L-Spine Pathology Flashcards
(66 cards)
1
Q
What 3 ligaments are continuous systems that wrap the lumbar spine in a “stocking”?
A
- Supraspinous ligament
- Interspinous ligament
- Ligamentum Flavum
2
Q
What is the function of the ligamentum flavum in the lumbar spine?
A
- Forms a roof for the vertebral canal that doesn’t buckle with flexion or extension
3
Q
What are the 4 key muscles/ muscle groups that stabilize the lumbar spine?
A
- Multifidi
- Transverse abdominus
- Pelvic floor muscles
- Diaphragm
4
Q
What force do the multifidi resist?
A
- Shear
5
Q
What is a protrusion of a disc?
A
- Posterior disc buldge without rupture of the outer annulus
6
Q
What is a prolapse of a disc?
A
- Nucleus contained only by the outermost fibers of the disc’s annulus fibers
7
Q
What is an extrusion of a disc?
A
- Disc material enters the epidural space due to a ruptured annulus
8
Q
What is a sequestration of a disc?
A
- Disc material within the epidural space fragments
9
Q
What are the 3 types of spinal stenosis?
A
- Central
- Lateral recess
- Foraminal
10
Q
Where does lateral recess stenosis occur?
A
- On the lateral aspect of the spinal canal
11
Q
What is the major symptom of lumbar spinal stenosis? What makes it better? What makes it worse?
A
- Neurogenic claudication (pain in the legs when walking
- Static standing, walking, and coughing make it worse
- Spinal flexion makes it better
12
Q
What are 2 ways that arterial ischemic claudication can be differentiated from neurogenic claudication?
A
- Assess pulse (a neurogenic claudication will have normal pulses)
- Have the patient ride a stationary bike (will provoke arterial; neurogenic will be mostly unchanged)
13
Q
What muscles should be trained to manage lumbar spinal stenosis?
A
- Transverse abdominis
- Pelvic floor
- Multifidi
- Diaphragm (?)
14
Q
What muscles should be stretched when managing lumbar spinal stenosis? Why?
A
- Stretch hip flexors to reduce lumbar lordosis
15
Q
How can posture be corrected to help manage lumbar stenosis?
A
- Encourage flexion when possible, and avoid extension postures/ movements
16
Q
How can the patient be educated to manage lumbar stenosis?
A
- Avoid extension of the lumbar spine, as well as quadrant like positions
17
Q
What type of orthotic can be used to help manage lumbar stenosis?
A
- If the symptoms are unilateral, put a heel lift in the contralateral shoe
18
Q
What is a spondylolisthesis?
A
- Forward subluxation of one vertebra on the vertebra below it
19
Q
What are 4 subjective reports that are common with spondylolisthesis?
A
- Generalized back ache
- Gluteal pain
- Lower back weakness
- Lower quarter weakness
20
Q
What specific movement can be used a clinical sign for spondylolisthesis?
A
- A pain with return to an extended position from flexion that is made better by contracting the glutes and core before performing the motion
21
Q
What muscles are strengthened, and which are stretched when managing spondylolisthesis?
A
- 4 key core muscles trained
- Careful stretching of the iliopsoas to avoid an anterior shear force on the spine
22
Q
How is the patient educated in managing a lumbar spondylolisthesis?
A
- Avoid extension movements/ positions and movements that cause shear
23
Q
What is one of the most common diagnoses in an outpatient setting?
A
- A sprain-strain of the iliolumbar ligament
24
Q
How a sprain of the iliolumbar ligament treated during the acute stage? (4 main components)
A
- Pt education to avoid reinjury/ aggravation
- Modalities and manual therapy for pain control
- Gentle stretching
- Aerobic activities as tolerated
25
What is the treatment for a ligament sprain of the lumbar region past the acute stage?
- Core training and conditioning
26
What are 5 red flags that may seem present as lumbar pain?
- Aortic aneurism (Pulsate pain in abdominal region)
- Pyelonephritis (kidney infection)
- Nephrolithiasis (kidney stones)
- Malignant tumors of the spinal column (cords or meninges)
- Metastatic tumors (from: thyroid, prostate, breast, colon, lung...)
27
How can a metastatic tumor easily be differentiated from a metastatic tumor?
- It is outside of the dura
28
Where are the 2 locations a tumor may appear as a primary cancer?
- Within dura, but outside of cord
| - Within the spinal cord
29
What are examples of what a job task inventory may entail during an intake/ physical exam of a patient with lumbar spine impairments?
- Lift-carry
- Bend-stoop
- Squat
- Walk
- Sit
- Stand
- Climb
- Environmental exposures
30
What are 3 scales used to measure a patient's perception of their disability/ pain?
- Oswestry disability questionnaire
- PACT-Sort
- FABQ
31
What is assessed during a postural screen of the lumbar spine?
