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MSK Final > Thoracolumbar Spine VII- Stenosis through Anomalies > Flashcards

Thoracolumbar Spine VII- Stenosis through Anomalies Flashcards

1
Q

_______ is narrowing around and compression of neurological structures

A

Stenosis

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2
Q

Stenosis is MOST common dx for spinal sx in adults > _____ yrs. of age

A

60

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3
Q

The population for stenosis is typically > ______ yrs. of age

A

65

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4
Q

The population for stenosis could be younger due to ___________

A

spondylolisthesis

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5
Q

_____% of asymptomatic individuals had canal narrowing on imaging

A

30

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6
Q

With stenosis involving compression from the outside in, it is typically more ________ than bilateral and central

A

unilateral

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7
Q

With stenosis involving compression from the outside in, is due to what commonly?

A

Age-Related Disc and Joint Changes

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8
Q

Besides Age-Related Disc and Joint Changes, what are some other causes for stenosis?

A

Instability (older or younger)
Enfolding of ligamentum flavum (likely need sx)

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9
Q

With stenosis involving compression from the inside out, it involves a _____ around the nerve that is ________ due to persistent inflammation

A

sheath; fibrotic

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10
Q

With stenosis involving compression from the inside out, it has _______ blood supply to the nerve with activity, particuraly with ______, which causes the nerves to enlarge

A

increased; walking

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11
Q

With stenosis involving compression from the inside out, the ______ nerve won’t expand, there is compression from inside out

A

fibrotic

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12
Q

With stenosis involving compression from the inside out, it has the same result as _______ but different mechanism

A

narrowing

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13
Q

With stenosis, there is ______ compression and ______ congestion with

  • spinal n.
  • radicular aa. supply spinal nn.
A

ischemic; venous

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14
Q

With stenosis there is NO _______ veins in the PNS or CNS

A

lymphatic

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15
Q

Review this

A
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16
Q

Lateral Stenosis Symptoms

_________ LE > LBP!
with _________ paresthesias and ______ type P! due to ischemia

Unilateral or Bilateral?

Non-segmental or segmental?

gripping; lengthening

A

Unilateral

Segmental

Gripping

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17
Q

A patient with lateral stenosis will have increased P! with what actions?

A

LBP- standing/walking, possibly coughing, sneezing if acute

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18
Q

A patient with lateral stenosis will have decreased P! with what actions?

A

LBP- FB/sitting/AM

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19
Q

A patient with lateral stenosis may have decreased symptoms with walking on incline why?

A

an incline causes some forward bending which reliefs their symptoms

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20
Q

What might you notice during observation on a patient with lateral stenosis?

A

Slouched posture
Possible scoliosis

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21
Q

A patient with lateral stenosis will have increased LE and LBP with what ROM?

It may demonstrate what kind of motion? (limited or excess?)

A

EXT
ipsilateral SB

limited motion due to contact with spinal n.

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22
Q

A patient with lateral stenosis will have decreased LE and LBP with what ROM?

It may demonstrate what?

A

FLX
contralateral SB

limited motion DUE to not being able to open lateral foramen

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23
Q

With lateral stenosis ______ ROM is inconstent to produce symptoms

A. SB
B. ROT
C. EXT

A

B.

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24
Q

Will neuro tests be + or - with lateral stenosis? If yes, what condition?

A

+; radiculopathy

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25
Q

Stress tests with lateral stenosis could be + with…?

A

with PA pressure/torsion when SUSTAINED

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26
Q

Lateral stenosis is a ________ condition

A. hypermobility
B. hypomobility

A

B.

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27
Q

With possible hypomobility indication, you should follow up with ______ _______ testing?

