Musculoskeletal dysfunction of Lsp

Question 1

Examples of red flags

Answer 1

Cauda equine
Malignancy- considered if previous diagnosis, failure to improve after 3-4 treatments= review plan/potential, night pain
Fracture- risk factors= older age, prolonged corticosteroid use, severe trauma
Infection- uncommon but serious (e.g., pancreatitis)

Question 2

Yellow flag

Answer 2

Someone who doesn’t seem to want to get better, predictors of chronicity

Question 3

Mechanical low back pain

Answer 3

Often acute and linked to injury or strain
Typically result of bad habits, e.g. bad posture

Question 4

Signs of mechanical low back pain

Answer 4

Localised/referred pain, daily pattern, aggravating/relieving factors, morning stiffness lasting longer than 30 mins

Question 5

Radicular pain

Answer 5

Shooting pain, neurological

Question 6

Referred pain

Answer 6

Brain not understanding where pain is coming from
Can go into dermatomal patterns

Question 7

Test for facet irritation

Answer 7

Kemp’s test

Question 8

Trigger points

Answer 8

Only referred to as TP if they are tender to touch and produced referred pain, should also be a twitch

Question 9

Prolapsed intervertebral disc

Answer 9

Herniated/bulging
20-35 most affected
L4/5/S1 most affected
Extrusion- immune doesn’t know what nucleus pulpous is so attacks it, reduced ability to work etc
Pins and needles, shooting pain, difficulty sitting down/standing up
Investigations after 6/52- don’t want to touch for first couple weeks

Question 10

Inflammation cycle

Answer 10

1. bleed 1-3 days till it stops
2. clean up- weeks-months to remove damaged material
3. remodel- e.g. cut–> scar
4. readaptation- mistakes can be made during this process –> chronic pain, need to reset and attempt healing pattern again

Question 11

Anky spon Hx

Answer 11

20-35
M>F
Insidious onset of vague LBP
Stiffness worse with waking, better with movement

Question 12

Anky spon SSx

Answer 12

Loss of lumbar/SI ROM
+ve blood test- HLAB27

Question 13

Anky spon DDX

Answer 13

Progressive sclerosis of SIJ

Question 14

Cauda equina syndrome Hx

Answer 14

Bilateral neuro symptoms
Saddle anasthesia
Loss of bladder control

Question 15

CES SSx

Answer 15

Gait abnormalities
Red motor strength
+ve Babinskis

Question 16

Lumbar sprain/strain Hx

Answer 16

Hx of trauma
Local P with motion

Question 17

Lumbar sprain/strain SSx

Answer 17

No neuro symptoms
Dec AROM + PROM
PROM due to P

Question 18

Piriformis syndrome Hx

Answer 18

Possible P down back of leg
Worse when sitting on hard surfaces

Question 19

Piriformis syndrome SSx

Answer 19

Tender to palpate
Dull ache in glute
Can be shooting P down back of leg (if sciatic N entrapped)

Question 20

Spinal stenosis Hx

Answer 20

M>F (2:1)
Chronic LBP
Worse with prolonged standing
Confirm with X-ray- dec spinal canal diameter

Question 21

Stenosis DDx

Answer 21

Vascular claudication

Question 22

Spondylolithesis Hx

Answer 22

Chronic LBP
Repetitive extension movement (e.g., rowing)

Question 23

Spondylolithesis SSx

Answer 23

Possible hyperlordosis
Repeatable ‘clunk’ or ‘catch’ with Lsp ROM
Step deformity