Lumbar/Sacral Conditions

Question 1

How is lumbar facet syndrome different from joint dysfunction

Answer 1

joint dysfunction would have no referred pain, just localized pain

Question 2

Lumbar facet syndrome positive orthos

Answer 2

Kemps (referral into the buttocks), painful PROM and AROM in extension, relieving in flexion, localized low back pain

Question 3

Lumbar sprain/strain most common cause

Answer 3

Falling injury or overuse injury

Question 4

Lumbar sprain/strain positive orthos

Answer 4

painful AROM

Question 5

SI joint dysfunction/syndrome

Answer 5

Trauma or prolonged sitting, pain with sit-to-stand and with extension, relieved with flexion (common in gymnasts and dancers - hypermobile lumbar)

Question 6

SI joint dysfunction/syndrome orthos

Answer 6

Thigh thrust, SI distraction, SI compression, and motion palpation are all painful

Question 7

Lumbar disc herniation

Answer 7

Breaking down of the annular fibers (internal derangement), protruding of nucleus pulposis (disc herniation), may experience NTW in a particular nerve root, slap foot/foot drop, antalgic position away from injured side

Question 8

Lumbar disc herniation orthos

Answer 8

Flexion painful, extension relieving, Slumps, SLR, valsalva, braggards, bow string, may have loss of reflexes and motor or sensory isues

Question 9

What direction of lateral flexion would make a trigger piont worse in the QL

Answer 9

Towards it

Question 10

Spondylolisthesis

Answer 10

Usually asymptomatic, increased lordosis, weak anterior core and tight hamstrings

Question 11

Spondylolisthesis types

Answer 11

Type I: isthmic, stress fracture in the pars (childhood)
Type II: Degenerative, elongation of the pars
Type III: Dysplastic, a congenital defect of the facet
Type IV: Traumatic, slip, and fall
Type V: Pathologic, cancer

Question 12

Spinal stenosis

Answer 12

Central stenosis: posterior osteophytes or central disc herniation (bilateral symptoms), shopping cart sign
Lateral stenosis: degenerative spondylolisthesis or severe facet degeneration (unilateral symptoms), relief when bending away

Question 13

Spinal stenosis orthos

Answer 13

SMRs affected, painful extension, flexion relieving (shopping cart sign)

Question 14

Vascular claudication

Answer 14

Too little blood flow to the legs, arteries narrowed (atherosclerotic), pain after walking for some time, relieved by rest

Question 15

Vascular claudication orthos

Answer 15

Measure pulse, ankle-brachial index (<0.90), exercise testing, doppler ultrasound

Question 16

Cauda Equina syndrome

Answer 16

Due to central stenosis or disc extrusion, low back and leg pain, anal and reproductive organ numbness, loss of bowel or bladder control (rapid or gradual)

Question 17

Cauda Equina Syndrome orthos

Answer 17

Anal wink test, MRI, SMRs