L14 Flashcards
(19 cards)
1
Q
Types of lower back pain
A
- Localised pain: soreness or discomfort when palpate
- Diffuse pain: affect larger area, from deep tissue
- Radicular pain: irritation of nerve root
- Referred pain: felt in the lower back, but the source is another location
2
Q
Causes of lower back pain
A
- Muscle strain or spasm
- Ligament sprain
- Hesitation of the central of the discs
(Press on the adjacent spinal nerve) - Spinal stenosis
3
Q
Acute lower back pain
A
- Last 4 weeks or less
- Trauma or activities causing stress in lumbar area
- Symptoms do not appear at the time of injury but develop within 24hrs
- Treatments:
NSAID, muscle relaxants, massage, spine manipulation, acupuncture針灸, cold/heat pad
4
Q
Chronic lower back pain
A
- Last more than 3 months or repeated incapacitating episode
- causes:
Degenerative or herniated disc, osteoporosis or congenital spine abnormalities, prior injury, chronic strain (obesity, pregnancy, heavy lifting) - treatments: NSAID, antiseizure drug (relieve neruopathic pain), exercise, physiotherapy, surgery, weight reduction, local cold or hot pad
5
Q
Pathophysiology of the herniated intervertebral discs
A
- Nucleus pulposus is squeezed out from between vertebrae
- Compression on the adjacent nerve root: pain, numbness, tingling, decreased motility, change in sensation and motor, deep tendon reflex
- Sciatica (pain from the lower back to the leg) if compress sciatic nerve (L4-S3)
- Protein from the disk content leak into the canal: inflammatory response with pain
6
Q
Compression in L4-5 level
A
Affect 5th Lumber nerve root
Pain in hip, lower back, posterolateral thigh, anterior leg, dorsal surface of the foot
7
Q
Compression in L5-S1 level
A
- Affect 1st sacral nerve root
- Pain in mid-gluteal region, posterior thigh, calf to heel, plantar surface of foot to 4-5th toes
- Paresthesia (numbness and tingling) in posterior calf to lateral heel, foot and toes
- Difficult walking on toes
8
Q
Cauda equina syndrome
A
- compressed by the ruptured herniated discs
- cause urine retention and constipation
- tingling or loss of sensation in lower pelvic area and bilateral leg
- require immediate medical attention and surgery
9
Q
Straight leg raise test
A
Test the L4, L5, and S1 nerve root irritation
1. Perform with knee extended and hip flex
2. Stretch the sciatic nerve and hamstring
3. Normal: hip flexion to 90 degree with knee straight
4. Herniated disc: cannot raise leg >30 degree without pain
10
Q
Per rectum examination
A
Test the tone of anal sphincter by ask the patient to squeeze the examiner’s finger
11
Q
Tests for the involvement of lumbar nerve roots
A
- Presence of neurological deficits
- Muscle strength
- toe walk: calf muscle, mostly S1 nerve root
- heel walk: ankle and toe dorsiflexion, mostly L5 and some L4 nerve toot
- a single squat and raise: quadriceps muscle, mostly L4 nerve root - Reflexes
12
Q
Diagnostic investigation of lower back pain
A
- Plain X-ray spine: spinal degenerative changes
- CT scan: spinal stenosis
- MRI: spinal stenosis; extrusion of disc material into the spinal canal and impingement of a spinal nerve root
- EMG: test the muscle response to nervous stimulation via needle electrode; for peripheral nervous system
13
Q
Medical treatment for lower back pain
A
- Maintain bed rest (for 2-4 days)
- Regular change of position: supine or lateral (on the unaffected side to reduce tension on sciatic nerve)
Xxx prone position or sleep with thick pillow - Apply ice in the first 48 hrs (relieve pain); and hot pad after the first 46 hours ( to relax muscle and increase blood flow)
- Administer muscle relaxant and analgesic regularly
- Refer to PT
14
Q
Pre-op care for laminectomy and disectomy
A
- Assess baseline neuromuscular function of the affected side
- Check correct marking
- Teach family of the technique of logrolling method of turning
15
Q
Post-op for for laminectomy and disectomy
A
- Monitor for hemodynamic status, any haemorrhage, check vital signs, any CSF leakage (test for glucose if bulge or clear drainage)
- Pain management: assess pain level and patient controlled analgesia for the first 24-48 hours
- Positioning: slightly elevated the bed head; use of pillow to reduce pressure; avoid lying on the side of surgical incision site
- Turning: logrolling every 2-4 hours; avoid twisting the spine and hip
- Sit out of bed: apply corset; xxx sit more than 1 hour a time in the first 2 weeks
- Monitor neuromuscular status (compare bilaterally), colour, temperature and sensation
- Monitor s/s of cauda equina syndrome: urine retention (should void within 8hrs); loss of sphincter control; anal numbness
- Observe and report for deep vein thrombosis; encourage leg and feet movement; wear compression stocking
- Use of fracture bedpan; assess for return of bowel function; use of stool softener
- Limit sitting time to 15-20mins for at least 3 weeks; apply heat; weight control
16
Q
Level of spinal cord injury
A
- C1-3: usually fatal; no respiratory function
- C4: require breathing assistance
- T1 or below: loss of bladder, bowel and sexual functions
17
Q
Complete spinal cord injury
(Grade A)
A
No voluntary anal contraction
No sensation in S4-5
No deep anal pressure
18
Q
Acute care for spinal cord injury
A
- Immobilisation of vertebral column
- Monitor vital signs
- C1-3: apnoea, unable to cough
- C4: poor cough, diaphragmatic breathing, hypo ventilation
- C5-T6: poor respiratory reserve
- for cardiovascular, injury above T5 has symptoms of hypotension, postural hypotension, bradycardia, absence of vasomotor tone
19
Q
Collaborative therapy for spinal cord injury
A
- vertebroplasty
- neck collar
- halo vest
—> inspect the pin of the halo traction ring for any loose and sign of infection
—> loosing one side of the vest to check the skin for pressure points, redness, swelling, bruising or sore