A

accesory motion

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28
Q

With lateral stenosis there could be hypomobility in the _______ joints

lower ________
upper ________ and or LE

especially _____

A

adjacent

thoracic
lumbar
hip

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29
Q

With lateral stenosis there could be hypomobility in the _______ joints

in ______ flexion and _________ SB to open lateral foramen

A

adjacent

lumbar
contralateral

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30
Q

With stenosis,
there are usually impaired _____ muscles to help with stabilization

A

local

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31
Q

With special tests involving stenosis,

Stability tests- possible excessive _______

______ discrepancies

______ deficits with wide based gait

A

shearing

LE

BALANCE

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32
Q

Cook’s CPR for stenosis

_______ symptoms (bilateral or unilateral)
____ P! > LBP (hip or LE)
Standing/_____ P! (Walking or sitting)
P! relief with ______ (standing or sitting)
> ____ yrs. of age (65 or 48)

A

Bilateral

LE

Walking

sitting

48

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33
Q

The Ankle Brachial Index (ABI): tests for ______ arterial disease

It is a ratio of which two arteries?

A

peripheral

tibial and brachial

34
Q

The bicycle test (neural vs vascular causes)

Cycle upright (slight extension) then bend to lean on handlebars for 3 min. each:

If stenosis, pain will decrease with ____ position. If it doesn’t, _____ is indicated

A

bent; PAD

35
Q

Lateral spurs are involved with ______ stenosis: and can affect multiple _____ because they are positioned more vertical than cervical spine

A

central; spinal n.

36
Q

2 hallmark signs of cauda equina syndrome

A

badder incontinence

saddle paresthesias

37
Q

With stenosis PT Rx: there should be patient _______ and overall has a good ________

A

education; prognosis

38
Q

A patient with stenosis, would perfer directional preference in ______

A

FLX

39
Q

With stenosis:

________ traction may be helpful with radiculopathy, especially, if no centralization

A

Intermittent

40
Q

Joint mobz with should be performed in which direction?

A

in the opposite direction to open up the ipsilateral symptomatic side

41
Q

Manipulation is MOST effective for sub-group of stenosis with LBP:

Lower ________

Lumbar manip, MOST effective when combined with _______

Evidence of support for addition of ____ joint manipulation

A

thoracic

exercise

hip

42
Q

With PT Rx:

If there is a gliding restriction, you want to use _______ mobilizations

A

neural

43
Q

With PT Rx, you want to focus on _____ opening

A

foraminal

44
Q

With MET involving stenosis you want:

Aerobic or Anerobic?

_______ walking

_______ as effective as un-weighted walking

This will improve _______

A

Aerobic

Unweighted

Cycling

Circulation

45
Q

With stenosis, you want to perform balancing training in what position?

A

sitting

46
Q

With stenosis and MD Rx:

Sx indications

  • Presence of constant or ______ symptoms
  • Failure to obtain relief with __-___ months of non-surgical treatments
A

worsening

3; 6

47
Q

With Sx and stenosis:

it is inconclusive and best with spinal decrompession of __________ and or partial __________ with or w/o fusion

A

laminectomy

disecotomy

48
Q

With Sx involving stenosis:

there is benefit with ____ but walking distance NOT better

Stenosis with _________ substantially greater pain relief and improvement in function vs. PT at 4 yrs

A

P!/disability

spondylolisthesis

49
Q

_____________ is a bony defect or fracture pars interarticularis unilaterally or bilaterally

A. Spondylolisthesis
B. Spondylolysis

A

B.

50
Q

With Spondylolysis, the etiology involves excessive and repetitive _______, particuraly when combined with ________

A

extension; rotation

51
Q

With Spondylolysis, it is ________ and could be _________ and caused my direct ________

A. non-congenital; symptomatic, contact

B. congenital; asymptomatic; trauma

A

B.

52
Q

With Spondylolysis, it is highest in ______ ________

A. older adults
B. adolescent athletes
C. older athletes

A

B.

53
Q

With Spondylolysis, it is more prevelant in biological _______

A

males

54
Q

With Spondylolysis, the risk factors include:

Most common- _______

Low vitamin ______ (in 75% of cases, more later with bone stress injuries in the LE)

________/bone morphology

Excessive _________

A

athletics

D

Genetics

lordosis

55
Q

With Spondylolysis, it is MOST common at the _____, ______ level

Secondarily at ____,______

A

L5; S1
L4; 5

56
Q

The S&S with Spondylolysis:

Like a worse case of _______ S&S
Possible _______ S&S
Conditions leading to low _____ ______

A

instability

fracture

vitamin D

57
Q

With _______ is anterior vertebral segment slippage

A. Spondylolysis
B. Spondylolisthesis

A

B.

