Lumbar Spine Flashcards
Spondylolysis
Defect in pars interarticularis-usually caused by repetitive stress Appears as a collared Scotty dog Unilateral stable fx Do not have rapid resolution of symptoms Access for spinous process rotation
S/S:
Localized back pain, increased during and after activity, and painful extension/rotation to involved side
Muscle spasm
ST:
Single leg stance test
Quadrant test
Spring test
Spondylolisthesis
Spondylolysis may progress to this-decapitation of dog Bilateral defect in pars interarticularis Anterior displacement of vertebrae Usually at L5-S1 More common in adolescents and women Asses for spinous process rotation Rapid resolution of symptoms High force Acute common In older
S/S:
Localized pain/muscle spasm
Worse with loading facet-extension/rotation to involved side
ST:
Single leg stance test
Spring test
Quadrant test
Spondylalgia
Pain arising from the vertebrae
ST:
Single leg stance test
Spondylitis
Inflammation of the vertebrae
ST:
Single leg stance test
Spondylosis
Arthritis or osteoarthritis of the vertebrae-degeneration of the vertebrae
ST:
Single leg stance test
Sacroiliac dysfunction
Ilium rotates and/or subluxes on the sacrum-mobility at SI limited
MOI: injury or degeneration of Pubic Symphysis, tight hamstrings, tight hip flexors
Repetitive unilateral movement
S/S:
Pain over SI joint and PSIS
Compression or distraction of pelvis duplicates symptoms
ST: Compression-Distraction FABER Patrick's test Gaenalens test Piedallu sign-PSIS symmetry Long sit test Gillets test-PSIS symmetry
Nerve root impingement
Stenosis of intervertebral foramen, facet joint degeneration, herniated IVD, other space-occupying lesion abnormality/spur
ST: Valsalva test-increased intrathecal pressure Milgram test-bilateral Kernig-active Straight leg raise-passive Well straight leg raise-passive Slump test Quadrant test-radiating
Facet joint dysfunction
Ext, rotation, or lateral bending
May invoke dislocation/subluxation of facet
Assess for spinous process rotation
Rapid resolution of symptoms
S/S:
Localized pain-radical at pain if nerve root compressed
Localized muscle spasm
Worse with loading facet-extension, rotation to involved side
ST:
Spring test
Quadrant test
Single leg test
Tx:
NSAIDS, avoiding painful postures, modalities, strengthening muscle imbalances, postural adjustments
Disc herniation-IVD lesion
Degeneration and aging of IVD involves loss of water from nucleus
Increase stress on annulus fibrosis that leads to bulging of nucleus
protrusion, prolapse, extrusion, sequestration
S/S: Nerve root compression-radicular pain that's aggravated by activity (anterior thigh most common) Insidious onset or acute Repetitive stress Painful to change body positions Slow, deliberate gait Lateral shift during standing Leg-length discrepancy-pain on shorter Pain in low back/buttocks area-may radiate to posterior thigh, calf, heel, and foot depending on level of nerve root irritation that follows dermatome/myotome pattern
ST: Valsalva test Milgram test Straight leg raise Well straight leg raise Femoral nerve stretch test Kernig Slump
Tx: MRI to confirm Rehab exercises emphasizing extension and core stability and avoid flexion and rotation early on Anti inflammatory meds Postural support
Sciatica
Inflammation of sciatic nerve
Causes: lumbar disc herniation, SI dysfunction, scar tissue formation around the nerve root, nerve root inflammation, spinal stenosis, synovial cysts, cancerous or non-cancerous rumors
S/S:
Similar to lumbar disc ruptures
ST:
Straight leg raise
Slump test
Tension sign-bowstring test
Coccygeal injuries
Acute, direct blow resulting in contusion or fx of coccyx
Pain from fx can last several months
Can cause Irritation to coccygeal nerve plexus
Tx:
Sitting on extra cushions or doughnut pad helps
Erector spinae strains
Rule out all other causes of pain
MOI: heavy or repetitive lifting
S/S: aching pain centralized to low back increased pain w/ Passive and active flexion pain w/ resisted extension Negative lower quarter screen
ST:
AROM, PROM, RROM/MMT
Ligament sprains
Difficult to assess so rule out others
ST:
Spring test
