EEO Midterm - Spine Lecture Flashcards
Foraminal stenosis
-Narrowing of intervertebral foramen, pinching the spinal nerve root.
-usually seen later in life, caused by prior injuries and repetitive motions
-SHOOTS IPSILATERAL RADICULAR PAIN DOWN THE ARM
What tests should you give to a patient who has foraminal stenosis, central stenosis, or a cervical disc lesion?
-NDI
-Grip strength dynanometer
-Cervical flexor endurance test
What is a primary difference in the symptoms of foraminal stenosis vs. central stenosis?
Foraminal stenosis will have unilateral symptoms, whereas central stenosis will have bilateral symptoms
What tests or measures can you give to someone who has foraminal stenosis?
-Cervical AROM
-Cervical MMT
-Reflex testing
What are typical causes and symptoms of central stenosis?
Anteriorly: Disc pathology
-affects motor and sensory function
Posterior: Hypertrophy of the ligamentum flavum
-affects certain types of sensory function
What are some unique tests and measures for central stenosis?
-Testing balance
-Hoffman reflex
-Shumizu reflex
These can be done because central stenosis will cause a UMNL, whereas foraminal stenosis will cause a LMNL!
What is a cervicogenic headache, and where would you expect the patient to report pain from?
-A headache that starts at the neck and migrates to the head
-Pain is usually experienced at the top of the head as well as the suboccipital region
-affects concentration, ability to read, vision, and mood
-likely due to an upper cervical spine dysfunction (C0, C1, C2)
What are some questions to include in the subjective interview for someone with cervicogenic headache?
-Which exact areas of the head or face hurt? Point to one specific area.
-Which activities bring on the headache?
-How much screen time do you have?
-What does a typical day look like for you?
What cranial nerve may contribute to cervicogenic headache?
Trigeminal (CN V)
In what age range are vertebral disc problems most common?
20’s to late 40’s
What are common causes and symptoms of cervical disc pathology?
Causes:
-prolonged flexion or whiplash
-typically dislocates posteriorly / towards the spinal canal
Symptoms:
-Bilateral presentation, motor symptoms first then can progress to sensory
-sensitivity to weightbearing
-will sometimes cause radiating pain down the arm. Not always!
True or false. Disc problems most often lead to chronic pain that does not dissipate.
False!
Disc problems tend to come in waves, with periods of relief then returning symptoms later on.
This is why it is important to ask patients if they have had previous episodes of radicular pain if you suspect disc pathology!
What are the patient presentations presentations of whiplash?
-Muscle spasm and tightness
-Disc-like symptoms in lower cervical spine
-Can sometimes present like brain stem-type injury in upper cervical spine
What are the tests and measures you would use for a patient who has whiplash?
-JPSE Laser-proprioception test
-Test UE reflexes like Shimizu for UMNL
-Eye movements for CN damage
-Screen cervical AROM and ROM as well as endfeels
-Cervical MMT
-UE myotomes + dermatomes
What is the typical cause of degenerative disc disease?
Spondylosis and/or wear and tear
Basically, the nucleus pulposis dehydrates with age which causes the discs to shrink and become more convex
What are some outcome measures you can use for lumbar DDD?
-Oswestry Disability Index (ODI)
-Modified plank
-5x Sit -> Stand
-Functional lumbar index (FLI)
When are some tests and measures to use for lumbar DDD?
-Assessing posture and gait
-Trunk and hip MMT
-Thoracolumbar AROM
-Nerve screen of the LE’s
What is the typical MOI for lumbar spine disc pathology?
Flexion and rotation, causes most of the discs to herniate POSTERIORLY
L4 and L5 are most commonly hurt!
What do the symptoms of lumbar disc pathology present?
-Unilateral presentation
-can be both motor and sensory, depends on how severe the herniation
-pain is reproduced with Valsava or weightbearing
A patient with lumbar DDD will typically have more pain at what time of day?
The morning
What are important subjective questions to ask in the differential diagnosis of DDD?
-Do you have any areas of the leg with less sensation?
-Any loss of strength to the lower leg or foot?
What motion will someone with lumbar DDD have a hard time performing?
Squatting
Before assessing a patient coming in for UE or LE pain, what should you ALWAYS DO?
Clear the spine!
What is the lumbopelvic rhythm, and what are some common errors associated with it?
Rhythm for bending forward (opposite when going back up)
1. Lumbosacral flexion
2. Anterior pelvic tilt
3. Hip flexion
Errors:
-only pelvic motion
-only lumbar motion
- a + Gowers sign
- a + “S” or “C” upon standing upright
