Musculoskeletal: 13. Wang : Rehab Med-Spine

Front 1

what is the number one risk factor for low back pain (LBP)?

Back 1

Genetics

Front 2

ankylosing spondylitis has a relationship with what disease?

Back 2

inflammatory bowel disease

Front 3

What injury has an increased risk with osteoporosis ?


*****TEST

Back 3

vertebral compression fractures

because the bone quality is not as good

Front 4

must know ligamentous attachments of sacrum

Back 4

sucks.

Front 5

iliolumbar ligament attachments

Back 5

origin-transverse process of L5

attaches to medial aspect of the posterior corner of the iliac crest

Front 6

posterior sacroiliac ligament attachements?

Back 6

1st, second, and 3rd transverse tubricle of the sacrum

to the

posterior superior iliac spine

Front 7

sacrotuberous ligament attachment

Back 7

From sacrum
To tuberosity of the ischium

Front 8

gluteus maximus attachments?

Back 8

P: Ilium and sacrum, D: Iliotibial tract and gluteal tuberosity

Front 9

gluteus medius attachment

Back 9

P: Ilium, D: Greater trochanter

Front 10

gluteus minimus attachment

Back 10

P: Ilium, D: Greater trochanter

Front 11

this pain is only in the back and/or buttock area without radiation into the legs

Back 11

Axial

Front 12

this pain is Caused by non-nerve injuries such as muscle, tendon, ligament or disc damage, arthritis or fractures

Back 12

axial

Front 13

pain usually in the legs > back, often with leg numbness, tingling or weakness

type of pain?

Back 13

Radicular

Front 14

Caused by nerve irritation/injury such as nerve root impingement by herniated disc or arthritis

type of pain?

Back 14

Radicular

Front 15

pain usually in the back > legs, with normal neurologic exam

type of pain?

Back 15

Pseudoradicular

Front 16

Caused by referred pain from injured non-nerve structures such as muscles, tendons, ligaments or joints

type of pain?

Back 16

Pseudoradicular

Front 17

a patient has pain that is on the iliac crest, and has pain that shoots down the back of the leg. You ask if the pain is found behind the knee, specifically at the joint. The patient says that the pain skips the knee. What kind of back pain is it?

Back 17

pseudoradicular b/c it skips the joint

Front 18

posterior sacroiliac ligament

please list referred areas of pain

Back 18

Posterior thigh and calf pain

anterior thigh pain

Front 19

iliolumbar ligament

please list referred areas of pain

Back 19

posterior on iliac crest

lateral hip

inguinal

Front 20

patient says taht they have leg pain that is worse than their back pain (what kind of pain is this?) and says they have some numbness/weakness.

what is this likely?
Emergency or seek attention?

Back 20

radicular pain

nerve damage

seek attention

Front 21

if pain wakes a patient in the middle of the night

Emergency or seek attention?

Back 21

seek attention

Front 22

person has pain with balance or bowel/bladder problems... what is this likely?


Emergency or seek attention?

Back 22

spinal cord damage

seek attention

Front 23

Pain after a significant injury (car accident, bad fall, bad sports/recreational injury) what could this be

Emergency or seek attention?

Back 23

tissue damage such as fracture, disc damage, or severe strain or sprain

seek attention

Front 24

Progressively worsening pain despite relative rest, ice/heat, and over-the-counter medicines

Emergency or seek attention?

Back 24

seek attention

Front 25

Significant or worsening weakness in the legs with or without pain

what could this be?
Emergency or seek attention?

Back 25

severe nerve or spinal cord damage

emergency

Front 26

Acute changes in bowel or bladder function with or without pain

what could this be?
Emergency or seek attention?

Back 26

conus medullaris syndrome.

emergency

Front 27

Numbness along the insides of both thighs (“saddle anesthesia”)

what could this be?
Emergency or seek attention?

Back 27

cauda equina syndrome.

emergency

Front 28

Acute back pain with fever, chills, and/or night sweats

what could this be?
Emergency or seek attention?

Back 28

infection of the spine.

emergency

Front 29

Acute back pain with a tearing sensation and bounding pulse in the stomach area

what could this be?
Emergency or seek attention?

