Class 6/7: ARJC-Stenosis Flashcards
(50 cards)
prevalence of stenosis
most common dx for adults >60/65
if younger due to spondylolisthess=is
30% asymptomatic individuals had canal narrowing
2 methods of compression with stenosis
outside in
-unilateral more than bilateral
-due to ARJC/ARDC, instability, or enfolding of ligamentum flavum
inside out
-sheath around n = fibrotic
-increased blood supply causes enlarged n
-fibrotic wont expand
structures involved with stenosis
ischemic compression
venous congestion
no lymphatic vv in PNS/CNS
symptoms of lateral stenosis
unilateral LE > LBP
segmental paresthesias + gripping pain b/c of ischemia
pain decreased with FB, sitting, in morning (pain moves from LE to LBP)
pain increased in LE with standing/walking
greater symptoms with decline walking
observation for stenosis pt
slouched
possible scoliosis
ROM finding for stenosis pt
flx/cont. SB decrease pain (but may not be able to open foramen completely so possible limited ROM)
Ext/ips SB increase pain (possible limited ROM due to contact with n)
Rot = inconsistent
neuro and stress test findings for stenosis
+ neuro for radiculopathy
possibly + PA/torsion when SUSTAINED
Accessory motion findings for lateral stenosis
hypomobility in adj joints (lower thoraci and LE, especially hip)
hypomobily in flexion and contralateral SB
special test results for lateral stenosis
possible + stability tests for excessive shear
LE discrepancies
balance deficits with wide based gait
cooks CPR
factors for cooks CPR
bilateral symptoms
LE P! > LBP
P! with walking/standing
P! relief with sitting
> 48 yrs old
how to differentiate between neural and vascular causes
Ankle Brachial Test for peripheral artery disease
-ratio of tibial and brachial aa
-Normal = 0.9-3.1
-0.41-0.9 = mild
-less that 4 = severe
bicycle test
-upright cylce then bend to lean on handlebars for 3 min each
-if stenosis = pain decreases with bent position
-if not better = PAD
central stenosis S&S
cord or cauda equina syndrome
no change with SB/RT
PT Rx for stenosis (foraminal opening)
pt edu of foramen/good prognosis
flx directional preference
possibly helpful intermittent tx
neural mobs
manual therapy
what specific manual therapies are best for stenosis
manipulation most effective for sub group of stenosis with LBP
-lower thoracic
-lumbar manipulation most effective when combined with ex
-early evidence fo support for additional hip jt mobilizaiton
MET for stenosis
aerobic
-unweighted walking
-cycling as effective as unweighted walking
-primary influence = circulation improvements
balance training ONLY if able to be upright w/o symptoms
local muscle stabilization
corsets
sx indications for stenosis
presence of constant/worsening symptoms
failure to obtain relief with 3-6 months of non-surgical treatments
sx effectiveness for stenosis
inconclusive best sx with spinal decompression of laminextomy and/or partial discectomy w/ or w/o fusion
benefit with pain/disability
walking distance NOT better
if just stenosis = outcome can be just as good as PT
if stenosis + spondylolisthesis = substantially greater pain relief and improvement in fx vs PT at 4 yrs
what is spondylolysis
bony defect or fx of pars interarticularis unilaterally and bilaterally
etiology of spondylolysis
congenital
repetitive stress (especially ext/RT)
direct trauma
prevalence of spondylolysis
6-12%
most common level for spondylolysis
L5/S1
S&S of spondylolysis
acute = fx S&S plus + B torsion test
persistent = asymptomatic often; like instability if symptoms are present
what is spondylolisthesis
anterior vertebral segment slippage
2 most common types of spondylolisthesis
isthmic or adolescent with spondylolysis
-most common
-age group with most rapid slippage
-due to repetitive trauma or ext
degenerative
-b/c of ARDC
-50+ years old
-No fx
