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21 Cards in this Set
- Front
- Back
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... : Loss of bowel and bladder control and numbness in the groin and saddle area of the pelvis, associated with weakness of the lower extremities (surgical urgency/emergency), hyporeflexia/areflexia
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Cauda equina syndrome
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...: Arthritis of the spine (spurring)
...: A fracture in the pars interarticularis where the vertebral body and the posterior elements, protecting the nerves are joined. Can be congenital or acquired (stress fracture/ degenerative) -Can lead to ... |
Spondylosis
Spondylolysis spondylolisthesis |
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...: Impingement of a nerve root with radiating pain, numbness, tingling or muscle weakness in a particular distribution
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Radiculopathy
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The level of disc herniation will typically affect the nerve root ... to that segment. If L4/L5 disc herniates, the nerve root of ... will be impinged.
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distal
L5 |
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Which part of the annulus fibrosis is most highly innervated?
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outer 1/3
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LBP – think of systemic disease if:
-History of ... -Age over ... years -Unexplained ... loss -Duration of pain greater than ... month -... pain -Unresponsiveness to previous therapies -IV drug use, skin infection, UTI, or recent fever (possible spinal infection) |
cancer
50 weight one Nighttime |
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Neurological compromise:
Pain below the knee is more likely to represent true ... than proximal leg pain -Increases with cough, sneezing, or Valsalva Bowel/ bladder dysfunction may represent ..., which is a medical emergency -Urinary retention with overflow incontinence -Saddle anesthesia -Bilateral radiculopathy -Leg weakness/ Areflexia Lumbar ... -Persistent back and leg pain relieved by sitting/ flexion Pain with walking aka "..." -Normal arterial pulses -Classic but rare finding |
radiculopathy
cauda equina syndrome stenosis pseudoclaudication |
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Make sure to focus on ... when doing the inspection of the back during the physical examination
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posture
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98% of clinically relevant lumbar disc herniations occur at ... and ...
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L4-L5
L5-S1 |
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neurological testing:
-L5 motor nerve root testing evaluates strength of ... and ... -L5 sensory nerve root damage results in numbness in the ... foot and first dorsal ... |
ankle
great toe dorsiflexion middle (dorsal) web space |
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... nerve root is tested by evaluating ankle reflexes and sensation at the posterior calf and lateral foot
... radiculopathy may cause weakness of plantar flexion, but is difficult to detect until quite advanced -Toe walking or toe up |
S1
S1 |
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Imaging in LBP:
Not needed in first 4 - 6 wks unless: -... neurological findings -Constitutional symptoms -History of ... onset -History of ... -Age 18 - 50 years -Infectious risk (IV drug use, UTI) -Osteoporosis |
Progressive
traumatic malignancy |
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“American College of Radiology identifies 10 "red flags" which indicate a more complicated status in whom radiographs, or other imaging studies, would be appropriate”
-Recent significant trauma or milder trauma age >... -Unexplained weight loss -Unexplained fever -Immunosuppression (history of cancer) -Intravenous (IV) drug use -Osteoporosis -Prolonged use of ... -Age >... -Focal neurological deficit progressive or disabling symptoms -Duration greater than ... weeks |
50
corticosteroids 70 6 |
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MRI is more sensitive in detecting ... and ...
CT is superior in demonstrating ... |
infection, cancer
bony abnormalities |
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L4-5: a lateral disc herniation will affect ..., a central disc herniation (MC) will affect ...
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L4
L5 |
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UrineAlysis is not generally helpful except in ... LBP
UrineProteinElectroPhoresis/ SPEP if multiple ... is suspected |
unexplained unilateral
myeloma |
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Electrodiagnostics:
Assesses nerve function ... is the most common reason for electromyography (EMG) -Value of EMG in is highly variable -Nerve conductions are of little value -Especially sensory studies (even less value) |
Radiculopathy
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Specialist consultation:
... consult indicated: -Cauda equina syndrome (rare) -Suspected spinal cord compression -Progressive or severe neurological deficit ... consult if any of the following: -Neuromotor deficit that persists after 4-6 weeks -Persistent sciatica (radicular pain) -Stable sensory or motor deficit -Reflex loss |
Surgical
Physiatry |
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acute back pain lasts less than ... weeks
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4
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...:
Non-opioid drug with opioid action Several controlled trials in chronic LBP found (combined with acetaminophen) more effective than placebo and comparable to codeine and acetaminophen |
Tramadol
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... syndrome:
Diagnosis: Trigger points Cervical whiplash -Stretch vs. contraction *In general, the back strap muscles become abnormally ... and the front (chest wall, anterior neck) muscles become abnormally ... *Muscle imbalance and pain cycle ensue ... points more common in the upper back |
myofascial pain
stretched contracted Trigger |
