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OMM Lecture > Lumbar II > Flashcards

Lumbar II Flashcards

1
Q

Questions to ask when forming differential diagnosis

A

. How severe symptoms are
. Is there traumatic anatomic damage
. Is there serious underlying medical condition
. DO symptoms have progressing neurologic involvement
. Is patient child, elderly, or high risk

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2
Q

Non mechanical differential diagnoses for back pain

A 
. 1%
. Neoplasia
. Infection
. Inflammatory arthritis
. Metabolic bone disease
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3
Q

Referred pain differentials of low back pain

A

. GI
. GU/reproductive
. cardiovascular

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4
Q

Mechanical differentials for LBP

A 
. Sprains
. Somatic dysfunction
. Fracture 
. Spondylolsis
. Facet syndrome 
. Spinal stenosis
. Disc issues 
. Congenital 
. Instability 
. 97% of cases
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5
Q

Characteristics of mechanic LBP

A

. Assoc. w/ bending/twisting
. Better w/ rest
. Pain varies w/ motion, position
. Assoc. w/ dec. range of motion, muscle spasm, trigger points in muscle, tendinitis or joint inflammation
. Strongest predictor of future mechanical LBP is history of previous mechanical LBP

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6
Q

Strain

A

Tendon inflammation

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7
Q

Sprain

A

Ligament back pain

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8
Q

Only consider xrays for mechanical LBP if ____

A

. Patient over 50

. There is additional medical info that raises suspicion for organic disease

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9
Q

T/F don’t treat X-ray, adults will have radiographic findings but are asymptomatic

A

T

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10
Q

Consider non-mechanical/systemic disease as underlying cause of LBP if _____

A 
. Abnormal vitals 
. History of cancer
. Spinal infection
. Prolonged steroid use 
. history of IV drug use 
. UTI
. Unexplained weight loss 
. Old
. Night pain or sweats
.  No pain relief w/ rest
. Failure to respond to standard therapies 
. Osteoporosis
. immunocompromised
. Rheumatologist disorders
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11
Q

WHen to consider diagnostic imaging and laboratory tests

A 
. Young patients under 18
. Patients over 50
. Trauma 
. Neurological deficit
. Fever
. Unexplained weight loss
. Cancer history
. Drug use history
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12
Q

Bat wing deformity

A

. Enlargement of 1 or both transverse processes of L5

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13
Q

Sacralization of L5

A

. Partial or complete fusion of 5th lumbar vertebra w/ sacrum
. Causes fewer moving lumbar segments that inc. mechanical stress at remaining lumbar levels

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14
Q

Lumbarization of S1

A

. Partial or complete separation of S1 from sacrum
. Patient functionality has 6 lumbar vertebrae
. Causes lumbo-sacral instability

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15
Q

Spina bifida

A

. Most common birth defects w/ incidence os 1-2 cases/1000 births
. Incomplete closing of embryonic neural tube
. Vertebra overlying spinal cord not formed and remained infused and open
.most common areas: lumbar and sacral
. Detected during pregnancy by testing mother’s blood (AFP screening) or detailed fetal ultrasound

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16
Q

Spina bifida occulta

A 
. Mildest form 
. Hairy patch on skin
. Dark spots or birth marks 
. Red/purple spot on back composed to blood vessels 
. Dimpling in back 
. Less skin color than other areas
17
Q

T/F disc repair is less efficient than other tissues

A

T

18
Q

Lumbar disc disease

A

. Compromised disc causes LBP
. Causes: multifactorial from wear and tear, trauma, or genetic causes
. Due to low energy injury of disc that progresses w/ time
. At least 30% people from 30-50 have some degree of disc degeneration
. Routine finding after 50 y/o

19
Q

Disc bulge mechanics

A

. Flexing forward motions inc. lumbar intradiscal pressure
. Repetitive/excessive force causes bulging/herniation in thinner post. Or posterolateral wall
. Invades space by nerve root
. Neurological signs may be present

20
Q

Radicular pain

A

. Annular tearing, compression of nerves or root sleeve from arthritic spurs or degenerating joints
. Most common it L4-5, L5-S1

21
Q

Radiculopathy considerations

A

. Consider MRI/surgical consult if they have significant neurologic deficits
. Surgery if large disk protrusion, spinal cord compression, worsening neuro deficits
. Contraindication for OMM (soft tissue finer, no HVLA or rotational maneuvers)

22
Q

Neurologic signs assoc. w/ LBP

A

. Motor loss
. Sensory loss
. Loss of deep tendon reflex

23
Q

Heeel walking checks which nerve root?

A

L4, ankle dorsi flexion

24
Q

Tow walking checks which nerve root?

A

. Ankle plantarflexion

. S1

25
Q

What nerve root is checked by great toe extension

A

L5

26
Q

Bragard test

A

. Modification of SLR involving dorsi flexion of ankle

. Has reticular symptoms when leg is raised or when ankle is doriflexed

27
Q

Contralateral straight leg test (contralateral laseque)

A

. Lift leg on uninvolved side
. Reproduces symptoms in involved side legs
. More specific than SLR but less sensitive for radiculopathy

28
Q

Nachlas test

A

. Differentiates btw femoral nerve, disc disease, radicular symptoms, lumbar ligamentous strains. And SI pathology
. Patient prone w. Knee bent until heel approaches ipsilateral butt
. Affects L2-3 and L3-4 discs and stretches lumbar nerve roots irritating femoral nerve
. If no symptoms, lift thigh off table w/ knee flexed and hold 1 min to stress lumbar dura (pos. If symptoms seen in but and post. Thigh)
. If pain in ant. Thigh it is pos. For tight quads and stretching for femoral nerve (Ely’s test)

29
Q

Screening tests done first for lumbar somatic dysfunction

A 
. Standing structural exam 
. AROM
. Standing flexion test
. Pelvic side shift 
. Seated flexion
. Modified Thomas test and prone psoas tests
30
Q

Lumbar segmental motion

A

. Sagittal plane
. Extension more than flexion bc of lumbar lordosis
. Considerably less rotation and sidebending
. Limited at L1-4 sue to z-joint shapes
. L5 permits more rotations due to it’s facet joints

31
Q

Lumbar segmental motion testing

A

. Prone or seated (prone easier, seated can assess flexion/extension)
. Use same naming as thoracic

32
Q

Prone lumbar segmental motion testing

A

. Rotate segments L and R
. Sidebending: apply lat. translation R and L
. Flexion and extension: downward pressure over spinous process
. Resistance to pressure is flexed, excess freedom is extension
. Patient also can prop themselves up using elbows to test extension, laying flat is flexed

33
Q

Seated lumbar segmental motion testing

A

. Similar to thoracic

. Important bc many LBP patients cannot lie prone

34
Q

Disc L3-4 root, reflex, muscles, and sensation

A

. L4 root
. Patellar reflex
. Ant. Tibialis muscles
. Medial leg and foot

35
Q

L4-5 disc root, reflex, muscles, and sensation

A

. L5
. No reflex
. Extensor hallucis longus
. Lat. leg and dorsum of foot

36
Q

L5-S1 disc root, reflex, muscles, and sensation

A

. S1
. Achilles reflex
. Proneus longus and brevis muscles
. Lat. foot sensation

OMM Lecture (16 decks)

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