Lecture 5 Flashcards
(122 cards)
1
Q
What are the causes for nonspecific back/neck pain
A
- postural back/neck pain
- 70-90% of originates form some form of POSTURAL/ERGONOMICAL STRESS and does not originate form specific or systemic pathology
2
Q
how much does back/neck pain are due to specific orthopedic pathology
A
10-30% originates from specific orthopedic pathology
3
Q
how much does back/neck pain are due to systemic pathology
A
1-2% originate form systemic pathology
4
Q
what are some systemic pathologies that can cause back/neck pain
A
- emergent spinal conditions
- trauma/fracture
- cauda equina syndrome - cancer
- infection
- epidural spinal abscess
- vertebral; osteomyelitits
5
Q
what are the PT applications for treating systemic pathologies back/neck pain
A
- “good news”
- systemic pathologies is relatively rare
- most of the time its due to orthopedic or psotural conditions
- “bad news”
- difficult to treat with lab/imaging work - good physical therapy exam can effectivetively screen for systemic conditions
6
Q
patients with spinal fractures instability caused by severe trauma DO NOT present directly to PT (T/F)
A
true
7
Q
Spinal fractures/instability caused by LESS SEVERE trauma present DIRECTLY to PT (T/F)
A
true
- subtle C1-C2 instability or dens fracture (thinks its neck pain)
8
Q
what are some relative trauma for vertebral compression fracture (VCF)
A
- severe osteoporosis - caused by simple ADLS (slipping off a curb, sneezing, cough)
- moderate/mild osteoporosis - caused by activities caused by force (tripping, lifitng objects)
- trauma
- healthy bone density - VCF are caused from high impact trauma
9
Q
what are the risk factors to look for in the patients medical history for emergent spinal conditions
A
- patient has been diagnosed with OSTEOPOROSIS or w/ risk factors of it
- patient is over the age of 50
- history of vertebral fractures
- patient has obvious bone pathology - cancer
10
Q
what is a grade 1 VCF
A
20-25% loss of heigh (LOH)
11
Q
what is a grade 2 VCF
A
25-40% loss of height (LOH)
12
Q
what is a grade 3 VCF
A
more than 40 % loss of height
13
Q
what are the treatments for vertebral compression fracture (VCF)
A
bracing for severe fracture
verterbroplasty - inject cement into fracture
kyphoplasty - insert ballon to restore height
14
Q
what is cauda equina syndrome
A
a rare emergent condition caused by compression of cauda equina (multiple lumbosacral nerve roots)
15
Q
what is the most common cause of cauda equina syndrome
A
severe disc herniation
16
Q
what are some signs/symtoms of cauda equina syndrome
A
- may develop gradually or rapidly
- urinary retention
- bowel incontinence
- saddle “anethesisa”/ parathesia
- Combo of weakness/numbness and bladder dysfunctions should be assessed for early CES
17
Q
what is the classic sign that a patient will present of cauda equina syndrome
A
if they present with a combo of LEG WEAKNESS/NUMBNESS + BLADDER DYSFUNCTION should be assessed for EARLY CES vs just an ortho problem
18
Q
what is the management for CES
A
- go to the ER
- GET AN MRI = GOLD STANDARD
19
Q
what is the prognosis for CES
A
untreated then IRREVERSIBLE NERVE DAMAGE
early surgical intervention
20
Q
what are primary spinal tumors (benign/malignant)
A
originate in the spine
rare and represent a small percentage of spinal tumors
21
Q
what are metastatic spinal tumors
A
originate from other areas (lung, prostate, breast, ect)
represent a majority of spinal tumor
22
Q
(T/F) back/neck pain is most common symptom of spinal cancer
A
true
23
Q
what is the initial sign of spinal tumor?
A
LOCALIZED and often starts as “night pain”
usually INSIDIOUS
24
Q
what are the physical exam findings for cancer with back/neck pain
A
- usually not consisitent
- PAIN PROVOKING/RELIEVING PATTERNS NOT CONSISTENT W/ PHYSICAL MOVEMENTS/POSTIONING
25
if a patient with cancer consult is with/refer to a medical provider if PERSISTENT BACK/NECK PAIN and >1 of the following:
1. current/recent history of cancer
2. over the age of 50
3. physical exam findings not consistent w/ postural/orthopedic patho
4. failure of conservertive treatment for back/neck pain
26
what is the treatment for cancer patients w/ back/neck pain due to systemic pathologies
1. radiation + surgery
2. surgical options
- decompression and stabilization
3. radical tumor resection
27
what is an epidural spinal abscess ?
