Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

From Flashcardlet > Lumbar Spine Monograph and Ortho Secrets > Flashcards

Lumbar Spine Monograph and Ortho Secrets Flashcards

1
Q

What are the 4 classification categories for acute LBP?

A

Manipulation, Stabilization, Specific exercise pattern (flx, ext, lat shift), traction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the exam findings for manipulation classification of LBP?

A

No sx distal to knee.
Recent onset.
Low fear avoidance beliefs. Hypomobile spine.
Hip IR>35 deg or IR diff L vs. R.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the exam findings for stabilization classification of LBP?

A 
Frequent episodes of LBP.
Increasing freq of episodes.
Instability catch or painful arcs.
Hypermobile spine.
\+Prone segmental instability test.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the exam findings for extension exercise classification?

A

Sx distal to knee.
Sx and signs of nerve root compression.
Sx centralize with lumbar extension.
Sx peripheralize with lumbar flexion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the exam findings for flexion exercise classification?

A

Age>65 years
Sx distal to knee
Sx and signs of N. root compression, neurogenic claudication or both
Sx peripheralize with lumbar ext or centralize with lumbar flexion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the exam findings for lateral shift exercise classification of LBP?

A

Front plane deviation of shlds relative to pelvis.
Asymmetrical SB AROM
Painful and restricted extension AROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Traction

A

Sx and symptoms of N root compression

No movement centralize sx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 recommended self-report measures for LBP?

A
  1. Pain body diagram + numerical pain scale

2. Oswestry or Roland Morris questionnaire.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the minimum clinically important difference for a 0-10 pain scale?

A

2 pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the minimum clinically important difference of the Mod. Oswestry?

A

6 pts. A successful outcome is 50% in some studies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the minimum clinically important difference of the Roland Morris Questionnaire?

A

2-3 pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the FABQ score the indicates likelihood of prolonged disability?

A

> 34.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What score on the work subscale indicates reduces success with manipulation?

A

> 18.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the components of a neurological examination for the lumbar spine?

A

1) Myotomes 2) Dermatomes 3) DTRs 4) Neural tension tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 5 criteria for Flynn et al’s clinical prediction rule for manipulation?

A

1) Sx duration < 16 days
2) Lumbar segmental mobility- at least 1 hypomobile segment
3) Hip IR- at least 1 hip > 35 degrees IR
4) Distribution of sx- none distal to knee
5) FABQ > 18 PTS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many factors should be present to suggest use of manipulation?

A

4/5 or the most important 2: duration, distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What two muscles are prominent in controlling spinal segmental stability?

A

Multifidus and TA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the origin and insertion of the multifidus mm.

A

O: spinous processes of lumbar vertebra
I: inf lumbar transverse processes, ilium and sacrum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the function of the multifidus mm?

A

Stabilizes during lifting and rotational movements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the contribution of obliques to spinal stability.

A

Increases lumbar stiffness, co-contracts with erector spinae to stabilize sidebending and extension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe fx of TA?

A

Stabilizes during extremity movements. Feed forward mechanism. Delayed in pts with LBP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe Hicks et al’s clinical prediction rule for a lumbar stabilization program?

A

1) Age: < 40.
2) SLR: >91 deg
3) Prone instability test: Positive
4) Sagittal plane ROM: Aberrant motions
Three of 4 must be present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name 3 aberrant motions that can be observed during lumbar movement in the sagittal plane?

A

Instability catch- movement that’s “out of plane.”
Thigh climbing.
Painful arc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe prone instability test

A

Lean over table in “spanking” position»P-A level by level» If sx, then have pt extend legs»Recheck painful level. Test is positive if pain is reduced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What exs provide activation of the obliques with minimal compressive forces in the spine?

A

“Side support” aka 1/2 side plank, “hanging SLR” aka Roman chair, Oblique trunk curls.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the role of QL?

A

1) Stabilization against compressive loads 2) Stabilization during side bending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe clinician assisted lateral shift movement?

A

Stand on opposite side of desired trunk shift and pull pelvis toward you.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Explain how hip ext mob will help with stenosis.

A

Decreased hip extension creates a demand for more lumbar extension when walking. Demand for more lumbar extension aggravates stenosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe uses of static vs intermittent mechanical traction.

