Medical Management of LBP Flashcards Preview

Orthopedic II > Medical Management of LBP > Flashcards

Flashcards in Medical Management of LBP Deck (10):

Radicular pain
- what causes it
- symptoms
- treatment

due to lumbar radiculopathy
--> can also lead to numbness and/or motor weakness

radicular pain due to:
--> inflammation and vascular compromise OR nerve root compression
--> stimulation of nociceptors in PLL & annulus

symptoms: sharp, shooting pain, leg pain worse than back pain, radicular and dermatomal pattern, possible sensory and motor impairments

treatment = conservative (PT, medication), injection or surgery


Epidural steroid injections
- rationale
- complications
- timeline

Rationale - direct localized anti-inflammatory

- direct needle trauma
- ischemic injury (injection into Artery of Adamciewicz)
- infection
- drug reaction

TImeline of injections: 3 over the course of 3-5 months w/ 4-6 weeks in between


Translaminar Approach

provides more spread of medication but which specific nerve roots it is spread to cannot be controlled as well

usually used if transforaminal approach cannot be used (stenosis, OA)

Approach from the midline, through LF to posterior aspect of epidural space


Transforaminal approach

Most common & most effective b/c directed at a specific nerve root by entering through the lateral foramen (subpedicular region)

can be technically difficult if severe degeneration or prior surgery/fusion


Caudal approach

very simple & least complicated way to access epidural space

cathedar can be threaded through needle to reach L5

provides a wider coverage


Spinal Cord Stimulation

Uses the gate control theory to minimze someone with chronic, severe LBP

electrically activating pain-inhibiting pathways in dorsal horn, providing a tingling sensation which will mask the sensation of pain

Contraindications: stenosis, infection, pregnancy, psychosocial problems, suppressed immune system

2 phases: trial and implantation


Differential Diagnosis for Lumbar Radiculopathy (3)

1. Lumbar facet arthropathy
2. Sacroiliitis
3. Piriformis syndrome


Lumbar facet arthropathy
- clinical feature
- how to differentiate between LR

Clinical features:
- Lumbar axial pain, may refer to lower limbs
- frequently more pain w/ extension and lateral rotation

- medial branch nerve block (the medial branch innervates the facet joint above & below the segment)
- if there is pain relief that is a POSITIVE response
--> treatment = radiofrequency ablation


- clinical features
- treatment

Clinical features:
- pain w/ referral along joint line to ipsilateral hip & trochanter
- can refer to posterior thigh (not past knee)
- similar symptoms to herniated disc
- pain w/ palpation

- PT
- SI injections
- Radiofrequency ablation of lateral branch nerves
- surgery: fusion of SI joint


Piriformis syndrome
- clinical features
- treatment

due to compression of sciatic nerve by piriformis muscle

clinical features:
- similar to L5/S1 radiculopathy (LBP/buttock to the knee)
- tender to palpation
- difficulty sitting
- reproduction of pain w/ stretching

- PT, NSAIDS, injection or surgery