RARE BUT SERIOUS infectious abcess that grows in the epidural space and causes back/neck pain
28
what are the risk factors of epidural spinal abscess
most common IV drugs use and diabetes
29
where is the location of epidural spinal abscess
thoracic or lumbar spine
30
what is the rate progress for symptom of epidural spinal abscess
progression is variable
31
what are the symptoms of epidural spinal abscess
back (most common)
pain
motor weakness
fever
progressive neurological deficits
32
what are the physical examinations for epidural spinal abscess
hyper reflexia
spasticity/paresis below level of lesion
saddle parasthesia
33
what test/imaging/lab work would detect the highest level of suspicion for epidural spinal abscess
MRI
34
what are the treatments for epidural spinal abscess
urgent antibiotic
urgent surgery
35
what are the prognosis for epidural spinal abscess
early diagnosis
the extent of the abscess
neurological deficits
irreverisble paralysis
36
what is vertebral osteomyelitis
acute/chronic infection of bone
(staph A)
37
what are the risk factors for vertebral osteomyelitits include
immunocompromised state
IVE drug use
endocarditis
age
38
what are the symptoms of vertebral osteomyelitis
back/neck pain
fever
fully progress within 2 weeks
39
what are some physical examinations for vertebral osteomyelitis
localized tenderness
may or may not have redness warm
negative neuro screen unless severe
40
what is the best way to see if a patient has vertebral osteomyelitis (labs/imaging)
MRI
x-ray is helpful but not diagnositic
41
what is the treatment for vertebral osteomyelitis
antibiotics
surgical debridement of infection
42
what is the prognosis for vertebral osteomyelitis
good prognosis if early
chronic osteomyelitis, reoccurance is likely to occur 30-50% of the time
prosthetic devices are more difficult to treat and reduces chances of favorable outcomes
43
what is osteoarthritis (spondylosis)
bone spurs along facets joints and loss of disc height and function
44
how would a patient with OA present
over the age of 50
repeated episodes of back/neck pain
if their symptoms are worse in the morning or prolong postural position (standing)
better with movement (MOTION IS LOTION)
45
what are the physical examinations for pt w/ OA
observation/gait
ROM = TRUNK EXTENSION LIMITED AND PROVOKES PAIN
TRUNK FLEXION “FEELS GOOD” TO STRETCH
NEURO SCREEN IS NORMAL
46
what are the special tests for examing pt w/ OA
radicular tests (SLR and PKB) negative
47
what are some goals for PT intervention for OA
Modalities and manual interventions
Optimize ROM
Therapeutic exercises focused on ADLS
Modify daily activities
ORTHO/NEURO CONSULT = if they have severe OA
48
what is spinal stenosis
bony narrowing of vertebral cancal or intervertebral foramen (IVF) at multiple levels
49
what are the types of spinal stenosis
acquired = OA
congential = abnormal vertebral growth /development
50
what are some patient prtesentations for spinal stenosis
leg pain and limping (claudication)
- provoked by walking, prolong standing or trunk extension activity
relieved w/ trunk flexion ( leaning forward or walking up a hill)
51
what are the physical examinations for a pt w/ spinal stenosis
gait
leg pain/limping w/ walking (neurogenic claudication) relieved with trunk flexion
vetebral tenderness
EXTENSION PROVOKES LEG SYMPTOMS
52
what are the special tests for spinal stenosis
neurological claudication (nerve root impinged)
vascular claudication (peripheral artery disease)
53
what is neurological claudication for spinal stenosis
flexion relieved symptoms
54
what is vascular claudication (peripheral artery disease) for spinal stenosis
symptoms are relieved with rest
55
what are the goals for PT intervention for spinal stenosis
SAME AS OA
EXACTLY THE SAMER SO SAY IT
56
what are some postive predictors for surgery for pt’s w/ spinal stenosis
male
younger
better gait
better health
less comorbidity
more pronounced canal stenosis
57
what are some negative predictors for surgery for pt’s w/ spinal stenosis
depression
bad walking ability
cardiovascular comorbidity
scoliosis
58
what is the benefit of interspinous spacer implantation for pt’s w/ spinal stenosis
prevents EXT
59
what is spondylolysis
pars interarticularis defect of a vertebra
60
what is spondylolisthesis
pars interarticularis defect w/ anterior displacement of the vertebra
61
what is a grade 1 of spondylolisthesis
0-25%
62
what is a grade 2 of spondylolisthesis
25-50%
63
what is a grade 3 of spondylolisthesis
50-75%
64
what is a grade 4 of spondylolisthesis
