Gi_Ocs_Lowerbackpain_+Mid Back Pain

Front 1

Where is there more motion in spine? What region(s) have less?

Back 1

Thoracic has more motion

Cervical and Lumbar have more
_lumbar

Front 2

Describe the Viscerosomatic Reflex?

Back 2

Visceral distrubance increases sympathetic outflow to the somatic structures
-Sensory experience-stimultion of spinal pathways that reveive visceral and somatic afferents lead to referred somatic pain and increas somatic muscle tone/tender points

What does OMT do?

Hint 2

OMT reduces somatic afferent input from facilitated segments which reduces somatosypathetic activity

Front 3

Name some Sympthetic outflow levels forT1-T4

Back 3

Head neck
Thyroid

Front 4

Name some Sympthetic outflow levels for T1-T6

Back 4

Mams
Esoph
Heat Lung

Front 5

Name some Sympthetic outflow levels forT5--9 L

Back 5

Stomach

Front 6

Name some Sympthetic outflow levels forT5--9

Back 6

Duod/liver

Front 7

T5R?
Important one!

Back 7

Gallbladdar

T7R?

Hint 7

Pancreas

Front 8

T7L?

Back 8

Spleen

T10-11?

Hint 8

Small Intestin

Front 9

R/L Colon or Rectum?

Back 9

T12-L2

T10-T11?

Hint 9

Ovary/Testes

Front 10

Adrenals and Kidneys

Back 10

T10-T11

Upper Ureter too

Front 11

What is a facilitated segment?

Rewatch lecture 20 mins in to get this one?

Back 11

Maintenace of a group of neurons

Front 12

How can costochondritis manifest

Back 12

defects in front of rib cage can mess up/transfer pain toward posterior.

This is Diagnosis of EXclusion!

Front 13

Stones in lower ureter would refer sympathetic pain to what spinal level?

Back 13

T12

Front 14

how might pancreatitis be described

Back 14

back pain, but seems to advance through to their anterior

Front 15

What can cause reflux spasm of the psoas mm. ?

Back 15

Kidney stones

Front 16

List the common causes of Back Pain in <10yrs?

Back 16

Scoliosis-though usually wont pain
leukemia, osteoblastoma
Intervertebral diskitis

Front 17

List the common causes of Back Pain in 11-19yrs?

Back 17

Spondylolysis and Spondylolisthesis
--are they overdueing sports

Front 18

List the common causes of Back Pain in 20-29yrs?

Back 18

Disk injuries (central protrusion or disk sprain)- Spondylolisthesis
---either in mid-back
-Fracture

Front 19

List the common causes of Back Pain in 30-39?

Back 19

Lumbar Disk Herniation --as in 20s
+
Lumbar Degeneration (thoracic too)

Front 20

List the common causes of Back Pain in 40-49

Back 20

Lumbar disk herniation or Degeneration (again, can be thoracic)
Spondylolisthesis with
Radicular Pain

Front 21

for 50s

Back 21

for 50s

Front 22

for 60s

Back 22

for 60s

Front 23

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Front 33

Now LOWER Back Pain with

Back 33

Jennifer Capra

Front 34

What defines Chronic pain

Back 34

more than 6 weeks

Front 35

What emergencies must be ruled out first?

Back 35

Cauda Equina Syndrome
--loss/change in bowel/bladder fxn
-Weakness, numbness, in lower extremities

Front 36

What is LBP with radiation past the knee for less than 6wks

Back 36

Acute Radiculopathy

Chronic if >6wks

Front 37

What is Pain that does not radiate past knee for less than 6 weeks?

Back 37

Acute LBP

Front 38

What are 2 important Hx for LBP?

Back 38

Cancer &
drug abuse

Front 39

List some relevant LBP Strength tests?

Back 39

Ankle Dorsiflxn strength
Great Toe dorsiflexion strength
Plantar flexion --able to toe walk
Hip Flexors

Front 40

What 2 reflex test impt for LBP

Back 40

Anke and Knee Reflexes
Knee Extension

Front 41

DDX for LBP

Back 41

Strain/Sprain
Disc Degenerative Dz
Lumbar Disc Her.
Lumbar Spinal Stenosis
Spondylolisthesis

Front 42

Which is injury to paravertebral Ligaments?

