LBP and HNP Flashcards
(42 cards)
localized LBP - mech w/p radiation below the knee
- non-specific muscular/ligamentous injury
- SD
- degen disc disease
- degen joint disease
- spondylolithesis
- fracture/spondlylolysis
localized LBP - mech with radiation below the knee
- cauda equina syndrome
- radiculopathy
- spinal stenosis
localized LBP - non-mech
- infection
- neoplasm
- inflamm
referred LBP
- GI disease
- renal disease
- gynecological
- vascular
- pyschological
relief only with complete immobility suggests what ddx?
- acute infection
- compression fracture (metabolic bone disease)
- pathologic fracture (tumor or infiltrative disease)
pain worsens with prolonged sitting suggests what ddx?
herniated disc
pain worsens with prolonged standing and extension suggests what ddx?
shopping cart sign - spinal stenosis
no position is comfortable suggests what ddx?
psychogenic pain - not well localized, follows no pattern, is constant, and patients can’t describe alleviating nor aggravating factors
radiating pain with extension suggests what ddx?
stenosis
radiating pain at rest suggests what ddx?
disc herniation
stiffness and pain upon waking suggests what ddx?
inflamm arthropathies
intense night time pain suggests what ddx?
bone tumors
red flags - would not treat these patients if these sx present
- bowel or bladder dysfx
- saddle anesthesia
- b/l weakness or numbness in legs
- acute neuro deficits in patients with cancer
- progressive or severe neuro deficit
- LBP along with a fever in a patient who uses IV drugs
yellow lights - gently treat patient during first visit if these sx present
pos straight leg raise test
latissimus dorsi
- originates in the thoracolumbar fascia, iliac crest, and spinous processes of lower 6 thoracic vertebrae
- inserts on intertubercular groove of humerus
- connects lumbar, thoracic, and pelvic regions to UE
- factor in cases of LBP combined with shoulder pain
quadratus lumborum
- origin: iliolumbar ligament and iliac crest
- inserts: L1-4 transverse processes and ant. surface of 12th rib
- considered a posterior inferior extension of the abdominal diaphragm
iliopsoas
- origin: vertebral bodies and anterior surfaces of transverse processes of lumbar spine
- inserts: lesser trocanter of femur
- often causes pain but inaccessible
sacro-iliac joint
- potential contributor to LBP
what compromises the intervertebral foramina and disc?
- arthritis
- ligament hypertrophy
- disc degen
- mm imbalance
- inherent tissue qualities
- SD
herniated nucleus pulposus - anatomy
intervertebral disc
- mostly water
- few pain fibers
- compression pressure balanced by hydrostatic forces
- annulus fibrosus and nucleus pulposus
disc herniations commonly occur in which direction?
posteriorly, paracentrally or parasagitally
- anterior longitudinal ligament much thicker and stronger than posterior
- posterior longitudinal ligament prevents central herniation
most common vertebral level for herniated disc?
L5-S1 and L4-5
- undergo most motion and stress
- posterior longitudinal ligament more narrow
why does disc herniation commonly affects the nerve root below?
- pedicles of the lumbar vertebra protect a nerve from being injured by the disc at its own level
clinical features of L4-5 herniated disc
- pain: over SI joint, hip, lateral thigh and leg
- numbness: lateral leg and first 3 toes
- weakness: dorsiflexion, walking on heel
- atrophy: minor
- reflex: internal hamstring reflex diminished or absent