75-100%
65
what is a grade 5 of spondylolisthesis
100+%
66
what is isthmic spondylolisthesis (type II)
affects PEDIACTRIC/YOUNGER ADULTS
excess extension forces causes the “break” and produce acute pain
most common in L5/S1
67
what is degenerative spondylolisthesis (type III)
affects OLDER pts
causes SMALL (LESS THAN 30%) IF ANTERIOR DISPLACEMENT of vertebrae
DOES NOT BREAK
68
what are some symptoms isthmic spondylolisthesis (type II)
LBP
repetitive extension activity (gymnastics)
severe cases may have LBP AND RADIATING LEG PAIN
69
what are some physical examinations for isthmic spondylolisthesis (type II)
ROM = limited trunk extension
“step off sign”
neuro screen = negative
70
what is the special test for isthmic spondylolisthesis (type II)
SLR often may not be “positive” but often will reveal “TIGHT HAMSTRING”
71
What will you find in an OBLIQUE VIEW if there is isthmic spondylolisthesis
“Scotty dog” defect
72
What are the goals for PT intervention for isthmic spondylolisthesis (type II)
Remove the pt from activity
Acute symptoms management (bracing)
ROM - restore trunk extension
Safely return to sports
73
What is the type of surgery for isthmic
spondylolisthesis (type II)
Spinal fusion if gross instability and/or progressive neurological deficits
74
What are some physical examinations for degenerative spondylolisthesis (type III)
Similar to OA
“Step off sign”
Positive straight leg raise test
(LBP and radiating leg pain)
75
How can you diagnose degenerative spondylolisthesis (type III)
X-ray
If neuro s/s then MRI
76
What type of surgery would a pt with degenerative spondylolisthesis would need to get
Spinal decompression and fusion
77
(T/F) scoliosis is the most common spinal deformity
True
2-3% of the population
78
What is the lateral curvature for scoliosis
W/ rotational deformity 10 degrees
Based on convexity
79
What is dextroscoliosis
Spinal convexity to the right
MORE COMMON
80
What is levoscolosis
Spinal convexity to the left
81
What is infantile idiopathic scoliosis
3 or younger
Least common
80-90% will spontaneously resolve
82
What is juvenile idiopathic scoliosis
Ages 3-9
Rapid progression may lead to severe deformity
83
What is adolescent idiopathic scoliosis
Most common
Happens at puberty
More common in females than males
84
What are the factors that influence curve progression in adolescent idiopathic scoliosis
Patient sex
Magnitude of curve on presentation
Growth potential
85
What are some physical examinations for adolescent idiopathic scoliosis
Lateral curvature of spine in upright position
Limited lateral flexion
“Rib hump”
Neuro screen = negative
86
What is the special tests for adolescent idiopathic scoliosis
Forward flexion test (Adam’s forward bend test)
A trunk angle of 10 degrees or greater warrants X-ray evaluation
87
What is Cobb angle
“Gold standard” for measuring scoliosis
At least 10 degrees is necessary for diagnosing scoliosis
88
(T/F) Cobb angle is used to monitor progression of scoliosis
True
89
Curve degree (Cobb angle) of 0-19 degrees and Risser grade of 0-4, referral is radiography every 6 months, no referral is needed for what kind of treatment
Observation
90
Curve degree (Cobb angle) of 20-29, risser grade of 0-1, radiography every 6 months, referral to ortho, is required for what kind of treatment
Brace after 25 degrees
91
Curve degree (Cobb angle) of 20-29, risser grade of 2-4, radiography every 6 months, referral to ortho, is required for what kind of treatment
Observe for brace
92
Curve degree (Cobb angle) of 29-40, risser grade of 0-1, referral to orthopedics, is required for what kind of treatment
Brace
93
Curve degree (Cobb angle) of 20-29, risser grade of 2-4, referral to orthopedics, is required for what kind of treatment
Brace
94
Curve degree (Cobb angle) of >40, risser grade of 0-4, referral to orthopedics, is required for what kind of treatment
Surgery
95
What are the goals for PT intervention for adolescent idiopathic scoliosis
Reduce/manage symptoms
PT INTERVENTION IS NOT EFFECTIVE FOR REDUCING SPINAL CURVE
96
What are the benefits of bracing for adolescent idiopathic scoliosis
Intended to minimize/slow progression of curve
97
What type of surgery would be required for adolescent idiopathic scoliosis
Intended to correct(reverse) the curve
SPINAL FUSION - stabilize w/ rods
98
What is radiculopathy
Spinal nerve root impingement due to space occupying lesion (DISC HERNIATION, TUMOR, ABSCESS) in vertebral canal or in the invertebral foramen (BONES SPURS FROM OA)
99
What symptoms will a pt w/ radiculopathy present with?