Back 42

LB Sprain

LB Strain is injury to paravertebral mm

Front 43

How does herniated Annulus Fibrosis cause pain

Back 43

Disk does NOT herniate into spinal canal, rather lateral to Nerve roots leaving canal
-Can also affect the Ligaments supporting the facets

Front 44

Can the Nucleus Pulposus enter canal

Back 44

Yest

Front 45

With Low back Strain/Sprain, where is ROM especially reduced?

Back 45

Flexion--harder to touch toes

Front 46

What levels does Straight Leg Raising Test cover

Back 46

Higher sensitivity for L5 and S1

Front 47

What is Tx for LBP (strain/sprain) in Acute Phase

Back 47

Soft tissue OMT, ROM
Pharms
Reference NIH

Tx most often full resolution in 2 months

Front 48

What is Tx for LBP (strain/sprain) in Sub Acute Phase

Back 48

More aggresive oMT as needed, aerobic condition + strength

Tx usally is 4 weeks

Front 49

What happens to Nucleus Pulposus in DDDz?

Back 49

Looses hydrophilic properties:
Disk Height lessens
Ligaments become loose: twisting and bending ca tear annulus
leads to chronic pain and osteoarthritis

Front 50

Major Sx of DDD
Makes worse?
Better?

Back 50

LBP radiating to buttocks
-Aggravated by bending, liftin stoopin or twisting
-Relieved by laying down

What can long term DDD pain cause?

Hint 50

Depression

Front 51

What Test might indicate DDD

Back 51

Straight Leg Raising and ROM mildly restricted

Front 52

What is the Vacuum Sign?

Back 52

Nitrogen in Disk Space

Front 53

What is Tx for DDD?

Back 53

Chronic Pain mgmt--NSAIDs/NON-Narcs
Facet Injections
OMT
Antidepressants to modulate pain perception
Weight Reduction
Excercise Prescription
Smoking Cessation

Front 54

Where does LB pain from DDD most often radiate?

Back 54

Buttocks

Front 55

Where does Nucleus Pulposus most OFTEN extrude through a weak area of the annulus fibrosus?

Back 55

-Most often in Posterolateral Portion
--allows bulging or hern. into lumbar canal


What Level is Most Often hernitated?

Hint 55

L4-L5 or L5-S1

Front 56

What is clinical presentation for the Onset of a Lumbar Disk herniation

Back 56

Usually abrupt
-Unilateral radicular leg pain with low back pain

What is test of choice of this?

Hint 56

MRI
-

Front 57

With spondylolysis, what is form of Anterior Lumbar column

Back 57

It is Smooth , just the pars interacticularis is broken

unlike Spondylolisthesis-where anterior is offset

Front 58

What are Some Sx of cauda Equina Syndrome?

Back 58

Urinary overflow incontinence
Perianal numbnessReduced anal sphincter tone
Bilateral involvement
-Motor/sense deficits
-Radicular Sx greater than 6 wkks

Front 59

What is narrowing of one or more levels of the lumbar spinal canal and subsequent compression of the nerve roots?

Back 59

Lumbar Spinal Stenosis
-Up to 30 % pop >60yrs
--
must be anatomically severe for Sx to be present

Front 60

In spondylolisthesis, are the lamina and pars interarticularis intact?

Back 60

Yes, but slippage occurs usually between L4-L5

What 2 motions cause Pain in Spondylolisthesis?

Hint 60

Agg by bnding, liftin or twistin-Narrowing of the lateral recesses can cause radiculopathy
-Narrowing of the central canal can cause neurogenic claudication or spinal stenosis sx

Front 61

For which spondy is there a step off sign

Back 61

Sponylolisthesis
-
also look for marked hamstring tension and very limited straight leg raising

Front 62

Tx for SPondylolisthesis?

Back 62

Flexion excercises, stretching
-OMT as with Spinal Stenosis
-NSAIDS if needed
-May need back brace/surgery

Front 63

In children, where does Spondylolisthesis usually occur?

Back 63

btw L5-S1

Front 64

Which 2 radiographs and why are they ordered for Spondylolisthesis?

Back 64

Lateral Radiographs to show the slippage

Oblique View to show Pars Defect--scotty dog without a neck is ONLY abnormality if NO slipage (listhesis)

Front 65

NOte about these cards?

Back 65

Use with Lecture, they are NOT comprehensive!