Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Lumbar Spine
Orthopedics
| Question | Answer |
|---|---|
| Low Back Pain: lifetime prevalence: | 60-80% |
| Leading cause of work related disability = | Low Back Pain |
| Low Back Pain Risk factors | obesity, sedentary, improper biomechanics |
| Low Back Pain: Prognosis | 70% improved in <1 week & asymptomatic in <1 month; 90% asymptomatic in 6-12 wks |
| Vertebral Disk contains: | central nucleus pulposus; peripheral annulus fibrosis |
| Disc degeneration MOA: | degeneration overloads facet joints in verts |
| Disc herniation MOA: | herniation impinges nerve roots |
| Anterior Mxs: | Abdominal & Psoas |
| Posterior Mxs: Superficial: | Erector Spinae, Iliocostal, longissimus & spinalis |
| Posterior Mxs: Middle: | Multifida |
| Posterior Mxs: Deep: | Intersegmental |
| Anterior & posterior muscles alternate to: | control trunk movement |
| Sensory Dermatomes: Lumbar & sacral n. innervate: | lower extremities |
| Pain: Simple sprains & strains = | Nonspecific pain in lower back or one or both buttocks |
| Nerve root pain: | Brief, sharp, shooting, increased by cough, standing, & sitting. |
| Pain: Neoplasm, Infection: | Severe, constant pain persisting at night |
| Pain: Red Flags | > 50 y.o.; kids; Night Pain; Fever, malaise, wt loss; Bladder/ bowel dysfunction; Progressive deficit; Prior ca; Pain > 1 month |
| LBP Hx: | C/C, meds, allergies |
| LBP HPI: | Initiating event, MOA; Site of pain; OLDCARTS; priors, tx, studies |
| LBP: PE: Inspection: | Gait; Posture; Deformity |
| LBP: PE: Palpation: | Bony; Soft Tissue; Pulses |
| LBP: PE: ROM: | Flex, ext, lateral flex, rotation |
| LBP: PE: Other Tests: | SLR; FABER test; Neuro Exam (Sensory, Motor, DTRs) |
| SLR test: | Pain on straight leg flexion reproduces radicular pain |
| Bragards test: | Foot dorsiflexion increases pain |
| Cross SLR test: | Raising contralateral leg causes radicular pain on ipsilateral leg |
| FABER test: | Pain in SI joint |
| LS Spine Exam: inspection: | Symmetry/ Deformity/ Scars |
| LS Spine Exam: motor: L1: | Hip flexion |
| LS Spine Exam: motor: L2: | Hip adductors |
| LS Spine Exam: motor: L3: | Knee extension |
| LS Spine Exam: motor: L4: | Ankle dorsiflexion |
| LS Spine Exam: motor: L5: | Hallicus Longus extension |
| LS Spine Exam: motor: S1: | Hallicus Longus flexion |
| LS Spine Exam: sensory: L1: | Upper outer thigh |
| LS Spine Exam: sensory: L2: | Mid anterior thigh |
| LS Spine Exam: sensory: L3: | Below patella |
| LS Spine Exam: sensory: L4: | Medial ankle |
| LS Spine Exam: sensory: L5: | First web space |
| LS Spine Exam: sensory: S1: | Lateral ankle |
| LS Spine Exam: DTRs: Knee: | L2,3,4 |
| LS Spine Exam: DTRs: Ankle: | S1 |
| Waddell Signs: Tenderness: | Superficial skin tenderness over wide area; Non-localized deep tenderness |
| Waddell Signs: Simulations Tests: | Axial load should not cause LBP |
| Waddell Signs: Distraction Tests: | Flip test |
| Waddell Signs: Regional Disturbances: | Widespread muscle pain in various groups |
| Waddell Signs: Over-reaction: | Pain out of proportion |
| Lumbar Strain: Hx: | MOI; site of pain |
| 70% of LBP = | Lumbar Strain |
| Lumbar Strain: PE: | Tender paravertebral or erector spinae mx; min radiation |
| Lumbar Strain: Rx : | Pain relief, modified activity, exercise, education, & encouragement; Injection with trigger point pain; PRICEMMM |
| 4% of LBP = | HNP |
| HNP: DDx: | Infection, tumor |
| HNP: Evaluation: | MRI / CT |
| HNP: MRI/CT: asymptomatic disc herniation found in: | 17-36% |
| HNP: Lumbar nerve root compression: L1-3 nerve roots: | 5%, pain & numbness above knee |
| HNP: Lumbar nerve root compression: L4 nerve root (L3-4 disk space): | 5%, numbness to shin, weak ankle dorsiflexion |
| HNP: Lumbar nerve root compression: L5 root: | 67%, weakness of EHL & numbness top of foot and 1st web space |
| HNP: Lumbar nerve root compression: S1 root: | 28%, numb lateral foot, weak plantarflexion |