A

Static: younger pts and disc pts
Intermittent: older pts, degenerative pts, stenosis

29
Q

What is the force necessary for therapeutic benefits of mech traction?

A

40-60% body weight

30
Q

What position is best for disc nutrition.

A

s/l knees bent. hooklying. No lordosis.

31
Q

Describe 4 types of receptors in the spine.

A

Type 1- Postural receptors (e.g. Ruffini’s). Mostly in C Spine. Sense jt position. Type 2-Dynamic receptors (eg. Golgi-mazzoni fat pads). Sense mvmnt. Type 3- Inhibitory receptors, associated with ligaments, facet capsules and deep multifidus. Type 4- Nociceptors. Non-adaptive and chemosensitive.

32
Q

Describe how a disc ruptures.

A

Tears in the annulus start in the dense outer layer, then move inward allowing the nucleus pulposus to “leak” out. Healing is possibe, but slow. GAG turnover is 500 days. Healing is way slower.

34
Q

At what levels do you most commonly see lumbar disc prolapse?

A

L4-5, then L5-S1, then L3-4, then L2-3, then L1-2

35
Q

Describe classes of disc herniations.

A

Protrusion (annulus intact)- 1) localized bulge 2) diffuse bulge
Herniation (annulus disrupted)- Prolapsed, Extruded, sequestered.

36
Q

What are PT outcomes for acute low back pain?

A

Satisfactory outcomes. Best with manipulation»then pt instruction»> then exercise.

37
Q

Stenosis classifications

A

1) Anatomic- lateral&raquo_space;in the foramina or nerve root canal as nerve exits. Central- in central canal affecting cauda eqina.
2) Primary- congenital. Secondary- due to degenerative changes

38
Q

Define and describe neurogenic claudication.

A

Claudication of neural origin, not vascular. Pain, paresthesia and cramping, uni or bilat. Worse with walking, relieved by sitting. Often in people with stenosis.

39
Q

Describe bicycle and TM test for stenosis.

A

Pt bikes erect, then flexed. If flexed is better»>stenosis. Pt walk level, then on incline. If incline is better»>stenosis.

40
Q

How is Lsp stenosis diagnosed in imaging.

A

CT or MRI, better. Myelogram, required dye, may be less accurate. All measure A-P diameter of spinal canal

41
Q

What are most common impairments and fx limitation with stenosis.

A

Walking tol is primary. Dec hip ROM, esp ext. Weak hip abd and ext. Dec lumbar ROM. Possible pos SLR test.

42
Q

Most common sx for Lsp stenosis

A

Decompression laminectomy.

43
Q

What spinal levels mark the conus medullaris and cauda equina?

A

Conus medullaris= T10/11- L1/2. Cauda equina starts at L 1-2

44
Q

How much nerve root movement occurs at spinal levels during SLR.

A

Max movement at sciatic notch 6.5 cm. less as you go upward.

45
Q

What are red flags for infective spondylitis?

A

Very, very rare. IV drug use, urinary tract injection, indwelling catheter, skin infection. Fever: highly SPecific, low SeNsitivity.

46
Q

What 7 clinical feature suggest anklosing spondylititis?

A

Hx of anklosing spondylitis. Hx of thoracic pain. Hx of iritis. Hx of heel pain. Reduced chest expansion (Specificity 0.9), Reduced lateral mobility (Spec=0.8). Sacroilitis

47
Q

What factors are key is suspicion of compression fracture in LBP patients

A

Corticosteroid use- Spec=0.9. +LR=12, Elderly people, trauma

48
Q

What are key factors in suspicion of Cauda Equina?

A

Urinary Retention. SN= 0.9. SP= 0.9. +LR=18. -LR= 0.1. Saddle numbness- 0.75. Decreased anal sphincter tone= SN- 0.6-0.8

49
Q

What is the Bell test for lumbar radiculopathy from IDH.

A

Pressure of thumb over L4-5 or L5-S1 produces LE sx (dermatomal).

50
Q

What is the imaging/medical recommendation for pt with malignancy “red flags”

A

x-ray and erythrocyte sedimentation rate if not hx. Straight to MRI if there is hx of CA

51
Q

What is the imaging test of choice for pts with infective spondylitis?

A

Bone scan. High SN and SP.

