Lumbosacral Strain and Sprain

Question 1

What is the onset, peak and duration for IV medication?

Answer 1

Onset: 10-15 seconds
Peak: 15-30 minutes
Duration: 1-2 hours

Question 2

What is the onset, peak and duration for IM medication?

Answer 2

Onset: 20 -30 minutes
Peak: 30-60 minutes
Duration: 3-4 hours

Question 3

What is the onset, peak and duration for oral medication?

Answer 3

Onset: 20 -30 minutes
Peak: 1 - 2 hours
Duration: 3-6 hours

Question 4

List the 7 myths of back pain

Answer 4

1 - slipped discs must have surgery
2 - xray, CT, MRIs can always identify cause of pain
3 - If you back hurts take it easy until pain goes away
4 - back pain is caused by injuries or heavy lifting
5 - LBP is disabling
6 - LBP requires xray
7 - bed rest is mainstay of therapy

Question 5

Damage to ligamentous tissue

Answer 5

lumbar SPRain

Question 6

Damage to muscular tissue

Answer 6

lumbar STRain

Question 7

Describe sprain grading

Answer 7

Grade 0 - minimal overstretching
Grade 1 - microtearing
Grade 2 - partial tearing of ligament
Grade 3 - Complete rupture of ligament

Question 8

Describe clinical features of grade 1.

Answer 8

moderate pain with tension
visible swelling
no visible bruising

Question 9

Describe clinical features of grade 2.

Answer 9

Maximal pain with tension
visible edema
macrohemorrhage with bruising
Partially torn ligament

Question 10

Describe clinical features of grade 3.

Answer 10

May be painless with tension
significant edema
macrohemorrhage w/bruising
ligament completely ruptured
joint instability

Question 11

Define sciatica

Answer 11

pain in sciatic nerves L4-S3

Question 12

What is included in initial management?

Answer 12

patient education
pain management
physical methods
activity alteration
work activities

Question 13

What is involved in patient education?

Answer 13

reassurance - time line

coexisting sciatica - longer recovery 12 weeks

Question 14

What is involved with pain management?

Answer 14

use non prescription analgesics:
acetaminophen (Tylenol)
Ibuprofen (Motrin, Advil)
Naproxen (Aleve)
Try to avoid NSAIDs

Question 15

What are some topical analgesics?

Answer 15

lidocaine patch
salicylate cream (unproven)

Question 16

List some types of opiates.

Answer 16

Tramadol
Propoxyphene (IV)
Codeine (III)
Hydrocodone  (III)
Morphine (II)
Oxycodonoe (II)
Hydromorphone (II)
Meperidine (II)

Question 17

A physiologic response of the body to the presence of a controlled substance.

Answer 17

Addiction

Question 18

A physiologic response of the body to the removal of any medication.

Answer 18

Withdrawal syndrome

Question 19

Are muscle relaxants any more effective than NSAIDs?

Answer 19

No

Question 20

When would you use NSAIDs?

Answer 20

as an adjunct to bed rest for acute muscular injury (causes drowsiness)

Question 21

Neurologic deficits in the distribution of nerve root with symptoms of reflex loss, sensory loss and muscle weakness.

Answer 21

Radiculopathy

Question 22

Inflammation of a nerve root with radicular pain and muscle spasm.

Answer 22

Radiculitis

Question 23

What coexists with every sprain and strain injury?

Answer 23

somatic dysfunction

Question 24

When is manipulation safe and effective for acute LBP?

Answer 24

first month

Question 25

When should you reevaluate?

Answer 25

if patient is unimproved after 4 weeks

Question 26

When is manipulation indicated?

Answer 26

in the presence of radiculopathy or radiculitis due to degenerative disc disease

Question 27

When might traction be effective?

Answer 27

may reduce disc protrusion

Question 28

Which types of physical modalities have no proven efficacy?