- Start from the head and shoulders
- Observe scoliosis
- Observe rib symmetry
- Check position of: Iliac crests, ASISs, PSISs
- LE symmetry/ length
- Lumbar lordsis
- Pelvic rotation
32
How can centralization or peripheralization be assessed during the exam?
- Sustained or repeated endrange movements: assess effect on symptoms
33
What is Gower's sign?
- Pressing through the hands to move the lumbar spine into extension
34
When should the painful spinal movements be assessed during the movement assessment?
- Last
35
How should lumbar extension be assessed for movement?
- Symmetry
- Quality
- Segmental recruitment
36
How should lumbar flexion be assessed for movement?
- Segmental motion
- Rib humps
- When the pelvis is recruited (lumbo-pelvic rhythm)
- A flattening of the lumbar lordosis
37
How should lumbar lateral flexion/ rotation be assessed for movement?
- Segmental movement/ symmetry
38
What is a rib hump indicative of?
Scoliosis
39
How can passive movements of the lumbar spine be assessed?
- Pt sidelying with hooked legs
- Place the patient's knees against your hip
- Guide motion of the L-spine through while holding onto the patient's ankles
40
What is a quick test to clear the joints of the lower quarter? For whom is this test inappropriate?
```
- Full squat with a bounce at end range
Avoid with:
- Patients who are pregnant
- Elderly patients
- Patients with know LE pathology such as arthritis
```
41
What is the March Test?
- A quick SIJ screen
- Pt stands; PT positioned behind patient
- Place one thumb on patient's PSIS, and place the other on the patient's spinous process
- Patient lifts ipsilateral knee towards chest
- PSIS should drop medioinferiorly
42
What are the break tests for lumbar myotomes L2 - S2?
```
L2: Hip flexion
L3 - L4: Knee extension
L4: Ankle dorsiflexion/ heel walk
L5: Great toe extension
S1: Ankle plantar flexion, eversion/ Walking on tip toes
S2: Knee flexion
```
43
How are dermatomes measured in the lumbar spine?
- Pinwheel/ light touch along the distribution of the lumbar myotomes
44
What are the 2 DTRs for the L-spine, and what spinal segment do they measure?
- Knee jerk (L3/4)
| - Ankle jerk (S1/2)
45
What is the iliac crest used to located in the L-spine?
- L4-5 interspace
46
What is the PSIS used to locate in the spine?
S2
47
What 3 accessory joint motions are assessed in the L-spine?
- CPA
- UPA
- Transverse pressure
48
What spinal segments are tested by a straight leg raise?
- L5
| - S1
49
On which side is the SLR performed first?
The uninvolved side.
50
How can the SLR be sharpened?
- With dorsiflexion of the ankle.
51
What is a positive test of the SLR?
- Radicular complaints distal to knee
52
What is a cross-over sign during SLR? What is indicated?
- A lightning bolt type pain down the contralateral leg
| - Neurological or central disc problem is indicated
53
What structure is tested by Ely's test? What spinal segments?
- Femoral nerve
- L2
- L3
- L4
54
How is Ely's test performed when assessing Femoral nerve lesions?
- Pt prone, flex knee and monitor for symptoms for 30 - 45 seconds
55
What are 4 positive tests for Ely's test
- Unilateral buttock pain
- LB pain
- Posterior thigh pain
- Unilateral quad tightness
56
How must the Femoral nerve stretch test be modified in individuals over 40?
- Move into and out of flexion slowly to avoid hamstring cramping
57
Describe a Slump Sign test.
- Pt sitting
- Pt flexes at the thoraco-lumbar spine
- Overpressure the shoulder girdle with combine C-spine flexion
- Sharpen with ankle dorsiflexion
- Sharpen with passive or active knee extension
- Assess presence of radicular symptoms
- See if neck extension reduces symptoms
58
What is tested by the Slump Sign test?
- Spinal cord
| - Nerve roots
59
What does the Thomas Test assess?
- Hip flexor tightness
60
Describe the quadrant position of the lumbar spine.
- Extension
| - Lateral flexion and rotation to the same side
61
What are positive signs of a quadrant test?
- Radicular signs
| - Localized pain
62
What is indicated by radicular signs in a quadrant test?
- Disc pathology
63
What is indicated by localized pain in a quadrant test?
- Facet joints
| - Degenerative joint disease
64
What is an easy way to guide the patient through a quadrant test?
- Patient stands
- Pt places hand on contralateral posterior thigh/ buttock
- Pt slides hand down leg rotating, sidebending, and extending
65
Describe a prone instability test.
- Pt prone on exam table with feet on floor
- Examiner applies CPA
- Assess symptoms
- Pt lifts feet slightly off floor contracting erectors, glutes, and abdominals
- Apply CPA
- Assess if symptoms are better
66
What may not be a successful treatment following a positive prone instability test is not positive?
- Core stability training
