Flashcards in Low Back Exam Deck (49):
What are the goals of a PE?
1. Determine the symptoms do not represent life or function threatening
2. Where pain is coming from
What are the four causes of LBP?
1. Referred pain
2. Activity related pain
3. Non-activity related
What is lumbago?
What is sciatica?
Pain in the lower back and hip, radiating down the thigh and into the leg. Is a descriptive term for a distribution of pain, not a diagnosis.
What is the cause of sciatic nerve neuropathy?
Foot and ankle paresthesias = ?
What causes a leg radiculopathy?
L5/S1 nerve compression by herniated disc
SI joint ligament pattern can cause what?
Steadily increasing back pain, especially in the elderly, could suggest what?
Continuous pain, not altered by posture or movement is suspicious for what?
True or false: isolated pain in the upper lumbar region is generally not concerning
false--could be AAA
What is spondylolysis?
Breakage of a vertebral segment
Scottie dog appearance on x-ray = ?
Why is coughing or sneezing that worsens back pain concerning?
Increased abdominal pressure leads to pressure on the spine
Back pain with lying down or wakes up at night (not relieved by turning over) is concerning for what?
Why is asking about function important with LBP?
See how bad it really is
Assess what needs to be done
Pt failing to improve is suspicious for what?
Heel and toe walking assess what?
What does the Adam's forward bending test check for?
Flexion of the spine loads the anterior or posterior parts of the spine?
Extension of the spine loads the anterior or posterior parts of the spine?
Flexion of the spine stretches the anterior or posterior parts of the spine?
Extension of the spine stretches the anterior or posterior parts of the spine?
What does side-bending spine load?
The facets of either sides, closing the neural foramen
What does ROM of the spine check for?
Non specific muscles
What is the capsular pattern for the lumbar spine?
limited ROM in all directions
What does capsular pain indicate?
Toe walking = which nerve root?
Heel walking = which nerve root?
Single leg calf raises checks for what nerve levels?
Weakness or inability to perform heel/toe walking without an explanable condition =?
Acute plantar fasciitis
Why is fixation of the back in lordosis with flexion of the lumbar spine concerning?
may indicate fusion of the spine, like ankylosing spondylitis
What does the slump test check for?
Dural tension for the sciatic nerve root
True or false: when looking at reflexes we need to look for only the maximal response
False--one that is most reproducible (and maximal)
What if LE MSR are brisk?
Look at UE reflexes to localize the issue
True or false: symmetric absence of Achilles is increasingly common with age
When are reflexes/sensory signs particularly concerning?
What does the FABER test check for?
SI joint pain
What are the positive signs for the FABER test?
Anterolateral hip region (hip path)
Posterior (sacroiliac) pain
SLR tests for what?
L4, L5, or S1 nerve root irritation vs hamstring pain
Positive SLR is what?
Pain that goes down the back of the leg and into the foot/ankle
What is Bragard's test?
Dorsiflex the foot in SLR. Confirms positive or ambiguous SLR
SLR is a sign of what?
Dural tension/pulling on sciatic nerve roots
How can you quickly assess for claudication?
check peripheral pulses
What is the buttock sign?
hip flexion more painful than SLR
Femoral nerve stress test is what?
Positive is what?
Checks for femoral nerve irritation (L2, L3, or L4)
Positive = pain or paresthesias along anterior/medial leg
False positives with femoral nerve stress test is what?
Axial spine pain d/t facet joints
OA of the hip
Step-off signs along the spine indicates what?