wk 1 & 2 quiz diagnosis and LBP Flashcards
__: decision regarding the pt complaint; the act of identifying a dx or a condition from s/s
diagnosis
____: a test that detects a symptom or sign
positive findings
_____: condition/ diagnosis given the signs and symptoms
indications
___: presence of specific S/S suggesting with almost certainty that the target condition is present
pathongnomic
_____: ability of a test to identify those WITH the dx (true pos. rate)
test sensitivity
___: ability of a test to identify those w/o the dx (true neg. rate)
test specificity
____: the use of current best evidence in making decisions about the care of a pt.
evidence based medicine
____: a list of cc that are possible given a particular set of s/s/ clinical finings
differential diagnosis
___:” A working hypothesis” formulated from significant items in hx, and physical findings, a tentative dx; or a working dx
clinical Impression
_____: any s/s that may suggest the presence of a serious health cc that may be life threatening or disabling
red flag
most LBP is ___ and recovers in ___wks
uncomplicated and recovers in 6 wks
2012 Prospective study: there was ___ of surgery for thoe who went to a chiro first
reduced odds
Which etiology caused LBP the most
disc disruption (39%)
5% of those are herniations
Which pop under goes spinal stenosis the most
older pop –> degeneration process
origin of LBP is often assumed to be ____, but it might not be mechanical LBP. It might be from ____ factors
thought to be: degenerative conditions
but might be: biochemical and inflam factors
in nonmechanical LBP a study was conducted that concluded 37% of disc herniations where caused by ___
bacteria (p.acnes)
bact. may be the cause of __% of chronic LBP
40%
Central portion of the disc is called: ___
derived from the cells of ___
called: nucleus pulposus
from: primitive notocord
outer portion of the disc is called ___
caled: annulus fibrosis
What are the two parts of the annulus fibrosis connected to :
inner fibers: cartilagenous endplate
outer Sharpy fibers: attached to the VB
What are shapy fibers?
the outer portion of the annulus fibrosis that are attached to the VB
What two lig.s strengthen the disc space
ALL (stronger- resist extension)
PLL (resist flexion)
Which is stronger? ALL vs. PLL
- what do they attach to?
ALL - resist extension
attach to: annulus fibrosis
Herniation occurs when the ___ moves through the torn ___
nucleus pulposus moves through the annular disc
___: any dx that affects the spinal N roots
radiculopathy
What is the first change of an aging disc
in the nucleus–> from soft gel to fibrous lumps
the strength of a disc is contributed to:
fluid and proteoglycans in the disc
____: gradual deformation of the disc when under constant load
creep
a primary cause of disc degeneration is :
failure of the nutrient supply to the disc cells
(5) factors that can affect blood supply to the VB
o Atherosclerosis o Long term exercise or lack of it o Mechanical stress/ injury o Major risk factors: heavy physical work, lifting, truck driving, obesity and smoking o Genetic
3 phases of progressive degenerative changes in the annulus nuclear complex:
- dysfunction: tears
- instability: internal disruption
- restabilization: osteophytes and traction spurs = stenosis
____ tears: from shear stress from loading in bending and torsion
circumferential tears
__:avulsion of annulus w/ sclerosis and osteophytosis of the bone
rim lesion
the annulus is attached to the VB, so it takes the bone with it
___disruption: inward buckling
internal disc disruption
____fissures: starting in inner annulus
radial fissures
_: displaced nuclear mat. Causing the outer annulus to bulge
annular protrusion
__:nuclear mat. Escapes from disc
nuclear extrusion
____: Nucleus protrudes through inner but not outer layer of annulus
contained disc
___: nuclear mat. Penetrates through annulus
non-contained disc
_____: mild displacement of the annular fibers, PLL is intact
bulge
___: fibers of the annulus are thinned with some tearing , PLL intact
protrusion
_____: rupture of the annular fibers → nuclear mat. Emerges through the annulus , NP remains confined by the PLL
Extrusion
Pt with severe Back pain and sciatica are 3x more likely to have this
o Pt with severe Back pain and sciatica are 3x more likely to have :____
disc extrusion
_____: PLL is disrupted and the nucleus protrudes into the epidural space → disc tiss is expelled from disc and no longer attached
sequestration
98% of lesions are to __ or ___ in the back
L4-L5 or L5-S1
If a lesion is present in the L5-S1 what are three probable signs
Pain in S1 area : sciatic
patho. achilles DTR
(s) deficit in S1 dermatome
If a lesion is present in the L4-L5 what are three probable signs
weak ext. hallicus weakness
pain in post/lat thigh and calf
(s) deficit of L5 dermatome
During a bulging disc there will be an increase during ___ motion and ___ is absent
pain incr with flexion
No Dejerine’s triad
What is dejerine’s triad
pain during: cough, sneeze, or bowel movement
name 5 test for Lower Lumbar Radiculopathy/ Sciatica (L4-S3)
- SLR
- Bowstring
- Bragard’s
- Lasegue’s
- Sicard’s
name 2 test for Lower Lumbar radiculopathy/ femoral N: (L2-L4)
- Femoral N traction test
* Nachlas Test
(2) imaging techniques used to diagnosis disc degeneration
MRI and CT
___ testing is used to test for Decr motor and sensory potentials in extrusion and sequestration
electrodiagnostic testing
What management technique is used when patient has primary leg pain or pain that is too severe for less invasive management
epidural steroid injections