Radiating pain is primary complaint
(Pain, numbness, burning) that radiates down the leg or arm
Patient MAY, OR MAY NOT HAVE BACK/NECK PAIN
100
What are the most common lumbar nerve roots for lumbar radiculopathy
L5 -> S1 -> L4 radiculopathy
101
What are some physical examinations for lumbar radiculopathy
Pt’s have antalgic gait
Limited trunk flexion that provokes leg symptoms
Neuro screen = dermatomes/myotomes
Decreased DTR
102
What are the special test for lumbar radiculopathy
1. Positive SLR test if L5 or S1 radiculopathy
2. Positive well leg raise sign in severe cases
3. Positive PKB test if L4 (or L2-L3)
103
What is the diagnostic imaging for lumbar radiculopathy
MRI not indicated unless signs of cauda equina, progressive neuro loss or failure to improve after 4-6 weeks of conservative treatment
104
What are the goals for PT intervention for lumbar radiculopathy
Centralization McKenzie treatment
Core stability
Therapeutic exercise , post re-ed
Ergonomic coping strategies/minimize fear avoidance
105
What happens if a pt w/ lumbar radiculopathy does not respond to PT, should consider what surgical management
Micro discectomy/discectomy
106
What are the indications for lumbar radiculopathy
Confirmed disc herniation/cauda equina/progressive neuro loss
Poor quality of life after conservative care
107
What are the common lumbar nerve roots for cervical radiculopathy
C7 -> C6 -> C5 radiculopathy
108
What are the physical exam findings for cervical radiculopathy
Antalgic posture head/neck
Ipsilateral lateral flexion
Vertebral tenderness
Decreased sensation
Decreased DTR
109
What are the special test for cervical radiculopathy
Positive compression or SPURLING’S TEST
Positive distraction tests
IPSILATERAL ROTATION LESS THAN 60 DEGREES
110
What is a positive spurlings compression test
Radiating/radicular pain in the UE
111
What is a negative spurling’s compression test
No pain or local neck pain
112
What is the diagnostic imaging for cervical radiculopathy
MRI not indicated UNLESS SIGNS OF MYELOPATHY, PROGRESSIVE NEURO LOSS OR FAILURE TO IMPROVE AFTER 4-6WEEKS OF CONSERVATIVE TREATMENTS
113
What are the goals for PT intervention for cervical radiculopathy
Centralization (McKenzie treatment)
Core stability
Functional therapeutic exercise
Ergonomic coping strategies
114
If a pt w/ cervical radiculopathy does not respond to PT, what other surgical treatments should they consider
Anterior cervical discectomy and fusion (ACDF)
- more common
Posterior cervical discectomy
- less common
115
What are the indications if a patient w/ cervical radiculopathy does not respond to PT
Progressive neuro loss
Confirmed disc herniation
Decreased of pain/quality of life after conservative care
116
What are pt w/ nonspecific back/neck pain medically classified as ?
Non-specific back/neck pain
117
What are ICD 9/10
Back pain
Cervicalgia
Myalgia
Mechanical back pain
Low back strain
118
What are the physical examinations for non-specific back/neck pain
Posture/gait deviations
Myofascial trigger points
Limited spinal motions
Limited functional movements
119
What are the goals for PT intervention for nonspecific back/neck pain
Modalities/manual therapy
Ther ex
Core stability
Therapeutic exercises
Ergonomics coping strategies
120
Re-evaluate 4-6 weeks for nonspecific back/neck pain if SYMPTOMS RESOLVED
End of story everyone is happy
121
Re-evaluate 4-6 weeks for nonspecific back/neck pain if SYMPTOMS PERSISTS
X-ray indicated
Radicular symptoms than MRI indicated
122
For emergent spinal conditions, why should PT history/exam must always screen for the potential fracture
“When in doubt refer out”
