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OPP Lect 28

OPP Lect 28 LBPI

Where is low back pain located? As pain b/w the costal angles and the gluteal folds
Characterize back pain in terms of length of persistence of symptoms **Know for test** 1.Acute: Less than 6 weeks. 2.Subacute: 6-12 weeks. 3.Chronic: More than 12 weeks (3 months).
Key Low back pain prognosis based on persistence of symptoms 1. At least 60% w/ acute LBP return to work w/in 1 month. 2. 90% return w/in 3 months regardless of the treatment. 3. 25-60% of patients will have reoccuring symptoms w/in 1-2yrs. 3.
What is 97% of LBP classified as? MECHANICAL: 1.Strain/sprain (70%). 2.Degenerative Disc (10%). 3.Disc herniation. 4.Spinal Stenosis. 5.compression fracture. 6.Spondylolisthesis (1 vertebrae slips anterior to another). **Non-mechanical: cancer, infection, inflamm arthritis, Visce
Red Flags during an initial assessment of a patient with LBP 1.Cancer. 2.Infection. 3.Fractures.
LBP Red Flags: Suspect Fractures with 1.Major Trauma. 2.Pain is immediate, axial, non-radiating, severe & disabling. 3.Palpation is EXTREMELY important to make sure the labs correlate with the history.
LBP Red Flags: Suspect Tumor with 1.Age less that 20 or older than 50. 2.History of cancer. 3.Unexplained wgt loss. 4.Failure to improve after 4-6 weeks. **Get and Xray.
LBP Red Flags: Suspect spinal Infection with 1.IV drug users. 2.Immunosuppression. 3.Fever and/or chills. 4.Pain worsens w/ supine, night time.
LBP Red Flags: Cauda equina syndrome Lesion compressing the cauda equina nerve roots. **LBP + Saddle sensory anesthesia (is it numb when you whipe your own ass?) or Bladder & Bowel dysfunction.
Difference b/w Radiculopathy Vs Cauda Equina Syndrome Radiculopathy: 1 nerve root. Cauda Equina Syndrome: Multiple nerve roots
Why is cauda equina syndrome a surgical emergency? Damage can be Irreversible. **Bowel & Bladder & ED take the longest time to recover.
Are imaging studies useful without any RED FLAGS w/in the first 4 weeks of LBP? NO. **Unless they are have progressively worse neurological deficits.
If you suspect neuropathy, what all should be included in your neurological exam? 1.DTRs. 2.Motor strength testing (by nerve root). 3.Sensation testing (by dermatome). 4.Straight leg raising.
Neurologic Level: L4 1.Motor strength: Inversion. 2.DTR: Patellar. 3.Sensation: Inside of foot & lower Leg
Neurologic Level: L5 1.Motor strength: Dorsiflexion. 2.DTR: none. 3.Sensation: top of foot.
Neurologic Level: S1 1.Motor Strength: Eversion. 2.DTR: Achilles tendon. 3.Sensation: lateral aspect of foot.
Differentiate b/w Spondylosis, Spondylolysis, Spondylolisthesis 1.Spondylosis: Ankylosis (stiffness) of vertebrae. 2.Spondylolysis: Degenerative OA of facets. 3.Spondylolisthesis: Ant movement of a vertebrae over the one below it. **All cause Degeneration.
Lumbosacral radiculopathy results from what? Nerve ROOT impingement/ and or inflammation. Will have pain, tingling along dermatome & muscle weakness. Think herniated DISC **associated with acute and chronic causes of LBP.
What can exacerbate the pain from lumbosacral radiculopathy? 1.Sitting. 2.Coughing. 3.Sneezing. **Will travel from the buttock down the posterior aspect of the leg.
Radiculopathy in what Lumbosacral nerve roots will refer pain down the ANTERIOR thigh? Does it radiate below the knee? L1-L3. NO.
What are the most common locations for Disc Herniations? L4, L5, and S1.
What is a KEY INDICATOR of Lumbar Spinal Stenosis? NEUROGENIC CLAUDICATION. **Leg symptoms will worsen when walking, but eased with sitting, or lying down. Compensate by flexing forward (shopping cart sign).
Does degenerative disc pain radiate? NO. **Discogenic pain w/out nerve root impingement typically is diffuse, vague, and axial.
Is it common to see a disc bulge on an MRI if there is NO back pain? YES, 52% at atleast one level. Therefore the lab tests must match the symptoms/history (if they have a L4 bulge with radiculopathy, then it fits).
Is bedrest bad for the back? YES, want them up and moving as soon as possible
Does OMT Change the final outcome of reducing/ healing LBP when compared to standard medical therapies? NO, however it did allow the same outcome to be reached with less medicine and less PT (COSTS LESS)
Patients with mechanical low back pain often benefit from what? CONSERVATIVE treatment: 1.OMT. 2.PT. 3.Ice & heat. 4.Medications (NSAIDS first, muscle relaxors, OPIOIDS).
Created by: WeeG