Thoracolumbar Spine IV- Acute IDDs Flashcards
______ IDD is less common than persistent IDD
Acute
Acute IDD is rare in the ______ region
thoracic
With acute IDD it is MOST common in the _______ region
lumbar
Only ___-___% of IDDs are symptomatic
1; 3
Persistent IDD is the source of pain in < ___% of LBP
5
Acute IDD is MOSTLY involved with ___-____ year olds
30; 50
95% of acute IDD’s occur at ___-_____ region
L4; S1
With acute IDD, the _______ portion of the disc is the MOST common area
posterolateral
The posterolateral portion of an acute IDD is ______, thinner, and with MORE _______ and LESS ______ annular fibers
weaker
vertical
oblique
The posterolateral portion of the an acute IDD is just lateral to the _____ ______ ligament
posterior longitudinal
`What is the main etiology for acute IDD?
trauma
With acute IDD there is ______ compression
axial
With acute IDD, forward bending or stooping without or with twisting/lifting leads to…
LESS _________ disc compression
Unevenly distributed ______ tension
Increased and asymmetrical stress on weaker and thinner __________ annular and end plate fibers
Less fixated _____ _____
circumferential
annular
posterolateral
end plates
With acute IDD, forward bending or stooping without or with twisting/lifting leads to…
MORE ______ _______ shearing force due to the above plus pull of gravity, except less at ____, _____
anterior segmental
L5, S1
With acute IDDs
It is MORE commonly OUTER ______ ______ and ______ ______ avulsion
LESS commonly INNER ______ ______ and ______ ________ herniation
annular tearing; end plate
annular tearing; nucleus pulposus
With acute IDD, the disc structures are ____________ once damaged and a large _______ immune inflammatory response occurs
immunoreactive; AUTO
With an acute IDD, a Large AUTO immune inflammatory response occurs:
There is excessive _______ pressure OR increased ______ fluid pressure in and around disc and spinal n.
osmotic; static
With an acute IDD, a Large AUTO immune inflammatory response occurs:
Static fluid consists of increased _______ chemicals that sensitizes n. and structures to ______/_______
inflammatory
pressure; tension
With an acute IDD, a large AUTO immune inflammatory response occurs:
__________/________ S&S could occur
NO ________ vv. in PNS or CNS; results in poor drainage on its own
there is an ________ inflammatory phase
radiculpathy/radicular
lymphatic
EXTENDED
With acute IDD, the typical postlat IDD symptoms:
____/_____ spinal pain
*The annulus is highly _____ so very P!ful
There is significantly MORE swelling than cervical disc due to higher number of ______
dull; achy
innervated
GAGs
With acute IDD, the typical postlat IDD symptoms:
Radiculopathy has possible ________ paresthesia’s within 24 hrs. into the _______ extremity
segmental; distal
A possible worse situation with acute IDD:
Presence of _______
Presence of coldness indicating greater _________ compromise
radiculopathy; circulatory
With acute IDD, there is reffered pain into the _______ and _______
glutes; groin
A patient with acute IDD will have _________ pain with lying and standing/walking
A. decreased
B. increased
A.
A patient with acute IDD will have _________ LBP and paresthesia’s with FB/sitting/lifting; also coughing and sneezing
A. decreased
B. increased
B.
With acute IDD, the 24 hr. behavior- ______ pain in the AM due to the pooling of _______ from sleeping in a static position
increased; swelling
With acute IDD, you may observe that your patient has a lateral shift of _______ on ________
They typically ___ away from the P!
Counter contralateral _____ to level eyes
shoulders; pelvis
SB
SB
With acute IDD and observation you rarely see a smaller _____ girth
Wasting likely at 4-6 weeks and indicative of severe _____ ______
( MORE of a sign for persistent _________)
calf; spinal n. compression
radiculopathy
The Scan findings for Acute IDD:
ROM all may increase pain
_____ and possibly _____ away from injured area of disc is likely MOST limited and increases ______ and _______
A. ROT; FLX; extremity; LBP
B. EXT; FLX; extremity; LBP
C. FLX; SB; extremity; LBP
C.
