Back Pain and Spine

Question 1

what are the red flags in LBP?

Answer 1

cauda equina syndrome, saddle region neuropathy, difficulty w gait and urinary continence, unremitting pain worsening, trauma, age over 65, B symptoms (cancer/HIV Hx), IVDU/steorids, neuro signs

Question 2

what are the associations of inflammatory LBP?

Answer 2

younger males, worse w rest, ankylosing spondylitis, seronegative spondyloarthropathy

Question 3

do degenerative joint diseases of spine cause pain?

Answer 3

no

Question 4

what is the only predictive factor for future back pain?

Answer 4

depression

Question 5

what are the yellow flags in LBP healing?

Answer 5

barriers to recovery due to mindset to illness, determined via STarT back test

Question 6

what is the goal of the second visit in LBP?

Answer 6

optimize functional level and get pt back to work

Question 7

what is the most common cause of LBP?

Answer 7

muscles and sciatica pain

Question 8

what are the global stabilizers of the back?

Answer 8

latissimus dorsi, bicep femoris, thoracolumbar fascia

Question 9

what is myofascial pain?

Answer 9

local/referred pain from myofascial trigger point

Question 10

what are the major Dx criteria for myofascial pain?

Answer 10

spot tenderness, TP present, referred pain, regional complaint, ROM restricted

Question 11

what are the minor Dx criteria for myofascial pain?

Answer 11

reproduction of symptoms, local twitch response, pain alleviated by stretching/injecting TP

Question 12

what are the TPs activated by Quadratus Lumborum TP?

Answer 12

glutes (3 muscles), piriformis, A/P iliopsoas

Question 13

what are the 3 joints of the pelvis

Answer 13

Left /Right Sacroiliac joint, pubic symphysis

Question 14

what are the factors contributing to form closure in SIJ pain?

Answer 14

vertical keystone fit-bone/joint/ligament, shape, friction

horizontal compression-fascia and muscles

Question 15

what test is indicative of SIJ pain?

Answer 15

+ Fortin’s finger test (point to posterior superior iliac spine as most painful)

Question 16

what functional test confirms pelvic girdle pain?

Answer 16

active straight leg raise

one leg standing balance

Question 17

what are the indications of lumbar facet syndrome?

Answer 17

Facet joints: set of synovial, plane joints between the articular processes of two adjacent vertebrae
axial pain (lumbar to thigh), extension w rotation exacerbates pain, worse w immobilization, direct pressure over facet joints relieve pain

Question 18

what are the indications for facet joint block (short term relief) prescription?

Answer 18

3 mo persistent axial pain, not responding to PT, functional disability

Question 19

what Tx provides long term relief for lumbar facet pain?

Answer 19

medial branch blocks or radio frequency ablation

Question 20

what are the anatomical results of poor sitting posture?

Answer 20

strained neck muscles, stiff soft tissue, increased load on discs, shorten/weaken abds and glutes, tighten iliopsoas

Question 21

what is spine surgery effective for?

Answer 21

decompressing neural elements, stabilize unstable spine, taking out tumors/infections, correcting deformities

Question 22

which part of the spine is radiculopathy likely to happen?

Answer 22

radiculopathy: pain that follows nerve

lower lumbar spine

Question 23

what are the symptoms of radiculopathy?

Answer 23

leg pain radiating over dermatome, worse w activity, numbness/weakness
many resolve spontaneously

Question 24

what is the most common cause of radiculopathy?

Answer 24

acute disk herniation/bulging from torn annulus fibrosis

leaking of nucleus propulus

Question 25

post lateral hernia affects the nerve at which level?

Answer 25

immediately below hernia | cause sciatic pain

Question 26

far lateral hernia affects the nerve at which level?

Answer 26

directly above hernia

Question 27

what are the worrisome features of lumbar radiculopathy?

Answer 27

progressive weakness, unable to cope with pain | manage with edu, analgesia, etc.

Question 28

what is spinal stenosis?

Answer 28

narrowing of spinal canal (degeneration), cause pinching on nerves-->pain

Question 29

what type of claudication is associated with spinal stenosis?

Answer 29

claudication: cramping pain induced by exercise neurogenic (heaviness in legs, better going uphills and leaning forward), sit for relief

Question 30

where does spondylolisthesis usually occur?

Answer 30

L5 (pars-connecting pedicle to IAP)

Question 31

what are the cauda equina?

Answer 31

nerves running through sacrum

Question 32

why is cauda equina syndrome dangerous?

Answer 32

sacral nerves don't recover if they stop working, recovery is low after 24 hrs

Question 33

what are the symptoms of myelopathy (cervial stenosis)

Answer 33

loss of hand control, numbness, off balance, bladder dysfunction, Tx with surgery

Question 34

what's the difference between lumbar and cervical stenosis?

Answer 34

lumbar: PNS, pain, minimal PE signs, reversible, wax/wane cervical: CNS, sometimes pain, PE present, non-reversible, progressive

Question 35

what is the most common form of scoliosis?

Answer 35

idiopathic (preteen-early adulthood): more females, rib hump, FHx

Question 36

what's the difference between low and high energy fractures?

Answer 36

low: bone density problem (compression fracture) high: from burst fracture or fracture dislocation, needs expert assessment, red flag in back pain

Question 37

where do most spine infections start?

Answer 37

in the disc (avascular, immune privileged)

Question 38

what are the surgical goals in spine metastases?

Answer 38

relieve neural compression, achieve stability

Question 39

lower back vs. pelvic girdle

Answer 39

Lower Back:12th rib to gluteal fold | Pelvic Girdle: Iliac crest to gluteal fold (16-30% LBP)

Question 40

sacroiliac pain refer to

Answer 40

lower lumbar, some to lower limb

Question 41

Tx for pelvic girdle pain

Answer 41

compression shorts/SI belt, heel lift, weight loss

Question 42

SIJ block indications

Answer 42

Diagnostic-r/o SIJ as cause of LBP | Therapeutic-when combined w corticosteroid