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clinical syndromes lumbar spine Flashcards

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1
Q

what is LBP?

A

low back pain is defined as pain and discomfort, localised below the costal margin and above the inferior gluteal folds, with or w/o leg pain

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2
Q

what is acute LBP?

A

-duration of an episode of low back pain persisting for less than 6 weeks

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3
Q

what is sub acute LBP?

A

-LBP persisting between 6-12 weeks

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4
Q

what is chronic LBP?

A

LBP persisting for 12+ weeks

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5
Q

describe the epidemiology and prevalence of LBP

A

-experienced at any age
-more prevalent in women
-increased prevalence with age up to 80 yrs
-highest number of LBP cases occurs at Aage 50-55 years

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6
Q

what is the most common presentation of LBP?

A

non specific low back pain

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7
Q

is recurrence likely?

A

yes - 70-80&

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8
Q

what does the global burden of disease state about LBP?

A

that is causes more global disability than any other condition

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9
Q

what are examples of non specific mechanical LBP risk factors?

A

-sedentary occupations
-work involving lifting, bending, awkward postures etc
-smoking
-obesity
-low socioeconomic status
-psychological factors

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10
Q

what are examples of physical causes of LBP- divided into trauma & degeneration and inflammatory?

A
  1. trauma and degeneration
    -ligament spain
    -muscle strain
    -fracture
    -spondylolysis
    -spondyloisthesis
    -facet joint athropathy
    -spondylosis
    -spinal stenosis
  2. inflam
    - ankylosing spondylitis
    -RA
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11
Q

what are metabolic causes of LBP?

A

-pagets disease
-osteoporosis
-osteomalacia

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12
Q

what infections can cause LBP?

A

-TB
-pygenic osteitis of spine
-tumours

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13
Q

what are examples of mechanical causes of LBP?

A

-deep gluteal pain syndrome
-hypermobility

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14
Q

what are the common systemic arthritis disorders affect young people (less than 20 years)?

A

-juvenile arthritis
-septic arthritis

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15
Q

what are common arthitic disorders in middle aged (aged 20 +)?

A

-ankylosing spondylitis
-RA
-enteropathic arthropathies
-reiters syndrome
-psoriatic arthritis

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16
Q

what is the most common arthritic disorder affecting older pts (>55 years)?

A
  • OA
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17
Q

what is an example of a masqueraders?

A

abdominal aortic aneurysm - can present with LBP
masqueraders= something that may present as LBP, but it actually something much more serious

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18
Q

if you think a red flag disorder is present, what do you do?

A

refer them to appropriate service for further investigation etc

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19
Q

what is a “specific” diagnosis according to the MSK clinical translation framework?

A

-a MSK disorder that refers to a disorder where pain and symptoms can be directly attributed to a biological process associated with the MSK system
-EG RA, stress fractures , tendon ruptures

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20
Q

how is LBP classified into systems?

A

-can be pathology / tissue based model
-it can be symptom base model eg LBP or LB and leg pain
-movement dysfunction model

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21
Q

define mechanical LBP

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A

Mechanical low back pain is the most common type of LBP, characterized by pain that varies with physical activity and position. It typically originates from the spine’s mechanical structures, such as muscles, ligaments, intervertebral discs, or facet joints
-more often comes with muscle + muscle imbalance

22
Q

what are examples of some muscles in the neck and back that can be overactive?

Study These Flashcards
A

SCM
-pectoralis
-upper trapezius
-rectus femurs and iliopsoas
-thoraco-lumbar extensors

23
Q

what can postural type of the patient help identify?

Study These Flashcards
A

muscle imbalances and weakness

24
Q

what does lordotic mean?

