Lumbar Spine Conditions Flashcards Preview

PTRS 845 Midterm > Lumbar Spine Conditions > Flashcards

Flashcards in Lumbar Spine Conditions Deck (39):
1

3 Categories of LBP

1. Serious Spinal Pathologies (tumors, infection, fx, cauda equina syndrome)

2. Sciatica

3. Nonspecific LBP (dysfunctions of msk tissues

2

Term: Back-related LE symptoms caused by back (nerve/nerve root) conditions

Sciatica

3

Distributions of LBP

1. Serious Spinal Pathologies

2. Sciatica

3. Nonspecific LBP

1. ~10%

2. ~40%

3. ~50(+)%

4

Term: narrowing of the central canal or lateral intervertebral foramina

Spinal Stenosis

5

Condition

- Male > Female

- 60+ yo

- Congenital or age related degeneration

Spinal Stenosis 

6

Term: Type of spinal stenosis most often due to degeneration

Lateral Spinal Stenosis 

7

Boundaries of the lateral foramen

- Anterior

- Posterior

- Superior

A: Vertebral body and disc

P: Ligamentum flavum

S: Facet joints

8

Term: Neural compromise due to obstruction of blood flow to the nerve, nerve root, or dural sleeve

Neurogenic Claudication

9

Condition: Symptoms

- Localized vauge pain

- Back and leg pain (can be bilateral)

- Presence of N/T and weakness in LEs

- Cramping

Spinal Stenosis

10

Conditon: Aggravating Factors

- Extension

- Prolonged standing or walking

- Walking downhill 

- Lying flat

** Anything that loads the posterior column **

Spinal Stenosis 

11

Condition: Easing Factors

- Flexion

- Sitting or squatting

- Walking uphill

- Bike riding

Spinal Stenosis 

12

Condition: Objective Exam

- Flat lumbar posture

- Painful/limited extension

- Pain with SB on involved side

Spinal Stenosis

 

Flat back posture unload the posterior column

13

Term: Compromised ciculatory system due to PVD

Vascular Cluadication

14

Condition: Pain worse with incline walking but improved with decline walking 

Vascular Claudication 

15

Condition: Symptoms

- Flexion does not ease symtpoms

- Rarely have back sx

 

Vascular Claudication

16

Condition: Objective Exam

- Skin color or temperature changes

- Hair loss

- Peripheral pulses absent

- LE cramping/tightness

Vascular Claudication 

17

Describe how the lumbar facet joints project the discs

Because they are oriented to prevent rotation

18

Describe what motions cause facet compression

Lateral flexion and rotation 

19

Nerve: Innervates the lumbar facet joints

Medial branch of the dorsal primary ramus

20

Describe the connection between LBP and mutlifidus atrophy

The medial branch of the dorsal primary ramus innervates the facet joints as well as multifidus.

 

The facet joint capsules are highly innervate and are a large source of LBP

 

When the facet joints are aggravated the body avoids activities that would worsen the pain, less firing of those nerves means less activity in multifidus leading to atrophy

21

Structure: Synovial fold within facet joints

Meniscoid

22

2 Functions of the Meniscoid

1. Provide smooth gliding motion

2. Prevent excess motion

23

Cause of Acute Facet Joint

Mechanical block from meniscoid

24

Condition: Symptoms

- Unilateral pain, sharp over facet 

- Increased pain with stretch/compression of joint

- Limitation in SB and extension

Acute Facet Joint

25

Condition: MOI of sudden unguarded movement (i.e. flexion or rotation)

Acute Facet Joint

26

5 Causes of Chronic Facet Joint

1. Degerenation

2. Hypertrophy

3. Osteophytes

4. Inflammation

5. Microfracture

27

Condition: Symptoms

- Unilateral pain

- Less sharpt over the joint

- Rarely radiates down leg

 

Chronic Facet Joint

28

Condition: Symptoms

- Stiffness and pain in AM

- Increased pain with stretch of joint

Chronic Facet Joint

29

Condition: History

- Past Acute Facet Joint

- Never entirely symptom free

- Trauma

- Degeneration

Chronic Facet Joint

30

Condition: Objective

- Localized pain but can refer to larger area

- Local tenderness with palpation, stiff, thick

- Initially hypomoble

Chronic Facet Joints

31

3 Things to Know about Facet Joints and Referred Pain

1. Facet joint have a referral pattern

2. The referral pattern becomes broad with facet joint pathology

3. The referral pattern is similar to many other LBP referrals

32

Condition: Irritation/Inflammation, compression, or tension to the nerve root

Acute Nerve Root (ANR)

33

3 Possible Causes of ANR

1. Disc pathologies

2. Degenerative changes

3. Other medical conditions

34

Describe the progression of pain with ANR

Can begin as a proximal ache and them move distally

35

Condition: Symptoms

- More distal than proximal signs i.e. radiating

- Limited ROM and activity

- Muscloskeletal involement is central/local

ANR

36

Condition: Chronic irritation of nerve root/adhesion

Chornic Nerve Root (CNR)

37

4 Possible Causes of CNR

1. Hx of disc pathology

2. NR injury

3. Degenerative changes

4. Spinal surgery/scaring

38

Condition: Symptoms

- More proximal than distal

- Minimal limitation of activity

CNR

39

Condition: Objective

- Localized thickness in tissues

- Stiff segmentally

- May report pain with OP

 

CNR