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82 Cards in this Set
- Front
- Back
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what is sciatica?
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pain originating in the back and radiating down the posterior or lateral thigh?
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what is radiculopathy?
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impairment of the nerve root
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what is spondylosis?
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arthritis of the spine
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what is spondylolisthesis?
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anterior dislocation of the pars
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what is spondylolysis?
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degeneration of the spine
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what is a sprain of the spine?
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involves the ligaments
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what is a strain of the spine?
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involves the muscle
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what are 4 critical differential diagnoses for lower back pain?
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cauda equina syndrome
fracture osteomyeltitis infection cancer |
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what does age over 50 put patients at risk for when presenting with lower back pain? (2)
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cancer
fracture |
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what could unrelenting lower back pain at night be a sign of? (2)
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cancer
fracture |
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what could progressive motor or sensory deficit be due to with lower back pain? (2)
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cauda equina syndrome
cancer |
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what could saddle anesthesia be due to?
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cauda equina syndrome
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what could difficulty urinating/incontinence be due to when presenting with lower back pain?
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cauda equina syndrome
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what could a history of osteoporosis lead to?
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compression fx
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what could chronic use of oral steroids lead to in the back? (2)
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infection
fracture |
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where can you test L1 in a neuro exam? (3)
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groin
iliopsoas hip flexion |
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what 2 things should you note when looking at a patient with lower back pain?
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gait
posture |
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where can you test L2 in a neuro exam? (5)
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anterior thigh
iliopsoas sartoious hip adductors hip flexion |
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where can you test L3 in a neuro exam? (7)
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medial aspect of the knee
iliopsoas quads sartorius hip adductors hip flexion extension |
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where can you test L4 in a neuro exam? (2)
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tibialis anterior
medial lower leg |
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where can you test L5 in a neuro exam? (1)
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big toe (extensor hallicus longus)
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where can you test S1 in a neuro exam? (1)
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achilles tendon
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what type of paralysis is seen with LMN injury?
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flaccid
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what will happen to DTR in LMN injury?
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decreased or absent
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will babinski be present or absent with LMN inj?
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absent
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will muscles atrophy with LMN inj?
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yes
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will fasciculations be present with LMN inj?
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maybe
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what type of paralysis is seen with UMN inj?
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spastic
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what will happen to DTR in UMN inj?
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increased
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will babinski be present or absent with a UMN inj?
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present
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will muscles atrophy with UMN inj?
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no unless due to dissuse
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will fasiculations be present with UMN inj?
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no
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when will the straight leg test be +?
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if the patient wants to lean back
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what are 4 special tests you can do for LBP?
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straight leg test
faber trendelenberg hoovers |
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what does the faber test look for?
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hip/sacroiliac dysfunction
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what does the trandelenberg test look for?
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gluteus medius dysfunction
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what 3 things will be observed on a LBP x-ray? (3)
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boney achitecture
fracture osseus lesions |
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what 2 things can a LB CT scan show?
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fracture
prior lumbar surgery |
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what 2 things can a LB bone scan show?
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cancer osteomyelitis
stress fracture |
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when is myelography used?
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absolute contraindications for MRI
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what is cauda equina syndrome due to?
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reduction of volume of the spinal canal
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what does cauda equina syndrome cause? (3)
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compression of spinal canal
muscle paralysis urinary or bowel dysfunction |
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what are 4 symptoms of cauda equina syndrome?
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radicular pain of both legs
saddle anesthesia difficulty voiding or loss of sphincter control leg weakness |
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what are 3 physical findings of cauda equina syndrome?
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sensory changes
difficulty standing difficulty with heel to toe walking |
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what is an emergent surgical referral for LBP?
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cauda equina syndrome
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what type of compression fracture affects the anterior half of the vertebral body?
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simple
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what type of compression fracture extends into the posterior third of the vertebral body?
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burst
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which type of compression fractures are unstable? (2)
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posterior ligament disruption
flexion-distraction injuries |
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what are 3 physical findings of compression fractures?
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tenderness to palpation over the vertebrae
step off hematoma |
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what are 5 causes of acute LBP?
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strain
sprain twisting repeated lifting vibrating equipment |
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will acute LBP have any neuro deficits?
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no
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how long must you have LBP for it to be considered chronic?
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3 months
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will there be neuro dysfunction with chronic LBP?
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no
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what life style change makes a difference in chronic back pain?
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smoking cessation
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what are the 2 most common sites for disk herniation?
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L4-5
L5-S1 |
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where will disc herniation pain be worse?
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leg
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when is disc herniation pain worse? (2)
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valsalva
motion |
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will there be neuro deficits in disc herniation patients?
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yes
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what should you do if there are no red flags present with disc herniation?
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wait until 4-6 weeks of conservative care before radiography
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what drug would be good for disc herniation and why?
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gabapentin because it is good for nerve pain
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what are 3 physical therapy treatments for disc herniation?
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ultrasound
transcutaneous electrical nerve stim traction |
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what is contraindicated with disc herniation?
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no HVLA
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what is spinal stenosis?
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narrowing of the central spinal canal by bone or soft tissue with compression of nerve root
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what 3 sites are most common for spinal stenosis?
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L2-3
L3-4 L4-5 |
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when will spinal stenosis pain be better?
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flexing forward (bending over a shopping cart)
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how do you differentiate spinal stenosis from PVD?
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pulses will be normal
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what test may be + in spinal stenosis?
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rhomberg
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what side is scoliosis named for?
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convexity
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what are 2 causes of scoliosis in adults?
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degenerative spondylosis or spondylolisthesis
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what do these symptoms indicate:
pain at region of deformity radicular symptoms at L4 or L5 nerve root |
scoliosis
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how do you treat scoliosis? (2)
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NSAIDS
exercise program |
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what is spondylolisthesis?
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anterior slippage of one vertebral body over the next
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what do these symptoms suggest?
loss of lordosis step off of spinal processes decreased reflexes weakness in toe or heel walking |
spondylolithesis
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what 2 xrays do you want for spondylolisthesis?
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AP and lateral
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what is one unique treatment for spondyloisthesis?
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abdominal binder
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what is spondylolysis?
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disruption of the pars interarticularis
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what is spondylolysis due to?
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repeated hyperextension
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what may spondylolysis become?
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spondylolisthesis
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where will you have spasms in spondylolysis?
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hamstrings
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when will spondylolysis pain be worse?
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with standing
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what do these symptoms suggest:
decreased lordosis step off decreased flexion secondary to hamstring spasm |
spondylolysis
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what is HIPLSIT?
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hip long restrictors
innominate shears pubic dysfunction lumbars sacroiliac dysfunctions innominate rotations and flares thoracic dysfunctions |