52
Q

What is the best imaging choice for active sacroiliits

A

Contrast-enhanced MRI. High SP and SN.

53
Q

Describe levels 1-5 of Sarhmann core stability test.

A

1) hooklying hip flx 2) heel slide 3) hover heel slide 4) Dbl heel slide. 5) double hover heel slide. Set stabilizer to 40 mmHg with abs tight. Test should involve no more than 10 mm Hg.

54
Q

Desc diff b/t ventral and dorsal rami

A

The dorsal rami supply the paraspinal muscles and skin overlying the paraspinal region.
The ventral rami give rise to the lumbosacral plexus and, eventually, the individual nerves supplying the lower limbs and sacral region.

55
Q

Exam findings for L3 radiculopathy

A

Ant thigh/knee and and leg pain. Medial thigh and knee paresthesia. Abnormal patellar reflex. Weak quad, psoas or hip aDd.

56
Q

Exam findings for L4 radiculopathy.

A

Pain/paresthesia at medial lower leg. Abnormal patellar reflex. Weakness of Ant tib (*more prominent in L5), quads, hip ADd.

57
Q

Exam findings for L5 radiculopathy.

A

Pain/paresthesia at lat thigh, lat leg, dorsum of foot, Great toe. Abnormal med H/S reflex. Weak toe ext/flx, hip aBd, ankle DF/IV/EV. FOOT DROP.

58
Q

Exam findings for S1 radiculopathy

A

Pain at post thigh, calf, heel. Paresthesia @ Sole of foot, lateral ankle, lateral 2 toes. Weakness of gastroc, h/s, glut max, toe flexors. Abnormal Achilles reflex.

59
Q

Desc use of ankle MMT to differeniate between L5 radiculopathy and peroneal nerve.

A

Weakness of foot EVERSION (mediated by the L5/PERONEAL- innervated peroneus muscles). Weakness of foot INV (mediated by the L5/TIBIAL NERVE-innervated tibialis posterior).

60
Q

Desc use of hip MMT to differentiate between L5 radiculopathy and sciatic N.

A

The involvement of hip abductors (gluteus medius and minimus) indicates a lesion proximal to the sciatic nerve.

61
Q

Desc use of MMT to differentiate between S1 radiculopathy and sciatic N.

A

Sciatic N should also affect L5 innervated mm.

62
Q

What are the risk factors for spinal epidural abcess?

A

diabetes mellitus, history of intravenous drug abuse, spinal surgery, spinal or paraspinal injection, epidural catheter placement, and immunocompromised status

63
Q

What are the clinical features of diabetic amyotrophy?

A

Severe lower extremity pain and weakness. Sudden onset. Uni LE pain, weakness follows shortly. Proximal muscles, in particular quadriceps, tend to be affected first and most conspicuously, majority of pts develop distal and bilat sx. Weight loss is a frequent accompanying symptom

64
Q

Desc presentation and treatment of spinal cysts.

A

Very common, can be asymptomatic. Dx by MRI. Presents just like lumbar radiculopathy. Definitive rx is fluoroscopic-guided aspiration and surgical treatment.

65
Q

What is a common cause for arachnoiditis?

A

Causes lumbar radiculopathy due to reaction to intrathecal oil-based contrast dye for myelography.
other causes of arachnoiditis include neurocysticercosis and other infections, blood in the intrathecal spa

66
Q

What is the SN/SP of SLR and Crossed SLR test?

A

SLR test has High SN. Crossed SLR has High SP.

67
Q

What precautions should be taken following epidural steroid injection?

A

No heat.

68
Q

Define McKenzie Postural syndrome. What is the intervention?

A

“Pain arising as a result of mechanical deformation of normal soft tissues from prolonged end range loading of peri-articular structures”.
Perform postural correction.

69
Q

Define McKenzie Dysfunction syndrome. What is the intervention?

A

Pain occurring as a result of mechanical deformation of structurally impaired tissues.
Perform Exercise in the direcNon of the dysfunction.

70
Q

Define McKenzie Derangement syndromes. What is the intervention?

A

“Pain occurring as a result of a disturbance in the normal resNng posiNon of the affected joint surfaces”.
Perform treatment based on direction pref.

From Flashcardlet (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions