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46 Cards in this Set
- Front
- Back
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define sciatica
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pain originating in the back and radiating down the posterior or lateral thigh (sciatic nerve distribution)
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define radiculopathy
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impairment of the nerve root, neurologic symptoms corresponding to the nerve root ie paresthesias, numbness, weakness, changes in their deep tendon reflexes. There is a nerve root affected.
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define spondylosis
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arthritis of the spine
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define spondylolisthesis
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anterior slippage of one vertebra on the otehr
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define: spondyloslysis
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pars interarticularis is interrupted
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what does OLDCHARTS stand for when taking a history'?
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O-nset
L-ocation D-uration C-haracter A-meliorating/ aggravating/ associated factors R-adition T-imeline S-everity |
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what are the 5 CANNOT miss ddx associated with low back pain?
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cauda equina syndrome, fracture, osteomyelitis, infection, cancer
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what do you need to know in order to rule out visceral diseases?
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if they are having any constipation, dirrhea, bloody stool, problems urinating, or vaginal discharge
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what are the 12 red flags associated with LBP?
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age >50
Fever/ recent infection significant trauma unrelenting night pain progressive motor or sensory deficit saddle anesthesia difficulty urinating or fecal incontinuence unexplained weight loss HX or strong suspicion of cancer hx of osteoporosis chronic oral steroids IVDA NUTS4 OF COD. bahahahaha |
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what is the distribution of the L1 dermatome?
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Groin, iliospoas, hipflexion
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what is the distribution of the L2 dermatome?
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anterior thigh, iliospsoas, sartorius, hip adductors
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what is the distribution of the L3 dermatome?
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medial aspect of knee, iliopsoas, quadriceps, sartorius, hip adductors, hip flexion, knee extension, hip adduction
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what is the distribution of the L4 dermatome?
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Make the figure four- tibialis anterior, medial aspect of the leg
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what is the distribution of the L5 dermatome?
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extensor hallucis longus, frontside of foot
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what is the distribution of the S1 dermatome?
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achilles tendon reflex and eversion of the foot
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what presentations would a low motor neuron lesion present with?
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flaccid paralysis, decreased of absent DTR, absent babinski marked atrophy, and fasciculations
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what presentations would a upper motor neuron lesion present w?
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spastic paralysis, increased DTR, present babinkski, absent atrophy and absent fasciculations
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what are the four specials tests for LBP?
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straight leg test (flex hip, pt leans back), faber (figure four-- flexion, abduction, external rotation), trendelenberg (gluteus medius disruption), and hoover (lift one leg)
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which test do you use to see if the person is lying?
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hoover's
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which special test is more sensitive than the seated straight leg test for disc herniation?
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crossed straight leg test
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T/F
cauda equina syndrome is the only LBP emergency. |
true :)
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what are the 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, foot drop symptoms of a LMN lesion |
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what are the two types of compression fractures? describe them?
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simple- anterior half of the vertebral body
Burst- extending into the posterior 3rd of the vertebral body |
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how do you diagnose acute LBP? what usually causes it?
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LBP <6 weeks duration; strain (muscles) or sprain (ligaments), twisting, repeated lifting, vibrating equipment.
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what are the symptoms of acute LBP?
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LBP radiates into buttocks and posterior thighs
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generally ____ of LBP w/ disc herniations will have sciatica, but only ___ of pts with sciatica will have a disc herniation
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95%; 4%
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what is degenerative disc disease/ chronic LBP?
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loss of the fluffiness of the disc and fluid causing a narrowing or compression of the vertebrae.
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how do you diagnose degenerative disc disease/ chronic LBP?
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LBP > 3 months duration
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what are the symptoms of degenerative disc disease/ chronic LBP?
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LBP radiating into the buttocks, aggravated by activities.
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On PE, how do you distinguish degenerative disc disease/ chronic LBP from disc herniation?
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degenerative disc disease/ chronic LBP will have a normal strength and neruo testing as well as a negative straight leg test. The disc herniation will have a positive straight leg test and neurological deficits.
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what is very important for pts with chronic LBP to stop doing?
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smoking
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what is the most common location of a disc herniation?
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L4/5, L5-S1
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what are the symptoms of a disc herniation?
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abrupt onset***
pain worse in leg than back, radiates in dermatomal pattern and pain is worse with valsalva |
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T/F
Best rest is an optimal form of tx for a disc herniation? |
FALSE!!
NO bed rest, limit lifting |
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what is spinal stenosis?
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narrowing of the central spinal canal (due to arthritis, osteophytes) by bone or soft tissue with compression of nerve root.
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at what level of the vertebrae is spinal stenosis most common at?
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L2-3, L3-4, L4-5
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what percentage of individuals over 60 have spinal stenosis?
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30%
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what are the symptoms of spinal stenosis?
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neurogenic claudication
pain relieved w/ flexing forward |
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how do you distinguish spinal stenosis from PAD or vascular claudicaion?
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on PE the pulses will be normal
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T/F
Spinal stenosis will cause an impaired proprioception and therefore a positive rhomberg. |
True
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what drug can be used for spinal stenosis that isn't used for any other LBP disability?
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Gabapentin
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what are the two causes of scoliosis in adults?
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degenerative spondylosis and spondylolisthesis
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on PE you noticed a flattened lumbar spine, decreased reflexes and a weakness in toe or heel walking in a pt complaining of LBP. Dx
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spondylolisthesis
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what population is more likely to suffer from spondylolysis?
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repeated hyperextension: gymnast, football players, etc
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Scotty dog on oblique Xray. Dx
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spondylolysis
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what does HIPLSIT stand for?
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H-ip long restrictors
I- nnominate shears P-ubic dysfunctions L-umbars (non-compensated L5) S-acroiliac dysfunctions I-nnominate rotations and flares T-horacic dysfunctions |
