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OPP Lect 28
OPP Lect 28 LBPI
| Question | Answer |
|---|---|
| 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). |
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WeeG
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