Spine Conditions - Subjective

Question 1

Spondylosis: DDD/DJD

Answer 1

Typical age: 40-50s M
Low back, bilateral - low grade ache, morning stiffness, constant or intermittent - leg symptoms rare
Agg: extending, bending, sit to stand, lifting, end ranges
Hx: repeated microtrauma, one significant trauma, occupation requires lifting/sitting or contact sport

Question 2

Herniated Disc

Answer 2

Age: 20-55 M
Low back INTO LEGS - sharp radicular, N/T
AGG: flexion, sitting, walking, cough/sneeze
EASE: lying down, unloading
HX: sudden onset typically with repetitive lifting/bending, AM pain

Question 3

Spinal Stenosis

Answer 3

Age: 60+ M
Back and leg pain, sometimes bilateral - N/T in back and legs, LE weakness, neurogenic claudication
AGG: extension, prolonged standing/walking, walking DOWNhill, lying flat
EASE: flexion, sitting, walking UPhill, riding bike
HX: long hx of intermittent back pain

Question 4

Acute Facet

Answer 4

Unilateral pain over facet - sharp, tenderness
AGG: stretch or compression of facet joint, SB and/or Ext
HX: sudden unguarded movement (flex, return from flex, ext)

Question 5

Chronic Facet

Answer 5

Unilateral pain over facet - stiffness and pain in AM
AGG: prolonged inactivity
EASE: flexed posture, activity
HX: past acute facet, never entirely sx free, previous trauma or degeneration

Question 6

Acute Nerve Root

Answer 6

Young or old
Pain begins proximally but distal sx > proximal sx - SEVERE with likely n/t
AGG: activity and ROM, everything hurts
EASE: nothing really
HX of herniation

Question 7

Chronic Nerve Root

Answer 7

Proximal pain > distal, n/t
AGG: minimal activity limitations
HX: disc pathologies, degenerative changes, spinal surgery/scarring

Question 8

Spondylolysis/Spondylolisthesis

Answer 8

Teens but can be adults
Low back pain - dull, can be n/t
AGG: extension
HX: overextending, gymnast, repetitive trauma or athletic stress

Question 9

Functional Instability

Answer 9

30-50 years old
Localized low back pain - severe, chronic, fluctuating
AGG: extreme extension and rotation, static posture, severe pain after vigorous activity
EASE: changing position
HX: chronic, recurrent LBP, catch/locking

Question 10

SIJ Hypermobility

Answer 10

Clunking pain in sacrum area
AGG: change in position or walking, SLR, going up and down stairs
EASE: not moving

Question 11

Thoracic Outlet Syndrome

Answer 11

Aching in neck, shoulder, arm, or hand - n/t inside forearm and 4th/5th digits
AGG: difficulty with overhead activies
HX: reduced BF resulting in swelling and redness of arm and hands, they may feel cool, easily fatigued

Question 12

Flattened upper thoracic spine

Answer 12

Stiffness of CTJ and mid thoracic (T3-7)
AGG: flexion
EASE: unloading
HX: stiffness of joints, MVA

Question 13

Generalized Upper/Mid Thoracic Stiffness

Answer 13

Middle/older age
Stiffness at multiple levels, limited arm elevation, muscle imbalance
HX: metabolic changes, prolonged acquired posture

Question 14

T4 Syndrome

Answer 14

Posterior thoracic pain or pain around scapula, headaches
AGG: worse last thing at night or with activities involving flexion/slumping
EASE: laying flat
HX: puffiness in glove distribution of both hands, altered and extreme temp, perception

Question 15

Upper/Mid Thoracic Hypermobility

Answer 15

Interscapular Pain
AGG: prolonged positioning, upper limb mvmt or lifting
HX: trauma (vomiting, childbirth, MVA, falls) gymnast or dancer

Question 16

Costal Joint Derangement

Answer 16

localized, pain and stiffness with rib mobility

AGG: twisting or reaching, breathing, trunk rot

Question 17

Elevated First Rib

Answer 17

trapezius spasm, radiculopathy, jaw pain, mid-back pain, chest and sternal pain
AGG: end range c spine rotation and shoulder elevation
HX: poor posture and chronic neck pain

Question 18

Rib Subluxation

Answer 18

localized pain, reduced motion during inspiration/expiration, local muscle spasms
AGG: coughing, sneezing
EASE: good posture

Question 19

Thoracic Disc Lesion

Answer 19

upperback or radiated in dermatomal pattern, shooting around chest wall, n/t below level
AGG: any movement, deep breathing, coughing/sneezing
EASE: unloading, good posture

Question 20

Tietze’s Syndrome

Answer 20

ant. chest pain, localized and superficial irritation
AGG: worse with breathing and trunk mvmt
EASE: anti-inflammatories
HX: swelling over joint and associated with hypomobility of TS

Question 21

Cervical Disc Herniation

Answer 21

30-35 years
Central or paramedian location, can radiate (cloward) - central ache, stiffness @ location of herniation but the cloward sign location is sharp, n/t
AGG: looking down, turning head, driving, sitting, ADL’s limited
EASE: laying down, resting
HX: rapid onset due to trauma or insidious and gradual onset

Question 22

Spondylosis: DDD, DJD, U-joints

Answer 22

diffuse sx, unilateral or bilateral - n/t
AGG: sustained flexion, quick movements, end of range
HX: long hx of neck pain

Question 23

Facet lock (acute)

Answer 23

localized pain with or w/o spasms - sudden locking

Question 24

Facet lock (chronic)

Answer 24

HX: injury or arthritis

Question 25

Acute nerve root (cervial)

Answer 25

older pts with degeneration/young with trauma distal pain with dermatomal pattern - constant and/or latent, shooting pain, n/t AGG: any mvmt of neck that closes foramen, arm movements, sustained flexion Hx: insidious then spreads, prior episodes of neck stiffness, pain awakes at night

Question 26

Chronic nerve root (cervical)

Answer 26

middle age and older dermatomal pain pattern not necessarily distal, "patchy" distribution - intermittent, 'nagging' AGG: sustained flexion, mvmts that narrow foramen HX: neck pain, post-surgical

Question 27

Cervical Stenosis

Answer 27

>55 yrs neck and arm pain AGG: ROM HX: high contact sport athletes, have difficulty writing bc of muscle wasting in hands