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Ax Midterm > Lumbar spine > Flashcards

Lumbar spine Flashcards

1
Q

What is Fryette’s 1st Law?

A

In neutral SB and rotation are OPPOSITE

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2
Q

What is Fryette’s 2nd Law?

A

In flexion or extension; SB and Rotation are SAME

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3
Q

What is Fryette’s 3rd law?

A

Movement in 1 plane decreases movement in other planes

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4
Q

What is type 1 lumbar dysfunction?

A

In neutral, many segments (NSR)
Adaptive: repetitive movement, imbalances, tightness
Corrected in both flexion and extension

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5
Q

What is type 2 lumbar dysfunction?

A

Either likes flexion (FRS) or extension (ERS)
ERS= corrects in extension (sphinx)
FRS= corrects in flexion (child’s pose)

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6
Q

How do you determine if a facet is open or closed?

A

You look at the sidebend if SB is R then R facet closed

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7
Q

What are some risk factors of low back pain?

A

Low educational status, stress, anxiety, depression, job dissatisfaction, low levels of social support in workplace

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8
Q

What can trigger acute LBP?

A

Physical factors and/or psychosocial factors

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9
Q

What does the American College of radiology recommend regarding LBP?

A

No imaging for first 6 weeks with LBP unless red flags are present:
recent substantial trauma or milder trauma in those over 50
Weight loss or fever with no known cause, immunosuppression
a previous cancer diagnosis, iv drug use, or osteoporosis
Being over 70 years old
Focal neurological deficit with progressive or disabling symptoms

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10
Q

What are the lumbar pathology pain regions?

A

Back
Buttock
Hip
Thigh
Leg
Foot

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11
Q

What are some signs of Lumbar spine pathologies?

A

LBP
Radiate in buttock, groin, leg, below knee
+/- neuro deficits reported
Pain with prolonged sitting or standing
+/- pain with sneezing
Relieved with rest

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12
Q

What is stenosis?

A

narrowing of vertebral space (better in flexion)

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13
Q

What is spondylosis (degenerative disc disease)?

A

begins in 20s overall OA and stenosis. General term for age related wear tear of the bones, cartilage, ligaments and disc of the spine

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14
Q

What is spondylolisis?

A

no displacement of pars interarticularis. Stress fx or complete fx of pars interarticularis

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15
Q

What is spondilolisthesis?

A

anterior translation of vertebral body relative to the other, and secondary to an abnormality of the pars interarticularis
90% at L5/S1, excessive lordosis, postural ache, mm spasm, tight psoas and hamstrings

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16
Q

What is ankylosing spondylitis?

A

inflammatory disorder of spine (synovial lining), morning stiffness, pain with exercise, leading to decrease vertebral movement (fusion)

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17
Q

What are some biomechanical restrictions?

A

ERS, FRS, NSR, neuromuscular control issues

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18
Q

What is radicular pain?

A

Evoked from inflamed or lesioned dorsal root or its ganglion (disc herniation most common cause)

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19
Q

What is radiculopathy?

A

impairs the conduction down a spinal nerve or its root, affecting sensory changes, motor fibers and possible reflexes

radicular pain can occur without radiculopathy

20
Q

What are common complaints of facet joint syndrome?

A

Pain off to the side
May or may not have radicular symptoms (will terminate above knee), often radiating to thigh or groin
Pain inc with hyperextension, rotation and lateral bending and walking uphill
exacerbated when waking up or sitting for long periods (stiffness)

21
Q

What is Lumbar spine stenosis and what are its common S/S?

A

progressive narrowing of central or lateral spinal canal, causing compression of neurovascular structures

S/S:
Midline back pain
radiculopathy (motor weakness, parasthesia)
Central: often bilat symptoms
Lateral: often lat symptoms
Ease discomfort: trunk flexion, sitting, lying
Aggravate: standing, lumbar extension

22
Q

What increases the risk of disc degeneration?

A

diabetes

23
Q

How can spondylolisthesis affect load sharing?

