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Flashcards in Clin med test 3 Deck (68):
1

How many US citizens miss work daily due to LBP

10 million

2

How many days of work are missed in great Britain due to LBP

15 million

3

How much money does it cost us industries on account of missed days from LBP

14 billion

4

Who is at the highest risk for LBP

Truck drivers

5

Who is at the higher risk for LBP (Sedentary or heavy labor workers)

Same due to the poor posture of sedentary

6

Explain how LBP progresses as the population gets older

25 year olds will start to develop LBP
35 years old it will get moderate to severe
40-45 years old is the peak age for LBP

7

What is the best medical examination process for detecting LBP

Xrays have a "moderate" correlation to determining back pain. But even withexpert medical examination sometimes it is impossible to detect

8

What are the time periods for LBP to be self limiting

44% get better in one week
86% get better in a month
92% get better in 2 months

9

What are the rates of reoccurring LBP

90% chance of getting it aging
40% chance of developing sciatica

10

Why do visceral organ diseases present as low back pain

They refer pain to along the TL spine or Sacral area.

11

How to differentiate between Visceral organ and a musculo problem

Visceral organs generally to not change with movement

12

What comes first DJD or DDD

More likely DDD

13

Where will Herniations most often occur

L4/L5
L5/S1
L3/L4
L2/L3
L1/L2
*In that order

14

Describe a protrusion herniation

The least severe
There is an angular bulge
Angular fibers still intact

15

Describe a prolapse herniation

Nucleus has migrated through the inner laminar layers but is still contained
The angular fibers will be disrupted

16

Describe disk extrusion herniation

Angular fibers have disrupted and the nucleus has now broken past the outer most layer

17

Describe a Sequestration hernia

Annular fibrosis is disrupted and the nucleus has now migrated outside the disk.

18

What are some clinical features with herniation of IVD

Dramatic onset of symptoms
Occurs day or 2 after rigorous activity
Usually in early adult and middle aged people
Acute sciatica
Muscular spasms
Pain with Motion, flexion and extension

19

What tests or measures to use for nerve irritation

Want to do a dermatome or myotomal testing
X-rays often not helpful

20

What imaging will be most useful in detecting nerve irritation

MRI
CT
Myelography
*in that order

21

What may prevent D2 from responding to extension repeated movements

The Kyphosis deformity

22

What may prevent D3 or 5 from responding to extension repeated movements

It may not respond to standing extension because it is on one side vs the other

23

What may prevent D4/6 from responding to extension repeated movements

They lay in the frontal plane, so they may respond better to frontal plane movements

24

Which derangements are easily reversible

D1-4 and D7

25

Which derangements are harder to fix

D5 and D6

26

What will degenerate first in the Disk with DDD

Nuclear pulposis

27

What are some physiological characteristics of the disc that occur with DDD

Disc height shortens
Angular fibrosis looses elasticity posteriorly
Angular fibrosis becomes thin and may even tear

28

What are schmorl's nodes

Weakness of the cartilage endplate

29

How common are schmorl's nodes

Common but not clinically significant

30

What can result from DDD

Compression on facet joints
DJD
Foraminal narrowing (stenosis)
Ligament laxity

31

What can cause DJD

Mechanical weakness or malalignment
Trauma (MVA, Sports)
Obesity, poor posture
Smoking
Infection

32

How much more likely are you to get DJD if you smoke

3x more likely

33

How does imaging help us detect stenosis

There will be decrease joint space on X-rays

34

What can cause narrowing of the foremen in the spine

Herniation
Decreased joint space
Osteophytes
DJD
Ligamentous flavum folding

35

What can compress the cauda equine

Central compression in the foremen (central stenosis)

36

What are the signs of lateral stenosis vs central stenosis

Radicular pain that is unilateral

37

What will stenosis mimic

Intermittent claudication

38

What is a weird feature of stenosis

Flaccid bladder

39

What can you rule out if there is no leg pain

Stenosis

40

What is the difference between hypermobility and instability

Hypermobility will be too much movement in the joint with A/PROM
Instability will create aberrant movement

41

Which is more severe hypermobility or instability

Instability

42

What does Lumbargo mean

Low Back pain

43

What are some clinical indications of segmental hyper extension

Better with flexion/worse ext
Local or referred to butt
Chronic or intermittent lumbargo

44

What are some clinical indications for hyperflexion

Herniation
DDD
Relieved with Ext

45

Will segment instability be worse or better with movement

Worse with movements, better at rest.
May centralize pain

46

What can cause segmental hyperextension

Extension checkrein compromised
Sprains subluxations
Malalignment

47

What role will DDD play in segmental instability

Aberrant or excessive moments in spine

48

What can occur with segmental instability

Osteophytes
Sprain of facet joints

49

What are the grades of displacements of the spine

Grade 1: 25%
Grade 2: 50%
Grade 3: 75%
Grade 4: 100%

50

Will spondylosthesis feel better with flexion or extension

Flexion
Provides more stability

51

Which lumbar are most likely to have spondylolosis

L5 85%
L4 15%

52

What sports are more likely to have spondylolosis

Football Linemen
Gymnastics
Butterfly swimmers
Weight lifters

53

What nationality Is most likely to have spondylosis

Eskimo

54

What is the treatment for grade 1 slipping

Strengthen core

55

What is the treatment for grade 2 slipping

Maybe a posterior fusion

56

What is the treatment for a grade 3-4 slipped disc

Posterior fusion

57

What is a laminectomy with decompression used for

Central Stenosis

58

What are the indications for a disectomy

Conventional methods have been ineffective for 6 or more weeks
Neurological deficit
Recurring sciatica

59

Microdisectomy

Disectomy of the disc using a scope

60

What are some symptoms of caudal equine syndrome

Lower Back pain
Pain in the leg
Numbness in feet

61

What is the treatment for cauda equina syndrome

Surgery

62

What are the "tell tale signs" of cauda equina syndrome

Urinary incontinence
Sciatica
Saddle anesthesia

63

What is saddle anesthesia

LOSS OF FEELING IN THE BUTT

64

What is anklosing spondylitis

Stiffening of the spine from inflammation
Have a hunched over posture

65

What is the ratio of male to femeale for anklosing spondylitis

4:1 males

66

Will anklosing spondylitis be better or worse with activity

Better with activity and worse with rest

67

Where can anklosing spondylitis refer and radiate to

Radiates to knee
Refers to trochanter and butt

68

What are some treatments for anklosing spondylitis

NSAIDS
Education
PT (heat, PRE, Extension)