TEST 3: Lumbar Spine SD Dx Flashcards Preview

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Flashcards in TEST 3: Lumbar Spine SD Dx Deck (46)
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1

incidence of low back pain

-85% of general public have low back pain
-in 35% of adolescent athletes
-overuse injuries are prone to recurrence
-27% of back pain in adults is due to MSK strains

2

what are some general considerations to remember when treating pts with low back pain?

-it is the number #2 reason its go to the doctor
-majority of causes do not require surgical intervention
-massive financial burden (cost of tx, expense of lost work, legal costs)
-emotional burden (inc stress, depression)

3

what is the majority of back pain due to?

mechanical dysfunction

4

lumbar spine is frequent site of:

-strain
-pain
-disability

5

anatomy of lumbar spine

-vertebrae are built to support heavy loads
-allows for flexion/extension
-less SB and rotation due to sagittal orientation of facets

6

lumbar herniated disc

-may compress lumbar spinal nerve
-may tear the annular ligament

7

mechanical etiologies of low back pain

-arthritis
-spondylosis/ spondylolysis/ spondylolisthesis
-degenerative disc dz
-somatic dysfunction

8

non-mechanical etiologies of low back pain

-viscerogenic
-vasculogenic
-infection
-tumors
-metabolic
-rheumatologic

9

what are examples of viscerogenic etiologies?

-renal colic
-endometriosis

10

what are examples of vasculogenic etiologies?

-abdominal aortic aneurysm

11

what are examples of infection etiologies?

-osteomyelitis
-diskitis

12

what are examples of tumor etiologies?

-primary-->myeloma
-metastatic
-breast
-prostate
-lung
-kidney

13

what are examples of metabolic etiologies?

-osteoporosis

14

what are examples of rheumatologic etiologies?

rheumatoid arthritis

15

what are some red flags in low back pain?

-major trauma mechanism
-great than 50 yo or less than 20 yo
-history of cancer
-cauda equina symptoms
-consititutional symptoms

16

what are caudal equina symptoms?

-saddle anesthesia
-new onset bladder/bowel dysfunction
-severe or rapidly progressive neurological symptoms

17

what are constitutional symptoms?

-fever
-chills
-unexplained weight loss
-recent bacterial infection
-IV drug abuse
-immune suppression
-severe nighttime pain

18

spina bifida

-example of mechanical etiology
-spinous process is formed from laminae
-failure of fusion--?spina bifida
-neural tube defects-->decreased incidence with folate supplementation

19

spina bifida occulata

-congenital
-common at L5-S1
-asymptomatic
-may have patch of coarse hair over site
-may have dimple or birthmark
-small split in vertebra
-no spinal cord protrusion
-usually found on radiograph

20

spina bifida meningocele

-meninges force out b/w vertebral spaces

21

spina bifida myelomeningocele

-most common type
-unfused portion of the spinal column allows spinal cord to protrude thru an opening

22

spinal stenosis

-spinal canal contains conus medullaris, hilum terminal, and caudal equina
-cord terminates at L1-2
-diameter can become compromised-->stenotic
-also normally decreases with age

23

causes of comprising diameter with spinal stenosis

-hypertrophy of posterior longitudinal ligament
-thickening of ligaments flavor
-osteoarthritis
-exostoses
-osteophytes
-tumors
-disc rupture

24

cauda equina syndrome

-multiple etiologies:
-infection/inflammation
-herniated disc
-metastasis
-spinal stenosis
-all place pressure on caudal equina
-causes:
-pain, numbness, or tingling in low back/lower extremity
-progressive weakness and paralysis of lower extremity
-bladder and bowel incontinence, sexual dysfunction
-often a surgical emergency

25

how do we figure out the problem with back?

-a thorough H&P
-especially ROS for red flags

26

parts of lumbar spine examination

-observation
-palpation
-motion testing
-meuromuscular exam--strength & sensation
-vascular assessment

1. ROM--pt seated/standing
2. screen with fingers
-TART, hip drop test for lumbar SD
-hone in on these areas for further examination
3. pt in prone
-induce anterior force on R TP and induce L rotation
-repeat for L inducing R rotation
-repeat in F and E

27

physiologic barrier

active ROM

28

anatomic barrier

passive ROM
-doctor pushes pt to this point

29

pathologic barrier

-less than physiologic
-this is where complaint lies
-physiologic-pathologic=motion lost

30

mechanics of lumbar spine

-follows type I mechanics in neutral
-follows type II mechanics in non-neutral
-lumbar SP and TPs are at the same level!