Flx and possibly SB away from injured area of disc likely MOST limited and ↑s extremity and LBP due to…
Swelling
being pushed toward ______
There is tension on torn ______, _______, and ______
spinal n.
annulus; endplate; dura
The Scan findings for Acute IDD:
______ and _______ toward injured area of disc possibly less limited
May ↑ LBP due to increased _______ pressure on end plate fx and high ________ pressure of disc
A. ROT; EXT; hydrostatic; osmotic
B. EXT; SB; hydrostatic; osmotic
B.
The Scan findings for Acute IDD:
Ext and possibly SB toward injured area of disc possibly LESS limited and it may….
________ extremity P! especially with repetition by squeezing _______ away from the spinal n.
Centralize; swelling
With acute IDD, which motion is NOT consistent with affecting symptoms?
ROT
___________ is the abolition of distal and/or spinal P! in a distal to proximal direction in response to repetitive motion(s) or sustained position
Centralization
With acute IDD, the typical postlat IDD signs:
Resistance and MMT- _______
Possible + stress tests with ________/_______/________/_______
Neuro tests possibly + depending on severity and timing
- diminished _______
- DTR- __________
- ________ FATIGUE
- + ________ mobility tests
variable
compression; distraction; PA pressures; torsion
dermatomes
hyporeflexive
Myotomal
neurodynamic
Rare central and posterior IDD S&S
Cord or _____ _____ S&S
Typically ___-____ level
_________ and emergency referral
cauda equina
L1; L2
Immobilization
_________ ______ and ______ developed by Robin McKenzie, PT
is based on the belief that MOST spinal pain comes from injuries to the disc which is not supported in the research
Classification system depending primarily on symptoms:
- _______ of symptoms
- ________ that decrease symptoms
Mechanical Diagnosis; Therapy
Location; Positions
The McKenzie method (Mechanical Diagnosis and Therapy) determines a __________ ________
directional preference
The McKenzie method (Mechanical Diagnosis and Therapy) may be associated with _________, decreasing severity, and improving ________
You should match up with _____ and ______ positions
centralization; function
exercise; ADL
The MOST common directional preference with the McKenzie method is ______/________
EXT/Hyperext
3 classification syndromes with Mechanical Diagnosis and Therapy:
_______- focuses on correcting poor posture
_______- focus on stretches to improve end range motion
_______- focus on using end range motion to improve the theoretical nucleus deformation in disc herniations
Postural
Dysfunction
Derangement
Mechanical Diagnosis and Therapy
- Dynamic disc theory
- ________ NOT migration in a normal disc
Deformation
Remember this!
The dynamic disc theory is ONLY predictable in ________ lumbar spines when the annulus is intact and with normal hydration
A.symptomatic
B. asymptomatic
B.
The dynamic disc theory is limited and has a contradictory finding in the symptomatic disc AND _____-_____ ____ disease with annular changes
Age-related disc
With Mechanical Diagnosis and Therapy:
there could be increasing hydrostatic pressure through repetitive motions; MOST often_______
Extension
PT Rx with Mechanical Diagnosis and Therapy is NOT _____ to other treatments for acute LBP/disability
superior
Acute IDD PT Rx:
MET- focuses on tissue _____ and _____ with local muscles
________ walking
proliferation; stabilization
unweighted
How should we squat and pick up items to minimize excessive stresses and maximize stability for the disc?
Equalize ______ body and _____ pressure
MORE circumferential disc ________ and evenly distributed annular _______ with greater ______ flexion and ______ pelvic tilt
LESS anterior segmental _______ with less _______
vertebral; disc
compression; tension; lumbar; posterior
shearing; stooping
Prognosis for acute IDD:
_____% start improve by ____ weeks resolve by _____ weeks
_____ will NOT require sx
It is a _______ process but the same overall outcomes without sx
90
6
12
MOST
slower