Answer 28

``` massage diathermy us cutaneous laser treatment biofeedback TENS ```

Question 29

Application of heat and cold is unproven but can give the patient something to do. (T/F)

Answer 29

True

Question 30

In what position should patients be during bed rest?

Answer 30

supine with legs elevated

Question 31

How long should bed rest last?

Answer 31

no more than 2-4 days

Question 32

What positions aggravate LBP?

Answer 32

sitting, bending forward

Question 33

How many minutes each hour should patient get into position of maximal comfort?

Answer 33

10-15 minutes every hour

Question 34

What equipment should be avoided when returning to aerobic activity?

Answer 34

treadmill | recumbent bicycle

Question 35

At the end of two weeks, activity should be up to how many minutes a day?

Answer 35

20-30 minutes

Question 36

What is the maximum number of months that activity should be restricted?

Answer 36

three months

Question 37

Based on pain level how long should one sit?

Answer 37

no pain - 50 minutes mild pain - 40 minutes moderate - 30 minutes severe - 20 minutes

Question 38

Based on pain level how much should a man lift?

Answer 38

no pain - 80 lbs mild pain - 60 lbs moderate - 20 lbs severe - 20 lbs

Question 39

Based on pain level how much should a woman lift?

Answer 39

no pain - 40 lbs mild - 35 lbs moderate - 20 lbs severe - 20 lbs

Question 40

When would you do routine testing during the first month?

Answer 40

when a red flag was listed during physical examination

Question 41

Why would you wait?

Answer 41

reduce potential of labeling asymptomatic age related changes in lower back

Question 42

What two things should be combined when looking at imaging?

Answer 42

combine patient's physical condition and location of pain with imaging

Question 43

How long will a bone scan remain positive?

Answer 43

2-4 years; must be interpreted with xray, CT, or MRI

Question 44

What is the initial imaging modality for LBP?

Answer 44

xray (MRI is second)

Question 45

If there is unresolved radicular pain what test would the physician use?

Answer 45

electromyography (EMG), nerve conduction velocity (NCV) (motor system & peripheral nerve function)

Question 46

What will a EMG/NCV differentiate between?

Answer 46

nerve root damage & peripheral nerve lesion | will not discover CNS etiologies

Question 47

What system will an SSEP & DEP evaluate?

Answer 47

sensory system

Question 48

An SSEP or DEP must be used in conjunction with what test and why?

Answer 48

must be used in combination with at least NCV to differentiate peripheral nerve from spinal cord or cortical dysfunction

Question 49

If the EMG/NCV or SSEP/DEP are positive, what should be done next?

Answer 49

use nervous system electrodiagnostic evaluation to guide MRI imaging

Question 50

What are MRIs best at demonstrating?

Answer 50

soft tissue pathology- herniated disc, spinal tumors, abscesses

Question 51

What is CT used for?

Answer 51

delineating bone pathology such as small fracture fragments

Question 52

What would you use in combination with CT for diagnosing intraspinal pathology?

Answer 52

myelogram (gold standard 99% accurate)

Question 53

List the order of the risk of complications.

Answer 53

1. CT/myelogram 2. myelogram 3. bone scan 4. CT 5. xray 6. MRI

Question 54

Compare open vs closed MRI

Answer 54

Open 0.2 - 0.3 T peripheral joints Closed 1.5 - 3.0 T spinal

Question 55

When would you use a vertical MRI?

Answer 55

when standard MRI was negative but patient has persistent radicular symptoms worse in the seated or erect posture

Question 56

During CBC, a WBC might indicate?

Answer 56

infection, leukemia

Question 57

During a CBC, a RBC might indicate?

Answer 57

anemia; could be due to marrow replacement by tumor

Question 58

During a urinalysis, RBC might be evidence of?

Answer 58

kidney stones, bladder or renal cancer

Question 59

During a urinalysis, WBC might indicate?

Answer 59

UTI

Question 60

During a urinalysis, nitrates might indicate?

Answer 60

UTI

Question 61

During a urinalysis, crystals may indicate?

Answer 61

propensity for stone formation

Question 62

How do you calculate ESR in men?

Answer 62

age/2

Question 63

How do you calculate ESR in women?

Answer 63

age + 10/2

Question 64

What would a high ESR indicate?

Answer 64

presence and intensity of inflammatory process

Question 65

What ESR method is preferred?

Answer 65

Westergren method

Question 66

What units are ESRs reported?

Answer 66

mm/hour

Question 67

Does a normal ESR exclude malignancies or other serious diseases?

Answer 67

NO but it does exclude polymyalgia rheumatic or temporal arteritis

Question 68

How is a ESR useful?

Answer 68

detecting occult diseases

Question 69

ESR assists with differential diagnosis. Is ESR increased in MI or Angina? appendicitis or ruptured ectopic pregnancy? rheumatoid arthritis or osteoarthritis?

Answer 69

MI appendicitis RA

Question 70

ESRs over 100mm/hour indicate..?

Answer 70

``` presence of metastic cancer osteomyelitis subacute bacterial endocarditis giant cell arteritis polymyalgia reheumatica ```

Question 71

What supportive care is available?

Answer 71

medical management of pain therapeutic exercise OMT

Question 72

When is OMT contraindicated?

Answer 72

HVLA is contraindicated in spondylolisthesis and herniated nucleus pulposus

Question 73

What is in the initial phase? second phase?

Answer 73

initial - relief of symptoms | second - return to activity

Question 74

Extreme elevation of ESR could indicate?

Answer 74

``` malignancy (colon/breast) hematologic disease collagen disease (RA) renal disease serious systemic infections ```

Question 75

When is EMG/NCV not useful?

Answer 75

in the absence of radicular symptoms

Question 76

In some cases EMG/NCV may not be positive for __ weeks.

Answer 76

4-6 weeks