| HNP: Lumbar nerve root compression: Rx: | Conservative, NSAIDs, mx relaxants, Exercise & Education |
| HNP: Lumbar nerve root compression: 10% require: | surgery d/t progressive neurologic deficit |
| Pharma Tx of Acute LBP: Pain relief: | NSAID; Cox-2, Celebrex; Narcotic; Lidoderm patch; Anti-inflammatory; mx relaxants; Steroids |
| Pharma: LBP: Pain: NSAID: | Ibuprofen 800 q6-8h pc; Naprosyn 500 BID |
| Pharma: LBP: Pain: Narcotic: | Percocet 5/325 q4-6h Vicodin 5/500 q 4-6h |
| Pharma: LBP: Pain: Anti-inflammatory: | NSAID, Cox-2 |
| Pharma: LBP: Pain: Muscle relaxants: | Flexeril; Skelaxin; Soma, Robaxin |
| Pharma: LBP: Pain: Steroids: | Hold NSAIDs; Burst of oral steroids; consider trigger point |
| Sacroiliac Dysfn: | Acute or chronic injury to SI joint |
| Sacroiliac Dysfn: Sx: | Pain in SI area, Pos FABER, No discogenic pain |
| Sacroiliac Dysfn: Lab: | consider CBC, ESR, ANA, RF, HLA-B27 |
| Sacroiliac Dysfn: RX: | Ice, Stretch, NSAIDs, injection |
| Cauda Equina Syn: affects: | L2-L4 nerve roots |
| Cauda Equina Syn: Mechm: | Compression of nerve roots causes paralysis without spasticity (LMN) |
| Cauda Equina Syn: Etiology: | Central disc herniation, abscess, hematoma |
| Cauda Equina Syn: Sx: | Loss of bladder/ bowel control, bilateral LE weakness & sensory deficits |
| Cauda Equina Syn: Rx: | Emergent Surgical Decompression |
| Lumbar Spinal Stenosis = | Progressive degeneration of disc & facet joints; Narrowing of canal; Compression of n. roots |
| Lumbar Spinal Stenosis: Signs: | Neurogenic claudication, radicular sx; Pain increased w/ sitting or spinal ext; Pain relieved w/ flexion, pt walks stooped-over |
| Lumbar Spinal Stenosis PE: | Sensory changes, dec DTR, mild weakness |
| Lumbar Spinal Stenosis: Course: | Deficits may progress |
| Lumbar Spinal Stenosis: Xray: | may show narrowing of the IVD, old burst fx; MRI demonstrates stenosis |
| Lumbar Spinal Stenosis: Rx: | PT, core strength, NSAIDs, dec impact & bending, surgical decompression for progressive dz |
| Spondylolysis = | Pars interarticularis stress fx |
| Spondylolysis: Prevalence | 5%-8 % of population; Dancers, gymnasts, lifters |
| Spondylolysis: occur most often at: | L5 |
| Spondylolysis: S/S | Pain adjacent to midline, inc with extension & rotation |
| Spondylolysis: xray | Scotty dog collar only on oblique xray |
| Spondylolysis: Rx: | modify activity, core exercise, gradual RTP |
| Spondylolisthesis = | Vertebral sliding (Dancers, gymnasts) |
| Spondylolisthesis: PE: | Step-off, may be asx. |
| Spondylolisthesis: Grading | Grade I – V (25 to >100%); Isthmic, degenerative |
| Spondylolisthesis: xray | Lateral film shows slip |
| Spondylolisthesis: Rx: Asx: | no restriction, core exercise |
| Spondylolisthesis: Rx: Symptomatic: | no restriction, core exercise, consider brace; Surgery for progressing slips or deficit |
| Piriformis Syndrome = | Irritation of sciatic n. (L4,5, S1,2,3) beneath piriformis mx |
| Piriformis Syndrome: etiology | Trauma, spasm, anatomic |
| Piriformis Syndrome: PE: | FROM of lumbar spine; Sciatic notch tenderness |
| Piriformis Syndrome: DDx: | HNP |
| Piriformis Syndrome: RX: | Rest, ice, meds, stretch, injection |
| Lateral spine curvature = | Scoliosis |
| Scoliosis: < 10 degree: tx | observe |
| Scoliosis: < 20 defree: tx | conservative Rx |
| Scoliosis: Occurs where: | T or L spine |
| Scoliosis: most common cause: | Idiopathic |
| Scoliosis: prevalence | Girls 7x > than males |
| Scoliosis: Adults: | secondary dz & pain |
| Scoliosis: Surgical Rx: | Fusion & Rod |
| Scoliosis: Exam: | Forward flexion; Look for spine, scapula or hemi-thorax asymmetry |
| Scoliosis: Xray Cobb angle: | Measure angle from tilted vertebrae above & below apex of curve |
| 50% of pts with solid tumors have: | mets to spine |
| Tumor: Highest prevalence: | BrCa, lung, prostate, colon, thyroid, kidney ca (hematogenous spread) |
| Tumor: Sx: | Night pain, n. root compression |
| 10% of spinal bone tumors are: | primary |
| Spinal bone tumors: in children, 20% are: | malignant |
