Ortho lab final

Question 1

Diagnostic cluster for lumbar stenosis

Answer 1

1. BL sx
2. leg pain > back pain
3. Pain during walking/standing
4. Pain relief upon sitting
5. Age >48yr

1/5 is 96% sensitivity, low 0.19 neg LR
4/5 is pos LR of 4.6 and post-test probability 76%

Question 2

Diagnostic cluster for cauda equina syndrome

Answer 2

• Rapid onset of sx (24hr)
• Hx back pain
• Urinary retention
• Loss of sphincter tone
• Sacral sensation loss
• LE weakness or gait loss

Question 3

Diagnostic cluster for lumbar radiculopathy

Answer 3

• Dermatomal pattern of sx
• Pain with cough, sneezing, or straining
• More pain on sitting
• Subjective muscle weakness
• Subjective sensory loss
• Motor loss
• • SLR
• UL ankle reflex

Question 4

Diagnostic cluster for lumbar compression fx

Answer 4

• Age >50 (0.84/0.61)
• Age >70 (0.22/0.96)
• Trauma
• Adequate trauma (may be minor in elderly)
• Corticosteroid use

Question 5

Diagnostic cluster for spine cancer

Answer 5

• Age >50
• Hx cancer
• Failure to improve in 1 month of therapy
• No relief with bed rest
• Duration of 1 month
• Insidious onset
• Constitutional sx

Age >50 + cancer hx + unexplained weight loss or failure of conservative tx (100% sens/60% spec)

Question 6

Diagnostic cluster ankylosing spondylitis

Answer 6

• Age at onset 3mo

- Improved by exercise