Lumbar I

Question 1

Red flags in correlation w/ LBP

Answer 1

. Tumor/cancer
. Infectious disease
. Fracture
. Progressive focal neurological deficits
. Bowel incontinence, bladder incontinence, saddle anesthesia
. Medical causes (aortic aneurysm, renal stones, pyelonephritis)

Question 2

Lumbar vertebral ligaments

Answer 2

. Annulus fibrosis
. Capsular ligaments
. Ant. And post. Longitudinal ligaments
. Ligamentum flavum
. Interspinous and supraspinous ligaments
. Determine limits of motion comprising the anatomical barrier

Question 3

An L5 disc pushes on what spinal nerve root?

Answer 3

S1

Question 4

What kind of dis bulge impinges on spinal roots?

Answer 4

Posters-lateral bulge

Question 5

What substance do degenerating discs lose?

Answer 5

Water

Question 6

Dominant posterior lumbar muscle

Answer 6

Multifidus

Question 7

Deep lumbar muscles

Answer 7

. Rotatores and multifidus (sidebend and rotate in opposite directions, travel down laterally from spinous process)
. Tissue texture change most specific muscular indicator of segmental somatic dysfunction because they receive innervation from least number of spinal segments

Question 8

Action of erector spinae

Answer 8

Extend and secondarily sidebend

Question 9

Quadratus lumborum

Answer 9

. Sidebends

. Stabilizes lower ribs in respiration

Question 10

Psoas

Answer 10

. Flexes T-L junctions
. Extends L-S junction
. Lat. stabilizer
. Primarily flexes hip
. Prevertebral muscle
. Balances lumbar sine and pelvis on femur
. Tight one can affect lumbar spine, sacrum, and hip

Question 11

Inf. Portion of sympathetic location

Answer 11

Upper lumbar

Question 12

Parasympathetic have ___outflow

Answer 12

Sacral outflow

Question 13

Nociceptor fibers in lumbar area pathway

Answer 13

. . Ascend in sympathetic trunk and synapse in thoracolumbar area

Question 14

Femoral nerve

Answer 14

. Lumbar plexus (L2-4)
. Roots pass through substance of psoas muscle
. Psoas dysfunction can result in ant. Thigh symptoms

Question 15

Sacral plexus

Answer 15

. Sacral outflow plus lumbosacral trunk

. Forms sciatic n.

Question 16

Facet tropism

Answer 16

. Unequal size and facing among facets
. Usual reference is lumbosacral junction
. Lumbosacral facets are normal coronal, lumbar is sagittal
. Is lumbosacral facets asymmetric, one will be sagittal and one will be coronal

Question 17

Spondylolysis

Answer 17

. Defect in vertebral arch btw sup. And inf. Facets (pars interarticularis)
. When bilateral the vertebra is in 2 pieces
. Post. Piece: laminae, inf. Articular processes, spinous process
. Ant. Piece: remainder of vertebra
. Congenital, brought on by vigorous physical activity
. SI pain common, but treat SI joint and pain persists is indicator

Question 18

Spondylolisthesis

Answer 18

. When bilateral spondylosis exists and ant. Portion of vertebra is displaced by ant. Inf. Gravity
. Detected by step sign: depression of spinous process compared w/ one below it
. Lateral x-ray best view
. Commonly L5-S1
. Treatment is active lifestyle

Question 19

Spondylolsthesis grading

Answer 19

1: 1-25% forward slippage
2: 26-50% forward slippage
3: 51-75%
4: 74-100%

Question 20

Psoas major

Answer 20

. Attaches to ant. Portion of lumbar spine and diaphragmatic crura
. Passes under inguinal ligament and is joined by iliacus muscle and attaches to lesser trochanter
.

Question 21

Psoas minor

Answer 21

. Absent in 40% of patients

. Connects lumbar spine to pelvis

Question 22

Psoas function

Answer 22

. Balances lumbar spine and pelvis on femur
. Hip flexion
. Long restriction muscle (hypertonicity compresses hip, SI joint, and lumbar spine)
. Assists w/ postural balance

Question 23

Psoas dysfunction

Answer 23

. Tight
. Sit ups make it worse
. Postural imbalance (bilaterally tight moves pelvis forward in sagittal plane, unilateral causes patients to look bent at waist)

Question 24

Psoas in pelvic sideshift test

Answer 24

. Tight on left, shift on right, lumbar curve convex left, sacrum sidebend left to accommodate

Question 25

Components of psoas diagnosis

Answer 25

. Restriction of hip extension
. Ipsilateral upper lumbar (L1-2) flexed, rotated, and sidebend to side of shorter psoas
.