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Ortho-Rheum > Low Back Pains, Sprains, & Strains > Flashcards

Low Back Pains, Sprains, & Strains Flashcards

1
Q

where does the spinal cord terminate?

A

T12-L2

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2
Q

why is radiating pain concerning?

A

could indicate spinal cord/nerve root compression

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3
Q

what does localized pain indicate? (4)

A

muscular strain
ligamentous sprain
facet joint injury
fracture

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4
Q

pain that persists despite changes in spine position indicates what?

A

inflammation

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5
Q

pain that varies depending on spine position and can be relieved/exacerbated indicates what kind of injury?

A

mechanical injury

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6
Q

where should the pelvic iliac crest lie?

A

L4-L5 interspace

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7
Q

what 3 muscle testing occurs in the neuro levels of L1, L2, and L3?

A

iliopsoas
quadriceps
hip adductor group

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8
Q

main flexor of the hip; place hand over distal femur while patient raises thigh against resistance

A

iliopsoas

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9
Q

muscle associated with the femoral nerve; patient extends knee/leg against resistance

A

quadriceps

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10
Q

muscle associated with obturator nerve; patient adducts legs against resistance

A

hip adductor group

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11
Q

dermatomes that cover the anterior thigh between the inguinal ligament and knee joint

A

L1, L2, L3

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12
Q

what reflex testing is done for neuro level L4?

A

patellar tendon reflex

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13
Q

which muscle testing occurs in the neuro level of L4?

A

tibialis anterior

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14
Q

what 2 nerves are associated with the tibialis anterior muscle in the L4?

A

deep peroneal (fibular) nerve
tibial nerve

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15
Q

when we place resistance against patient’s dorsiflexion and inversion, what muscle are we testing?

A

tibialis anterior

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16
Q

dermatome that covers the medial side of the lower leg

A

L4

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17
Q

which muscle testing occurs in the neuro level of L5?

A

extensor hallucis longus

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18
Q

what nerve is associated with the extensor hallucis longus?

A

deep peroneal (fibular) nerve

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19
Q

dermatome that covers the dorsum of the foot

A

L5

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20
Q

what reflex test is done for neuro level S1?

A

achilles tendon reflex

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21
Q

what 2 muscle testing occurs in the neuro level of S1?

A

peroneus (fibularis) longus + brevis
grastroc-soleus

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22
Q

what nerve is associated with peroneus longus and brevis?

A

superficial peroneal (fibular) nerve

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23
Q

what nerve is associated with gastroc-soleus?

A

tibial nerve

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24
Q

what 2 ROM test is for peroneus (fibularis) longus and brevis?

A

plantarflexion and eversion of foot

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25
Q

what ROM test is for gastroc-soleus?

A

plantarflexion of foot

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26
Q

dermatome that covers the lateral malleolus, and the lateral and plantar surface of the foot

A

S1

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27
Q

what reflex testing is for neuro levels S3 and S4?

A

superficial anal reflex

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28
Q

2 dermatomes that are around the anus

A

S3 and S4

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29
Q

muscle reflex grading associated with 0 muscle strength (no muscle contraction)

A

absent (0)

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30
Q

muscle reflex grading associated with muscle contraction but unable to produce joint motion

A

diminished reflexes (1)

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31
Q

muscle reflex grading associated with 2 muscle strength (muscle contraction with full ROM of joint without force of gravity)

A

normal (2)

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32
Q

muscle reflex grading associated with 3 muscle strength (full ROM against gravity but without resistance)

A

hyperactive without clonus (3)

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33
Q

muscle reflex grading associated with moderate resistance and full resistance

A

hyperactive with clonus (4)

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34
Q

what does an abnormal babinski test indicate?

A

upper motor neuron lesion

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35
Q

what does an positive clonus test indicate?

A

CNS disease

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36
Q

test used to assess sciatic nerve compromise d/t lumbosacral nerve root irritation

A

Lasegue test (straight leg raise test)

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37
Q

during a straight leg raise test (lasegue test), a patient has pain on their posterior thigh. where is the problem?

