Flashcards in TEST 3: Lumbar Spine SD Dx Deck (46)
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
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)
what is the majority of back pain due to?
lumbar spine is frequent site of:
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
lumbar herniated disc
-may compress lumbar spinal nerve
-may tear the annular ligament
mechanical etiologies of low back pain
-spondylosis/ spondylolysis/ spondylolisthesis
-degenerative disc dz
non-mechanical etiologies of low back pain
what are examples of viscerogenic etiologies?
what are examples of vasculogenic etiologies?
-abdominal aortic aneurysm
what are examples of infection etiologies?
what are examples of tumor etiologies?
what are examples of metabolic etiologies?
what are examples of rheumatologic etiologies?
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
what are caudal equina symptoms?
-new onset bladder/bowel dysfunction
-severe or rapidly progressive neurological symptoms
what are constitutional symptoms?
-unexplained weight loss
-recent bacterial infection
-IV drug abuse
-severe nighttime pain
-example of mechanical etiology
-spinous process is formed from laminae
-failure of fusion--?spina bifida
-neural tube defects-->decreased incidence with folate supplementation
spina bifida occulata
-common at L5-S1
-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
spina bifida meningocele
-meninges force out b/w vertebral spaces
spina bifida myelomeningocele
-most common type
-unfused portion of the spinal column allows spinal cord to protrude thru an opening
-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
causes of comprising diameter with spinal stenosis
-hypertrophy of posterior longitudinal ligament
-thickening of ligaments flavor
cauda equina syndrome
-all place pressure on caudal equina
-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
how do we figure out the problem with back?
-a thorough H&P
-especially ROS for red flags
parts of lumbar spine examination
-meuromuscular exam--strength & sensation
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
-doctor pushes pt to this point
-less than physiologic
-this is where complaint lies