Exam 1 Prep Flashcards
(47 cards)
What are the 4 types of herniated nucleus pulposus (HNP)?
-Intra-spongy nuclear herniation
-Protrusion/prolapse w/ and w/ out spinal nerve root involvement
-Extrusion
-Sequestration
What are the 4 grades of intra-spongy nuclear herniation?
-Grade I: subchondral fx in vertebral body
-Grade II: small cracks in ednplates
-Grade III: a crack in which a piece of bone has shifted
-Grade IV: a crack in which pieces of bone has shifted and disc material is forced through the crack
What is a protrusion without spinal nerve root involvement?
-Displacement of nuclear material beyond normal confines of the inner annulus, producing a discreet bulge in the outer annulus
-No nuclear material escapes the outer annulus fibrosis or posterior longitudinal ligament
-Most common in L4-L5 and L5-S1
What is extrusion?
-Displaced nuclear material extrudes into the spinal canal through disrupted fibers of the annulus fibrosis and PLL but is still in contact with the disk
-Nuclear material escapes into the spinal canal as free fragments
What is facet impingement?
-Usually occurs due to a sudden, unguarded movement involving extension, SB, and/or rotation with little to no trauma
-“Nipping” of intervertebral menisci
What is facet sprain?
-More severe injury than impingement or a progression of a repetitive facet impingement
-Moderate to severe trauma
What can facet movement dysfunction be a result of?
-Hypomobility secondary to ligament tear, muscle tear, contusion, meniscoid entrapment, facet subluxation
-Hypermobility secondary to extra-articular or periarticular cause of distinction made by end feel during PPIVM and PAIVM
What is the clinical prediction rules for spinal manipulation?
-Low fear avoidance behavior questionnaire (FABQ) < 19
-Duration of symptoms 15 days or less
-No symptoms distal to knee
-Lumbar spine hypomobility at any level
-Either hip with greater than 35 degrees of internal rotation
What is the clinical prediction rule for lumbar stabilization for LBP?
-SLR > 91 degrees
-+ prone instability test
-Aberrant movements
-Age < 40 years old
What is the diagnostic criteria for ankylosing spondylitis?
-Morning stiffness > 30 minutes
-Improvement in back pain with exercise but not with rest
-Awakening because of back pain during the second half of the night only
-Alternating buttock pain
-Diagnosed if three or more are present
What is the diagnostic criteria for lumbar spinal stenosis?
-Age 60-70= 2 points
-Age > 70= 3 points
-Symptoms present > 6 months= 1 point
-Symptoms improve when bending forward+ 2
-Symptoms improve when bending backward= -2
-Symptoms exacerbated when standing up= 2
-+ intermittent claudication= 1
-Urinary incontinence= 1
How are spinal ligaments innervated?
-Innervated with nocicepetive afferent fibers
-pain generators with chronic or acute tissue strain
What treatments are indicated for facet impingement?
-Joint mobilizations
-Mobilizations with movement
-STM and contract relax
-Muscle energy techniques
-Therapeutic exercise
What treatments are indicated for facet sprain?
-Mild to moderate mobilizations and ROM during acute and subacute stages
-If patient remains immobile during subacute stage, joints may become hypomobile when healed
-Guard against development of postural changes
What treatments are indicated for DDD in the mild to moderate stages?
-With hypomobility: mobilizations, manual or mechanical traction, flexibility exercises, postural training
-With hypermobility: back supports, core stabilization, postural training
-Modalities for pain relief
-Initially, exercise in the direction opposite that of the aggravation
What treatments are indicated for DDD in the severe stage?
-Active mobility therapeutic exercise in positions that eliminate or minimize vertical loading
-If this causes increased symptoms, try bracing or supporting to reduce movement and vertical loading
What treatments are indicated for intra-spongy nuclear herniation?
-Rest and avoiding compressive forces on the disc
-Control the muscle guarding as it increases intradiscal pressure
-Hyperextension and mild traction may help
-Corset or brace
What treatments are indicated for HNP protrusion w/ out spinal nerve root involvement?
-Correct lateral shift then passive extension
-Teach patient to maintain lordosis at all times until symptoms are stable and predictable
What treatments are indicated for HNP protrusion w/ spinal nerve root involvement?
-Exercises, mobilizations, or activities that involve rotation are contraindicated initially
-Active rest
-Once protrusion is stable, restore full ROM in flexion and extension
-Address predisposing impairments of trunk, pelvis, and LE
-Modalities
-Initially SLR, active extension, and sit ups are contraindicated
-Back strengthening exercises as soon as the patient can perform without peripheralization
-Bring patient into normal lordosis and out of flexed position
How long does it take to return to strenuous activity after a disc protrusion with spinal nerve root involvement?
6-10 weeks
What treatments are indicated for radiculopathy?
-Manual or mechanical traction
-Patient education
-Reduce foraminal entrapment
-Therapeutic exercise to address the pt’s key impairments
-Make appropriate referral
What treatments are indicated for spinal stenosis?
-Educate pt’s to avoid aggravating or irritating postures
-Measures to increase mobility and flexibility
-Traction
What treatments are indicated for neurogenic claudication from spinal stenosis?
-Directional preference exercises, typically flexion based
-Manual therapy to increase hamstring and erector spinae length
-Therapeutic exercise and NMRE to facilitate improved control into flattened L/S posture
-Improve fitness level
What treatments are indicated for nerve root adhesions and dural tension/adhesion?
-Mobilizing nerve root adhesion by lower limb tissue tension techniques
-May cause increase in symptoms during technique only, but should subside quickly after stretch is discontinued
-Home nerve mobilization