Back 29

dissecting or ruptured aortic aneurysm

emergency

Front 30

a patient with pain with a structural origin (e.g. arthritis, myofascial, ligamentous or tendinous dysfunction) and/or functional deficits (e.g. decreased strength, flexibility, activity tolerance, work capacity) should see what type of physician

Back 30

Musculoskeletal physiatrist

Front 31

if a patient has well-localized pain generators without profound neurologic deficits (e.g. painful radiculopathy, facet arthropathy, discogenic pain), unresponsive to other conservative treatments such as physical therapy, OMT, or medications what type of physician should they see?

Back 31

Interventional pain specialist (spinal injections under fluoroscopic guidance)

Front 32

patient has Localized pain with/without pain in other joint areas, particularly the hands, and associated findings such as rash (e.g. lupus, psoriatic arthritis, dermatomyositis) or lab abnormalities (e.g. elevated ESR, ANA or rheumatoid factor).

who should they see
?

Back 32

Rheumatologist

Front 33

patient has peripheral neurologic deficits without an identifiable structural cause (low motor neuron lesions, e.g. peripheral neuropathy, ALS), or central nervous system deficits (upper motor neuron lesions, e.g. multiple slerosis, stroke, ALS

who should they see

Back 33

Neurologist

Front 34

person has profound and/or emergent neurologic deficits from structural causes (e.g. large disc herniation causing severe radiculopathy, spondylosis causing severe spinal stenosis), unresponsive to other treatments such as medications or spinal injections

who should they see?

Back 34

Neurosurgeon

Front 35

most important! Often this is all that is needed to make the diagnosis.

what diagnostic test?

Back 35

History & Physical exam

Front 36

good for bones (e.g. fractures, arthritis, alignment and dynamic stability with flexion/extension views).

what diagnostic test?

Back 36

Plain radiograph (X-ray):

Front 37

excellent for bones, discs, joints, nerves, soft tissue.

what diagnostic test?

Back 37

MRI (magnetic resonance imaging):

Front 38

excellent for bony anatomy (e.g. complex fractures, arthritis, alignment)

what diagnostic test?

Back 38

CT (computed tomography):

Front 39

pt comes in with history of prostate cancer and some back pain. Should he use an MRI or Nuclear Bone Scan?

Back 39

Nuclear Bone Scan

Front 40

excellent for bone metabolism (e.g. fractures, tumors). (gets whole spine)

what diagnostic test?

Back 40

Nuclear bone scan (nuclear scintigraphy

Front 41

excellent for vascular problems (aneurysms, aortic dissection, and arterial stenosis

what diagnostic test?

Back 41

Angiogram

Front 42

burns the nerves that transmit pain signals from the facet joints, long-lasting

what treatment is this?

Back 42

Radiofrequency ablation

Front 43

minimally invasive, cements and stabilizes compression fractures

what treatment is this? 2

Back 43

Vertebroplasty or kyphoplasty

Front 44

spondylosis

spondylolysis

spondylolisthesis

NEED TO KNOW****

Back 44

spondylosis:arthritis of the spine

spondylolysis: fracture at the pars

spondylolisthesis: decapitation of the pars, entire lumbar segment slides forward

Front 45

a patient is having problems with sensation of their inner thigh closet to the pubic bone, what spinal root is this most likely due to?

Back 45

L1

Front 46

a patient is having sensation problems starting from the outer hip down the middle of the thigh, extending down the shin to the medial ankle. What is the problem?

Back 46

problem with L4 spinal root

Front 47

patient is having problems with sensation on the top of their foot including their big toe.. what is the problem?

Back 47

L5 spinal root

Front 48

fill in the associated dermatomes

Back 48

Front 49

patient is a gymnast who has pain worse with flexion or extension. You see a step-off sign at spinous process, paraspinal spasm, and foraminal narrowing causing rediculopathy. What does this patient have?

Back 49

spondylolistheis

Front 50

patient has a radiograph with"Scottie dog" neck broken. What does this patient have?

Back 50

spondylolisthesis