Deck 8 Flashcards
(44 cards)
45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.
The pt’s symptoms a week after the first visit are suggestive of what pathology?
A. Disc herniation producing radiculopathy
B. Spinal stenosis
C. Cauda equina syndrome
D. Myasthenia gravis
C. Cauda equina syndrome
With CES, will likely have (hypo/hyper)reflexive stretch reflexes
hyporeflexive
45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.
What is the maximum time the pt can wait before undergoing surgery for this pathology?
A. < 12 hrs
B. < 48 hrs
C. < 72 hrs
D. < 96 hrs
C. < 72 hrs
Why does surgery need to be performed within 72 hrs for CES?
decrease risk for permanent neuro comopromise
Best timeframe for surgery with CES within ___ hrs
48 hrs
45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.
All of the following items are suggestive of the pathology in this vignette except for what?
A. Inc in anal sphincter tone
B. Perianal sensation deficit
C. No anal wink or cremasteric reflex
D. Urinary retention
A. Inc in anal sphincter ton
Cauda equina is (UMN/LMN) disorder
LMN
45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.
Once the pathology from this vignette is identified, which imaging modality is most recommended?
A. Dx US
B. Radiographs
C. CT scan
D. MRI
D. MRI
45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.
What would be the most appropriate referral for the pt in this vignette?
A. PCM
B. Urgent care
C. ED
D. Neurosurgeon
D. Neurosurgeon (or orthopedic spine surgeon)
45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.
Which surgical procedure is most indicated for the pathology in this vignette?
A. Ablation of sacral nerves
B. Laminectomy and discectomy
C. L4-5 fusion
D. L5-S1 fusion
B. Laminectomy and discectomy
Which are the most common levels for a disc herniation to occur?
A. L1-2 and L3-4
B. L2-3 and L4-5
C. L4-5 and L5-S1
D. L2-3 and L5-S1
C. L4-5 and L5-S1
Of 40,000 operations, (%) of disc herniations were at L4-5/L5-S1
95%
Which nerve innervates the adductor longus and gracilis, and provides sensation to the medial thigh?
A. Anterior branch of obturator nerve
B. Posterior branch of obturator nerve
C. Femoral nerve
D. Sciatic nerve
A. Anterior branch of obturator nerve
The posterior branch of the obturator nerve innervates which muscles?
- obturator externus
- adductor magnus
The posterior branch of the obturator nerve has no (sensory/motor) innervation
sensory
The anterior branch of the obturator nerve innervates which muscles
- adductor longus
- gracilis
Does the anterior branch of the obturator nerve contain sensory fibers?
yes
You have been treating 33F for L knee pain that started 5 weeks ago after beginning half marathon training. Pt is new to running and wears tight fitting compression pants. Though knee pain is improving, she reports sensation of numbness in her anterolateral thigh. What is the most likely dx?
A. Femoral neuropathy
B. L2-3 disc extrusion
C. Meralgia paresthetica
D. ITBS
C. Meralgia paresthetica
26M presents with new onset LBP and radicular sx to posterior aspect of R thigh after deadlifts. Sx centralize to lower buttock with REIL. Pt has low fear and PROM IR greater than 35˚. What is the best intervention for this pt today?
A. REIL
B. Sidelying lumbar manipulation
C. Isometric trunk stabilizer strengthening
D. Nerve tensioners with sciatic nerve bias
A. REIL
If you have to choose between repeated motions vs. manipulation, should do what first?
repeated motions (exhaust directional preference), then manipulation - use hierarchy
35M presents via direct access with sudden sharp LBP that comes and goes. Reports it radiates to R testicle. He does not have a fever. Lumbar exam is inconclusive. What is the most likely dx and best mgmt for this pt?
A. Central sensitization. Multidisciplinary mgmt is recommended.
B. Renal infection. Refer to ED
C. Kidney stone. Refer to ED
D. Transverse myelitis. Refer to ED
C. Kidney stone. Refer to ED
35M presents via direct access with sudden sharp LBP that comes and goes. Reports it radiates to R testicle. He does not have a fever. Lumbar exam is inconclusive.
If we were to consider renal infection, what would likely be present?
fever
35M presents via direct access with sudden sharp LBP that comes and goes. Reports it radiates to R testicle. He does not have a fever. Lumbar exam is inconclusive.
If we were to consider transverse myelitis, what would likely be present?
weakness
Middle aged pt presents with LBP and a Later sign. Denies radicular symptoms and reports inc morning stiffness that improves with movement. What is the most likely dx?
A. Lumbar stenosis
B. Ankylosing spondylitis
C. Chronic LBP
D. L3 spondylolisthesis
B. Ankylosing spondylitis
