Week 2 Flashcards
(36 cards)
Describe the clinical presentation of discogenic low back pain
- pain radiation to the buttocks or proximal posterior thigh and increased pain with prolonged sitting, coughing, sneezing, or a Valsalva maneuver.
- Disk herniations typically cause mechanical or chemical irritation of a nerve root (or both) with corresponding radicular symptoms of numbness, tingling, or weakness.
Acute back pain
- how long does it last?
- how do you fix it?
- how is it caused?
- lasts a few days to a few weeks
- resolve on its own with self-care and there is no residual loss of function.
- mechanical in nature, disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move.
Subacute low back pain
pain that lasts between 4 and 12 weeks.
Chronic back pain
- how long?
- how many people?
- does it go away?
- pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated.
- 20 percent of people affected by acute low back pain develop chronic low back pain
- pain can persist despite medical and surgical treatment.
Sprains
caused by overstretching or tearing ligaments
Strains
tears in tendon or muscle
Intervertebral disc degeneration
discs lose integrity as a normal process of aging
Herniated or ruptured discs
when the intervertebral discs become compressed and bulge outward (herniation) or rupture,
Radiculopathy
- what is it?
- what does it feel like?
- how is it caused?
- compression, inflammation and/or injury to a spinal nerve root
- results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve
- spinal stenosis or herniated/ruptured disk
Sciatica
- form of radiculopathy caused by compression of the sciatic nerve
- causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot
Spondylolisthesis
condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column
Spinal stenosis
narrowing of the spinal column that puts pressure on the spinal cord and nerves
Infection causing back pain
- osteomyelitis: infection of vertebrae
- discitis: infection of intervertebral discs
- sacroilitis: infection of sacrum and illiac bones
Cauda equina syndrome
serious but rare complication of a ruptured disc. It occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots, causing loss of bladder and bowel control. Permanent neurological damage may result if this syndrome is left untreated.
Osteoporosis
-metabolic bone disease marked by a progressive decrease in bone density and strength, which can lead to painful fractures of the vertebrae
Kidney stones
can cause sharp pain in the lower back, usually on one side
Abdominal aortic aneurysms
large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that the aneurysm is becoming larger and that the risk of rupture should be assessed.
utility of NSAIDs for acute mild low back pain
- relieve pain and inflammation
- inhibit Cox1 and Cox2 which prevents arachadonic acid from being made into prostaglandins, thromboxane, and prostacyclin–stops increased inflammation
Side effects of NSAIDs
- stomach irritation, ulcers, heartburn, diarrhea, fluid retention, kidney dysfunction and cardiovascular disease
Ketorolac
- inhibition of COX-1 and COX-2
- indirect analgesic effect by inhibiting prostaglandins E and F
- bio availability is 100% orally
Ibuprofen
- inhibition of COX-1 and COX-2
- indirect analgesic effect by inhibiting prostaglandins E and F
- bio availability is 80% orally
DOCSIFY the straight leg test
- name
- use
- how performed
- positive
- negative
- Name: Lasegue’s Supine Straight-Leg-Raising Test.
- Use: Checks for radiculopathy and impingement of the nerves
- Steps to Perform Test: The patient lies supine with legs extended. The examiner places one hand under the heel of the affected side and the other hand is placed on the knee to prevent the knee from bending. With the limb extended, the examiner flexes the thigh on the pelvis to the point of pain, keeping the knee straight.
- Positive: maneuver is markedly limited by pain, suggests sciatica/ radiculopathy (usually caused by herniation)
- Negative: limb extended to almost 90° without pain.
DOCSIFY the Thomas test
- Name: Thomas test
- Use: measure the flexibility of the hip flexors, which includes the iliopsoas muscle group, the Rectus Femoris, pectineus, gracillus as well as the Tensor Fascia Latae and the sartorius.
- Steps to Perform Test: patient is supine on the examination table, butt at the end allowing knees to be off and flexed; patient brings both knees to chest then extends one leg, bring one knee towards chest;
- Positive: If quad is extended while knee is bent and quad is raised off table OR If quad is extended while knee is bent and quad is touching table but knee cant bend more than 70 degrees then rectus femoris tight; If quad is extended and knee is extended and leg is raised off table then iliopsoas tight;
- Negative: If extended leg is able to lie flat on table and when bent able to bend more than 70 degrees then iliopsoas and rectus femoris not tight
strength testing
-levels and what they designate
- 0/5: no contraction
- 1/5: muscle flicker, but no movement
- 2/5: movement possible, but not against gravity (test the joint in its horizontal plane)
- 3/5: movement possible against gravity, but not against resistance by the examiner
- 4/5: movement possible against some resistance by the examiner (sometimes this category is subdivided further into 4–/5, 4/5, and 4+/5)
- 5/5: normal strength