Lumbar Pathologies (PPT 5)

Question 1

What happens to the nucleus in intra-spongy nuclear herniation

Answer 1

-nucleus displaced in vertebral body thru cartilaginous endplate

Question 2

What is a cause of ISNH

Answer 2

mod to severe flexion trauma

Question 3

What are the four grades of ISNH

Answer 3

1: subchondral fx in vertebral body
2: small cracks in endplates
3: crack and bone shifted
4: crack, bone shift, and disc leaks

Question 4

What happens to the nucleus in HNP protrusion w/o n root involvement

Answer 4

discrete bulge in outer annulus

Question 5

Where is HNP protrusion w/o n root involvement commonly found at

Answer 5

L4-L5 and L5-S1

Question 6

What movement causes HNP protrusion w/o n root involvement

Answer 6

cumulative forward bending and lifting
-sitting slumped in bent posture

Question 7

Characteristics of HNP protrusion w/o n root involvement pt

Answer 7

30-50, male

Question 8

What are relieving and agg factors of HNP protrusion w/o n root involvement

Answer 8

relief: standing and walking

agg: sitting

Question 9

Pt presentation of HNP protrusion w/o n root involvement

Answer 9

-pain greater on one side
-refer pain in leg usually unilat (dermatomal pattern)
-gradual onset
-norm neuro
-involved seg tender
-lat shift and flat lordosis

EXT limited

Question 10

Describe the nucleus for HNP protrusion w/ n root involvement

Answer 10

-nucleus bulges but still contained within annulus and PLL
-bulge intrudes into spinal canal and/or vertebral foramen

Question 11

Which nerve root does a HNP protrusion w/ n root involvement impinge

Answer 11

segment level BELOW bulge

Question 12

Findings for HNP protrusion w/ n root involvement

Answer 12

-pain greater on one side
-refer pain in leg usually unilat (dermatomal pattern)
-gradual onset
-norm neuro
-involved seg tender
-lat shift and flat lordosis

EXT limited

AND positive neuro s/s

Question 13

What neuro s/s would you find in HNP protrusion w/ n root involvement

Answer 13

-decreased myotome strength
-decreased DTR
-loss sensation
- (+) SLR

Question 14

Describe how the pt will shift with a lateral or medial n root involvement for HNP protrusion

Answer 14

-HNP lateral, pt shifts opp
-HNP medial, pt shifts toward

Question 15

What needs to be corrected first before McKenzie in HNP protrusion w/ n root involvement

Answer 15

protective scoliosis

Question 16

What happens to nucleus in HNP extrusion

Answer 16

nuclear material escapes into spinal canal

Question 17

What color is white and black in MRI

Answer 17

white = healthy

black = disc desiccation

Question 18

What are the findings for HNP sequestration

Answer 18

-peripheral s/s likely greater than spinal s/s
-pain from disc bugle gone

Question 19

Pathophysiology of DDD (4)

Answer 19

-dehydrated NP
-narrow intervertebral space
-weakening of degen. annular rings
-facets approximate

Question 20

DDD findings (3)

Answer 20

-tender at segmental levels
-early stage (A/PROM restricted)
-advanced stage (pain w/ any movement, hypermob)

Question 21

MOI of facet impingement

Answer 21

SUDDEN unguarded movement w/ ext, SB and/or rot
-little to no trauma

Question 22

Clinical findings of facet impingement (6)

Answer 22

-ease = rest
-agg = movement
-intermittently LOCKED protective posture
-AROM decreased in 3/6 ranges, w/ end range pain
-single seg involvement
-TTP

Question 23

Which directions would be agg/limited for facet impingement

Answer 23

ipsilat SB and contralat rot

Question 24

What is key to identify facet sprain

Answer 24

pt’s hx

Question 25

How does a facet sprain occur

Answer 25

progression of repetitive facet impinge

Question 26

S/S of clinical instability

Answer 26

-recurrent BP -constant when exacerbated, catch/lock -unprovoked repeated episodes -minor ache AFTER sensation of giving way -consistent click/clunk -protracted pain w/ FULL ROM -excessive AROM

Question 27

Agg postures and movements for instability

Answer 27

-sustained sit, prolong stand, semi flexed pos -forward bend, sudden movement, return upright from bending, lift/sneeze

Question 28

4 examples of DJD

Answer 28

-calcific deposits in and around jt periphery -wearing away of hyaline cartilage -thickening of synovial jt and jt capsule -thickening of subchondral bone

Question 29

4 signs of DDD

Answer 29

-dehydrated NP -narrowing intervertebral space -weaking and degen. annular rings -approx facets

Question 30

What is spondylolysis

Answer 30

defect of pars interarticularis

Question 31

Findings of spondylolysis

Answer 31

-STEP OFF of SP can be felt -hyperlordosis -pain prolong stand -relief w/ sit -original onset from vig act or athletics when younger

Question 32

What is spondylolisthesis

Answer 32

-forward displacement -common L5-S1

Question 33

Describe the grades of spondylolisthesis

Answer 33

G1: 1-25% G2: 26-50% G3: 51-75% G4: 76-100% G3 and 4 cause cauda equina symps

Question 34

What is n root compression? Describe the pain

Answer 34

-impinged/irritated n root -causes true neuro s/s -deep and superficial burning of one n root

Question 35

N root swelling and inflammation findings

Answer 35

true neuro signs

Question 36

How does nerve root swelling and inflam occur

Answer 36

-insidious onset -accompany mus and jt inflam -following severe injury within a few day s

Question 37

nerve root adhesion findings

Answer 37

marked absence of STANDING flexion -little to no restriction in sit or supine -disc protrusion signs NOT present

Question 38

What is ankylosing spondylitis

Answer 38

-systemic inflam process -progressive jt sclerosis and lig ossification

Question 39

ankylosing spondylitis pt characteristics

Answer 39

20-35 yo male

Question 40

Findings of ankylosing spondylitis

Answer 40

-chronic -initially vague LBP and stiff -worse waking and eased with light exercise -onset insidious, no MOI -flat of lumbar lordosis and increased t/s rounding

Question 41

UMN or LMN for cauda equina

Answer 41

young: UMN adult: LMN

Question 42

Clinical prediction rule for lumbar stability tx

Answer 42

-SLR > 91 degrees + prone instab test + aberrant movements age < 40 yo

Question 43

Manip. successful intervention

Answer 43

< 19 on FAB-Q symps 15/16 days or less no symps distal to knee l/s hypomobility any level hip w/ >35 degree IR