SpineOrtho Flashcards
(29 cards)
What pertinent history questions do you address for a patient with back pain?
inciting event (fall, lifting heavy load, etc)
s/s constant or intermittent?
where is the exact distribution of pain? (helpful to clarify ant/post/lat leg)
aggravating/alleviating
constitutional s/s: fevers, chills, night sweats or weight loss?
loss of bowel/bladder control
Specific alleviating/aggravating characteristics/questions for spine pain that help indicate cause:
Better/worse:
leaning forward, sitting, standing, lying down, past treatments
What could loss of bowel or bladder function indicate?
loss of neurologic function as seein in cauda equina syndrome (emergency!)
Necessary components of physical exam for spine pain.
come back to this lol
Pertinent physical exam for neck and back pain
shoulder, hip/knee exam, gait, motor, sensory, reflexes, upper motor neuron signs, pulses
What should you examine for on the back?
incisions or wounds, deformity
What gait characteristics need to be evaluated?
-can they perform heel to toe tandem gait (myelopathic if unable)
-wide based and spastic gait while grasping for walls?
How do you document/quantify motor strength?
0-5/5
How do you document sensory exam?
Normal= 2/2
Abnormal= 1/2
Absent= 0/2
Upper Motor Neuron Signs
clonus, babinski test, hoffmann’s sign, hyperreflexic DTR
If DTR is hyper-reflexic is present?
if present- examine neck/upper extremities for myelopathy-
Hoffmann’s reflex/inverted brachioradialis reflex
Physical exam for scoliosis
should always be evaluated undressed from behind; neuro exam, long tract signs, reflexes
scoliometer
HS tightness
gait abnormalities
trunk shift
flexibility with side bending
Incidence of low back pain?
Up to 80% of americans within their lifetime; up to 45% of the population will experience LBP annually
#1 cause of disability worldwide
Define kyphosis
Increased curvature toward BACK of body (10-40 degrees)
Lordosis
Increase in curve toward FRONT of body of lower back. (40-60 degrees)
Scoliosis
actually an issue of rotation, not spinal curvature
10 or > degrees
Presentation of scoliosis
school/preparticipation physicals
back pain
parental concern
altered body image
Back Pain with Scioliosis Characteristics
idiopathic scoliosis is non-painful
secondary degenerative change
paraspinal muscle fatigue
low back pain physical exam
standing motor strength- tiptoes, heals
low back pain physical exam
seated motor strength
low back pain physical exam
straight leg test, FABER test
what is spondylolysis?
defect in the pars interarticularis
Spondylolysis treatment
-typically stable unless neuro deficits are present
-conservative tx: PT, NSAIDs, bracing
-if severe or neuro deficits present– surgical fusion
what is sponylolisthesis?
slippage of one vertebra over another
*important to obtain standing radiographs, as it can be reduced in supine position during MRI
