Lumbar Flashcards
- Axial neck pain, above shoulders, unilateral
- Pain with and/or limited Extension + Rotation
- Tenderness upon palpation
- Local pain radiation into shoulders or upper back
Cervical Facet Syndrome
- Pain and tenderness in low back
- Local stiffness alongside the spine
- Pain, stiffness, difficulty certain movements (sit-stand)
- Pain with extension
- Upper can radiate to flank, hip, thigh
- Lower can radiate deep into thigh and lower leg
Lumbar Facet Syndrome
- Localized buttock pain
- Sharp, stabbing/shooting pain down to post. thigh
(above knee) - Difficulty sitting for too long, lying on same side
- Local tenderness near PSIS
- Pain with forward bending
SI joint dysfunction
- Symptoms vary patient to patient
- Chronic LBP
- Pain radiation into buttock and thighs
- Pain can be uni or bi
- Sitting intolerance (>60)
- No radicular pattern
- Directional preference, (+) valsalvas
Discogenic Pain
Pain:
- LB
- Lateral hips
- Butt
- Anterior groin
Trigger Point
Quadratus Lumborum (Subcostal L1-L4 APR)
- Unilateral leg pain > LBP (dermatomal pattern)
- Pain below knee, into foot or toes
- Numbness + paresthesia (same area)
- SLR (+)
Segmental Radiculopathy
Lumbar myotomes
1
2
3
4
5
S1
1= hip flexion
2 = hip flexion
3 = hip flexion + knee extension
4 = knee extension + ankle dorsiflexion
5 = Hallux extension + ankle plantar flexion
S1 = ankle plantar flexion + eversion
Lumbar Dermatomes
1
2
3
4
5
S1
1 = Inguinal
2 = ant-mid thigh
3 = ant-distal thigh
4 = med lower leg/foot
5 = lat leg/foot
1 = lat side of food
Lumbar reflexes
3
4
5
S1
3 = Patellar
4 = Patellar
5 = Achilles
S1 = Achilles
- Low back pain
- (-) extension (+) flexion
- decreased ROM (Extension)
- Tight hamstrings
- Disturbance of coordination and balance
Spondylolisthesis
- Pain aggravated by prolonged ambulation, standing
- (+) flexion, (-) extension
- Neurogenic claudication (decreased walking capacity)
- Shopping cart sign
- Symptoms bilateral (but usually asymmetrical)
- Walking upstairs (Flex) easier than walking downstairs
Lumbar Spinal Stenosis
- Pain in/around the tailbone (localized)
- Pulling/cutting sensation
- Guarded seated position
- Pain with bowel movemets
- +/- LBP
Coccalgia
Red Flags:
- Acronym?
- Conditions?
- NIFTI + A
- Neuro: Cauda Equina Syndrome
- Infection
- Fracture (Burst, Compression)
- Tumor
-Inflammation
- Bilateral sciatica (with saddle anesthesia)
- Reduced perineal sensation
- Neurogenic bladder + Fecal incontinence
- Loss of anal tone
- Loss of sexual function
- Management?
Cauda Equina Syndrome
Immediate ER referral
(1) Fever, Immunocompromised, Hx of IV drug use, recent GI or GU procedure
(2) >50 y.o, Hx of cancer, Night pain/sweats,
unexplained weight loss
(1) Infection
(2) Tumor