A

increased shearing forces
higher sacral slope and pelvic tilt (ant pelvic tilt and hyperlordosis)
increased pressure on discs, facet joints leading to degeneration
Muscle spasm of ES to protect

24
Q

How do postural muscles tend to respond to injury?

A

with tightness in the form of spams or adaptive shortening

25
Q

How do phasic muscles tend to respond to injury?

A

with atrophy

26
Q

What could difficulty sitting indicate?

A

lumbar instability or muscle spasm

27
Q

What could discogenic pain indicate?

A

Flexion for extended periods of time

28
Q

What are the dermatomes of the LE?

A

L2: anterior thigh
L3: knee
L4: medial foot
L5: dorsal aspect of foot
S1: lateral foot
S2: medial posterior thigh and calf

29
Q

What are the myotomes of the LE?

A

L2: hip flexors
L3: knee extension
L4: dorsiflexion + inversion
L5: Big toe extension
S1: plantarflexion + eversion
S2: knee flexion

30
Q

What does the straight leg raise test indicate and how do you perform it?

A

Pt supine, hip medially rotated and adducted to neutral, knee extended, flex hip until pain or tightness. Compare Bilat

Back pain==> most likely from disc herniation
Leg pain==> pathology causing pressure on neurological tissues more laterally

31
Q

What are the movements of SLR 1 and what nerves does it test?

A

Hip: Flexion/adduction
Knee: extension
Ankle: dorsiflexion
Nerve==> sciatic and tibial

32
Q

What are the movements of SLR 2 and what nerves does it test?

A

Hip: flexion
Knee: extension
Ankle: DF, eversion
Toes: extension
Nerve==> tibial

33
Q

What are the movements of SLR 3 and what nerves does it test?

A

Hip: Flexion
Knee: Extension
Ankle: DF, Inv
Nerve==> Sural

34
Q

What are the movements of SLR 4 and what nerves does it test?

A

Hip: Flexion, medial rotation
Knee: Extension
Ankle: PF, inv
Nerve==> Common peroneal nerve

35
Q

What are the movements of SLR 5 and what nerves does it test?

A

Hip: Flexion
Knee: Extension
Ankle: DF
Nerve==> nerve root

36
Q

What is the SLUMP test?

A

Slump position
Neck flexion
DF
Knee extension

if unable to extend knee fully, extend neck if now able to extend knee fully and the symptoms decrease then + for tension in neuromeningeal tract

37
Q

Which test between SLR and Slump in more sensitive and more specific for indicating L/S disc herniation?

A

Slump test most sensitive
SLR slightly more specific

38
Q

What is the prone knee bending test?

A

prone, passively flex knee as far as possible (no hip rotation)
unilat neuro pain in lumbar area, buttocks or post thigh may indicate an L2-L3 nerve root lesion
Also stresses femoral nerve

39
Q

What does the valsalva maneuver indicate?

A

If pain increases= increased intrathecal pressure

40
Q

What does a positive Lumbar quadrant test indicate?

A

radiation, local irritation, SI joint irritation

41
Q

What is the one leg standing (Stork Stance)?

A

SL balance extend spine
+ve indicated by back pain (pars interarticularis stress fx)
if fracture is unilat, standing on ipsilat leg causes more pain

42
Q

What indicates a positive McKenzie Slide (Side?) Glide Test?

A

+ve = increase neuro symptoms on affected side

43
Q

What is the pheasant test and what does it test for? (Roasted chicken, you peasant)

A

Prone, apply pressure on vertebrae
Passively flex knees
if hyperextension of spine causes pain then test is considered positive for unstable spinal segment

44
Q

What is the passive Lumbar extension test?

A

It tests for lumbar instability
Patient prone and relaxed
examiner passively lifts both legs at same time (1foot off)
while maintaining lift gently pull on legs

+ve: pt complains of strong pain in L/S, very heavy feeling

45
Q

What does positives indicate with H and I?

A

If both H and I cause pain ==> hypomobility
If either H or I ==> instability

46
Q

What should the lumbar facets do in lumbar extension and flexion?

A

L extension: facets should close
L flexion: facets should open

47
Q

Dysfunctions are named after what?

A

Named for what they can do

Ax Midterm (4 decks)

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