A

hamstring

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38
Q

during a straight leg raise test (lasegue test), a patient has pain all the way down their leg. where is the problem?

A

sciatic

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39
Q

patient experiences pain along their lower limb in the same distribution of the lower radicular nerve roots (L5 or S1) at an angle of <45 degrees. what test was this?

A

straight leg raise test (lasegue test)

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40
Q

what is the most common cause of a positive straight leg raise test (lasegue test)?

A

lumbar disc herniation

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41
Q

after performing a straight leg raise test (lasegue test), the provider lowers the leg 5-10 degrees and dorsiflexes the foot to reproduce the same pain. what test is this?

A

bragard sign

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42
Q

what should we think about when a patient presents with midline back pain? (3)

A

musculoligamentous injury
disc herniation
vertebral fracture

43
Q

what should we think about when a patient presents with back pain that is off midline? (3)

A

sacroiliitis
trochanteric bursitis
hip arthritis

44
Q

occurs from lifting, bending twisting
can radiate to buttocks but NOT legs
restricted ROM
inability to maintain posture d/t pain
muscle spasms with activity or rest
persists for max 10-14 days

A

sprain/strain

45
Q

a patient presents with paraspinal muscle tenderness, pain with back movement, and loss of normal lumbar curvature. what is their most likely Dx?

A

lumbar sprain/strain

46
Q

what should NOT be present in a lumbar sprain or strain? (2)

A

motor/sensory loss
reflex abnormalities

47
Q

what is the first line imaging for lower back pain, but is not necessary if the exam is normal?

A

plain film xray

48
Q

what should be ordered when we are concerned for nerve pathology, infection or a mass with low back pain?

A

MRI

49
Q

what is the treatment for acute, mechanical low back pain? (3)

A

NSAIDs
rest
physical therapy

+/- PO steroids
+/- IM steroid injection

50
Q

what does an increased lordotic curve the cervical spine indicate? (2)

A

poor posture
muscular weakness/imbalance

51
Q

what does a decreased lordotic curve the cervical spine indicate? (2)

A

muscular spasm/guarding
nerve root impingement

52
Q

what does tenderness to C7 indicate?

A

stretched nucal ligament d/t neck flexion injury (whiplash)

53
Q

where does flexion and extension of the neck occur?

A

occiput and C1

54
Q

where does rotation of the neck occur?

A

C1 and C2

55
Q

where do cervical nerves 1-7 exit?

A

above the cervical vertebra

56
Q

where does cervical nerve 8 exit?

A

below C7 and above T1

57
Q

what are the 5 peripheral nerves of the brachial plexus?

A

musculocutaneous nerve (forearm)
axillary nerve
radial nerve (dorsum of hand)
median nerve
ulnar nerve

58
Q

what 2 muscles are associated with neuro level C5? and what nerve are they associated with?

A

deltoid - axillary n
biceps - musculocutaneous n

59
Q

what reflex can be performed at the neuro level of C5?

A

biceps reflex

60
Q

dermatome that covers the lateral side of the arm

A

C5

61
Q

what nerve does sensory testing of the C5 neuro level test?

A

axillary nerve

62
Q

what 2 muscles are associated with neuro level C6? and what nerve are they associated with?

A

wrist extension - radial n
biceps - musculocutaneous n

63
Q

what reflex test can be performed at the C6 neuro level?

A

brachioradialis reflex

64
Q

what nerve does sensory testing of the C6 neuro level test?

A

musculocutaneous n

65
Q

dermatome that convers the lateral forearm, thumb and index finger

A

C6

66
Q

what 3 muscles are associated with neuro level C7? and what nerve are they associated with?

A

triceps - radial n
wrist flexion - median/ulnar n
finger extension - radial n

67
Q

what reflex test can be performed at the C7 neuro level?

A

triceps reflex

68
Q

dermatome that covers the middle finger

A

C7

69
Q

what 2 muscles are associated with neuro level C8? and what nerve are they associated with?

