scoliosis
if Cobb angle>50
posterior spinal fusion & instrumentation & bone grafting
anterior spinal fusion & instrumentation
combo of anterior & posterior
growth modulation techniques
CC for acute lower back pain
if duration<6 weeks then is acute
if duration>6 weeks then subacute LBP
What is a red flag with lower back pain?
findings assoc w/ cauda equina syndrome (surgical emergency)
progressive motor or sensory deficit, saddle anesthesia, bilateral sciatica, fecal incontinence, nerve root problems
What are some other important considerations for lower back pain?
red flag finding when <20yo
pain that is unrelenting @ night or unrelated to activity
widespread neuro symptoms
unexplained weight loss
feeling unwell/fever or chills
trauma or penetrating wound near spine
structural spinal deformity
previous history of illness
To diagnose fracture in spine…
Age, drug use, trauma
age>50 years has sensitivity of 84% & specificity 61%
corticosteroid use has sensitivity 6% & specificity 99.5%
trauma has sensitivity 30% & specificity 85%
To diagnose herniated disk
sciatica has sensitivity 95% & specificity 88%
To diagnose spinal stenosis
pseudoclaudiation has sensitivity 60% (painful cramps NOT caused by peripheral artery disease but by SPINAL or neuro or orthopedic disorders)
To diagnose ankylosing spondylitis
age @ onset <40 yo (100% sensitivity, specificity 7%)
pain not relived supine (80%, 49%)
morning back stiffness (64%, 59%)
pain duration >3 months (71%, 54%)
4 of 5 positive responses (23%, 82%)
Sciatica
refers to pain or discomfort associated w/ the sciatic nerve (sharp or burning pain that radiates from lower back or hip)
Nerve involvement in back pain
suggested w/ sciatica or pseudoclaudication (pain radiating BELOW KNEE, history of numbness or weakness)
What should you prioritize for DDX for lower back pain?
acute or chronic functional LBP
muscular strain (acute v chronic)
OA
Sciatica
Herniated disk
Spinal stenosis
Pseudoclaudication
lumbar spinal stenosis (causes impingement or inflammation of nerves leaving spinal cord)