Study These Flashcards
A

increased lumbar lordosis
anterior pelvic tilt
hyperextended knees

25
what can be weak and elongated with lordotic postures?
- anterior abdominals -hamstrings can be elongated initially
26
what can be short and overactive for lordotic postures?
-low back musculature -hip flexors
27
what are kypho-lordotic postures?
-increased lumbar lordosis and thoracic kyphosis -pelvis is anteriorly tilted and most forward bodily placed segment
28
what can be weak and elongated vs short and overactive in kyphosis lordotic postures?
elongated and weak - neck flexors -external oblique -upper erector spinae short and overactive -hip flexors -sub-occipital neck extensors
29
what is sway back posture?
-long kyphosis with pelvis most anterior body segment and flat low lumbar area -hip joint moves anterior -pelvis neutral and hips and knees are hyperextended
30
what are examples of elongated and weak muscles with swag back posture?
-external oblique muscles -thoracic extensors -neck flexors -hip flexors
31
what is a flat back?
loss of lordosis with pelvis in posterior tilt
32
what muscles are elongated and weak for flat back posture?
single joint hip flexors
33
what muscles are short and overactive with flat back posture?
-hams -maybe abdominals
34
what is acute locked back?
sudden and severe inability to move the spine, often due to muscle spasm, joint dysfunction, or disc-related issues
35
what is the clinical pattern of acute locked back?
-sudden onset- sudden movement, may or may not have click -patient is stuck in flexion -all movements bring pain and could be spasm -there can be a spontaneous recovery 1-2 weeks
36
what can cause acute locked back?
-disc injury / prolapse -meniscoid entrapment in facet joint
37
describe the pathology of discogenic LBP
stage 1: protrusion: annular fibrosis tear stage 2: prolapse- nucleus escapes further into the annulus and the AF protrudes stage 3: escape - nucleus escapes beyond the AF completely stage 4: sequestration - nucleus has exited the disc and has travelled somewhere - serious! but rare
38
describe the clinical pattern with discogenic LBP
-5% of all LBP - 90% of radicular pain -age 30-55 years -more common in males -work hx: prolonged lumbar flexion or sitting at desk etc or sometimes a macrotrama -most commonly affects L4/5 or L5/S1 -most often resolves in 6-8 weeks -central or unilateral LBP / leg pain -WB compression is painful -loss of lordosis due to spasm -lumbar flexion most limited
39
does discogenic LBP reoccur?
yes
40
what can happen with lumbar flex and ext with discogenic pain?
-flexion may peripheralise pain (ie into the legs) -extension may centralise the pain - ie in the back
41
are PAIVMS provocative for discogenic LBP?
yes
42
what happens with nociception with a person who's disc injury is stimulated?
pain can spread from back- thigh - lower leg
43
referred pain vs radiculopathy
radiculopathy causes: compression or irritation of spinal nerve eg herniated disc or spinal stenosis symptoms: numbness, P+N's, weakness, sharp shooting pain that follows nerve root pain pattern: radiates along a nerve pathway eg LB- down back of leg etc neurological signs: may include reflexes, muscle weakness & sensory changes along the nerve root Referred pain cause: pain from a structure eg muscle, joint etc that is perceived in a different location due to shared neural pathways symptoms: deep aching pain with no p+n's, numbness etc pain pattern: more diffuse (doesn't follow a dermatomal pattern) neuro: no change with reflexes etc eg shoulder pain from a rotator cuff issue can be felt in the upper arm
44
what are examples of contributory factors to discogenic LBP?
-fam hx -macro-overload - twist or sudden high loading in flexion -microoverload - repetitive lifting, bending twisting etc -occupation - manual work - nursing, construction etc
45
what is a radiculopathy?
back and leg pain due to compression / irritation to nerve root - may also have pins and needles or numbness -burning or shooting pain
46
what can cause a radiculopathy?
-prolapsed IV disc -foraminal stenosis eg degeneration, tumours, osteophytes -epidural disorders eg infections meningeal disorders - cyst of nerve root sleeve
47
what would you expect with L3-L4 radiculopathy?
-weak quads and tip ant -patellar jerk reflex -sensory loss in medial knee and shin -pain and anterior thigh
48
what would you expect in neuro exam of L4-5 radiculopathy?
-EHL weakness -1st toe sensory loss -pain in posterior thigh and lateral calf
49
what would you expect in a neuro exam with a L5-S1 radiculopathy?
-- weak gastrocs - achilles reflex -pain in back of thigh and calf
50

ADVMSK2 (18 decks)

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