58
Q

With Spondylolisthesis, what is the MOST common type?

A. Isthmic or adolescent with spondylosis

B. Degenerative

A

A.

59
Q

With Spondylolisthesis, which age group has the MOST rapid slipping and which action is repetitive and traumatic?

A. adolescent; extension
B. older; extension

A

A.

60
Q

With degenerative spondylolisthesis, it is due to what?

Does it involve a fracture?

A

Age-related disc changes; NO

61
Q

With Spondylolisthesis and degrees of disc slippage:

Grade I= ___-__%
Grade II= ___-____%
Grade III=_____-____%
Grade IV= ___-____%

A

0; 25
26; 50
51; 75
76; 100

62
Q

With Spondylolisthesis S&S:

It is like a worse case of ______

Possible lateral or central _____
S&S with slippage

NO correlation with ______ and degree of symptoms

A

instability

stenosis

slippage

63
Q

With Spondylolysis and Spondylolisthesis PT Rx and MET:

Better outcomes with ____ weeks of ______ muscle training vs traditional ther ex alone out to 1 1/2 years

A

10; local

64
Q

With Spondylolysis and Spondylolisthesis PT Rx and prognosis:

there is greater healing with ______ lesion (71%) than _______ (18%)

A

unilateral; bilateral

65
Q

With Spondylolysis and Spondylolisthesis PT Rx:

____% of children and young adults improved after 1 year with up to ____% slippage

A

85; 25

66
Q

With Spondylolysis and Spondylolisthesis PT Rx:

____% of adolescents returned to sports within ____ months

A

92; 6

67
Q

With Spondylolisthesis and MD Rx:

Sx indications- confirmed ______ without conservative benefits

Sx outcomes- 83% ______ to _____ outcome with modified Scott technique vs others (fusion)

A

imaging; excellent; good

68
Q

Repetitive extension/hyperextension with McKenzie directional preference is often used (70%) when a _____ _____ is indicated

A

disc change

69
Q

Sitting with forward head posture reduces _______ and how much MVC %?

A

circulation; 30

70
Q

_____ _______ and regular change of ______ is helpful for circulation

A

proper posture; positions

71
Q

With sitting FHP the thorax becomes ______ and ________

This leads to compression in what area?

A

flexed; depressed

diaphragm

72
Q

With sitting FHP, the diaphragm becomes overworked and is associated with persistent _______

A

LBP

73
Q

With sitting FHP, _______ extensors and accesory ______ muscles overwork to compensate

A

thoracic; respiratory

74
Q

With sitting FHP, there is a decrease in the ____-_____ reflex of muscles and leads to _____ muscle inhibition

A

anti-gravity

local

75
Q

With sitting FHP, there is a smaller ______ ______ in those with persistent neck P!

A

Transversus Abdominis

76
Q

With sitting FHP,the load ______ on the _____ region for every anterior inch of FHP

A

doubles; lumbar

77
Q

With sitting FHP and PT Rx should focus on:

_______/ergonomics

Education- sit ____ and have a ______ chair

__________ breathing to help minimize accesory respiratory mm.

____/______ in the thoracolumbar regions to improve mobility

MET to improve _____ muscle functions in the thoracolumbar regions

A

Posture

tall; supportive

Diaphragmatic

MT; MET

local

78
Q

With anomalies what are the two types of fusions?

A

Congenital and Autolytic

79
Q

With congenital anomalies you have ______ization and _______ization

A

Lumbar; Sacral

80
Q

With lumbarization has ____ vertebra and sacralization has ____ lumbar vertebra

A

6; 4

81
Q

With autolytic anomalies, it is due to…..

A

age-related joint disease

82
Q

With autolytic anomalies, it involves _____ bridges and _____ joints

A

spurring; fuses

MSK Final (30 decks)

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