A

finger flexors - median/ulnar n
interossei muscle - median/ulnar n

70
Q

dermatome that covers the little finger, ring finger, and medial forearm

A

C8

71
Q

what is a cervical sprain/strain commonly called?

A

whiplash

72
Q

a patient presents with neck pain, stiff neck, headache, dizziness, and pain in the shoulder/between shoulder blades. Dx?

A

cervical sprain/strain

73
Q

what is the treatment for a cervical sprain/strain? (2)

A

NSAIDs
physical therapy

+/- muscle relaxants

74
Q

what imaging should be done for a cervical sprain/strain?

A

xrays

75
Q

what are the 2 most common causes of cervical trauma?

A

MVA
fall from height

76
Q

what should be done with a patient with cervical trauma? (6)

A

assess ACBD
avoid head tilt-chin lift
cervical collar
eval LOC
neuro exam
rectal exam

77
Q

what should be done for a patient who presents with cervical trauma from MVC, fall, assault, or sports injury?

A

immobilize with C collar

78
Q

what imaging should be done for cervical trauma?

A

xray

79
Q

what imaging should be done for cervical trauma if we are concerned about a neuro deficit?

A

CT/MRI

80
Q

cervical nerve root compression leads to what?

A

cervical radiculopathy

81
Q

a patient presents with neck pain, sharp burning or tingling pain down one or both arms. Dx?

A

cervical radiculopathy

82
Q

what commonly causes cervical radiculopathy? (2)

A

arthritis
herniated cervical disc

83
Q

patient lies supine, clinician stabilizes head at chin and occiput, passive traction force straight up off cervical spine relieves symptoms

A

distraction test

84
Q

patient lies supine, clinician applies axial traction on top of patient’s head and increases the pain

A

axial cervical compression test

85
Q

extension of neck, rotating of head with axial downward pressure with increased pressure on side that is rotated

A

spurling’s test

86
Q

what is the first line imaging for cervical radiculopathy?

A

xrays

87
Q

what tests nerve root function and is helpful if symptoms are believed to be from peripheral nerve compression?

A

EMG/NCV

88
Q

what is the main goal in cervical radiculopathy?

A

determine root cause and refer

89
Q

cervical cord compression

A

cervical myelopathy

90
Q

a patient presents with neck pain with bilateral weakness and paresthesias in both upper and lower extremities. Dx?

A

cervical myelopathy

91
Q

what is the most common cause of cervical myelopathy?

A

large disc herniation

92
Q

neck flexion that causes worsened symptoms

A

Lhermitte’s sign

93
Q

flicking the nail of the middle finger causes reflexes in the index finger and thumb; used for cervical myelopathy

A

hoffman’s test

94
Q

series of quick alternating movements of flexion and extension of the wrist; used for cervical myelopathy

A

wrist clonus

95
Q

what is needed if there is a positive hoffman’s sign or wrist clonus?

A

MRI

96
Q

compression of the subclavian artery / brachial plexus between the clavicle and 1st rib or tightened anterior and middle scalene muscles

A

thoracic outlet syndrome

97
Q

a patient presents with muscle fatigue, ischemic pain, discoloration, parasthesias, weakness, and muscle wasting. Dx?

A

thoracic outlet syndrome

98
Q

patient seated, arms at sides, radial pulse palpated; have patient rotate their head to side being tested and extend the neck; abduct and externally rotate the arm and have pt take deep breath and hold - a positive test results in diminished radial pulse, numbness, and tingling. what test is this and what is it used for?

A

adson’s test
thoracic outlet syndrome

99
Q

what should all patients with thoracic outlet syndrome receive?

A

vascular + neuro referral

100
Q

what is the management for thoracic outlet syndrome? (3)

A

physical therapy
weight loss
NSAIDs

101
Q

painfully twisted and tilted neck that usually resolves in several days to a couple of weeks

A

torticollis (wry neck)

102
Q

what is the treatment for torticollis (wry neck)? (4)

A

physical therapy
stretching
NSAIDs
muscle relaxants

103
Q

what is the treatment for chronic spasms of torticollis (wry neck)?

A

botox injections

Ortho-Rheum (27 decks)

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