| Spinal bone tumors: Primary malignant: | Osteosarcoma, Ewing Sarcoma, Chondrosarcoma |
| Degenerative joint dz = | loss of articular cartilage & growth of new bone around facet joint |
| Facet Syndrome = | n. root compression by loss of disc height & facet hypertrophy |
| Osteoarthritis: X-ray: | joint narrowing, sclerosis, osteophytes |
| Osteoarthritis: Rx: | Wt reduction, pt education; Pain relief |
| Ankylosing Spondylitis: involves: | SI joint, and spine |
| Seronegative spondyloarthropathy: | HLA-B27 usually positive |
| Ankylosing Spondylitis: Sx: | Chronic low back pain in young adults; morning stiffness, improves with movement; 20% peripheral joint sx (Enthesopathies common; 25% with anterior uveitis) |
| Ankylosing Spondylitis: PE: | Schobers test (normal is 5 - 7 cm movement) |
| Ankylosing Spondylitis: X-ray: | Erosion & sclerosis on plain films |
| Ankylosing Spondylitis: Rx: | PT, NSAIDs, Sulfasalazine, Infliximab |
| Testing Spinal Mobility: | Schobers Test |
| Schobers Test: | 2 midline marks 10 cm apart starting at PSIS (dimple of Venus); remeasure w/ lumbar spine at maximal flexion |
| Schobers Test: Less than 5 cm difference suggests: | pathology |
| Ankylosing Spondylitis = | Calcification btw vertebral bodies at edge of discs; gives appearance of bamboo stalk; sclerosis of SI joint |
| Osteoporosis = | Reduction in bone mass (Low peak mass; inc bone loss; hyperparathyroid, chronic steroids) |
| Visceral Causes: prevalence in LBP | 2% of LBP |
| LBP: Visceral Causes: Referred pain from: | GB; Pancreas; AAA; Endometriosis; Chronic PID; Prostate CA; Renal stones or pyelonephritis |
| LBP: Need for imaging | Rarely needed in nontraumatic, recent onset ALBP |
| LBP: Imaging: when | Plain films approp: trauma/ longstanding sx ; if conservative Rx fails |
| LBP: Imaging: Order: | AP / Lateral; Obliques; Flex & Ext |
| LBP: MRI study of choice for: | discopathy |
| LBP: Tc 99m bone scan for: | primary tumors, metastatic disease, or infection |
| Reading Spine Films: looking for: | Fx; Disc space changes; Arthritic changes; Listhesis; Tumors |
| Spine Film: Frontal View: each vert resembles: | an owls head, straight on; each eye = pedicle; beak = spinous process |
| Spine Films/ Frontal: Horizontal displacement may = | fx or dislocation |
| Spine Films/ Frontal: Decreased intervertebral space = | Fx, DDD, HNP |
| Spine Films/ Frontal: Vert body (owl head) for: | Missing eye (destrn); pedicle |
| Spine Films/ Frontal: Vert body: Crack in owls eye: in = | Chance fx (seat belt fx) |
| Spine Films/ Frontal: Vert body: Inc space btw owls eyes: in = | Burst fx |
| Spine Films/ Frontal: Vert body: Dec head height: in = | Burst fx |
| Spine Films/ Frontal: Vert body: Open bea, or inc distance btw 2 beaks: in = | Chance fx or spinous process fx |
| Spine Films: Oblique: each vert = Scotty Dog: look for: | a collar |
| Spine Films: Oblique: Scotty Dog: front & hind legs = | inf intervertebral articular processes |
| Spine Films: Oblique: Scotty Dog: Ears & tail = | superior intervertebral articular processes |
| Spine Films: Oblique: Scotty Dog: Dog body = | the lamina |
| Spine Films: Oblique: Scotty Dog: dogs eye = | a pedicle |
| Spine Films: Oblique: Scotty Dog: nose = | a transverse process |
| Spine Films: Oblique: Scotty Dog: Neck = | the pars interarticularis |
| Spine Films: Oblique: Scotty Dog: If the tail is to your right, you are looking at: | right lamina (& vice versa for left) |
| Spine Film: Lateral View: Vert alignment: displacement seen in: | fx & listhesis. |
| Spine Film: Lateral View: decreased intervert disc space in: | fx, DDD, & HNP |
| Spine Film: Lateral View: Cf ant & post vert body cortex for: | changes in ht cf to the others (Burst or wedge fx) |
| Spine Film: Lateral View: fx lines in spinous processes = | black (lucent) fx lines |
| Spine films: stable fxs = | Wedge fx; spinous process fx |
| Spine films: unstable fxs = | Burst fx; Chance fx |
| Chance fx: Unstable: best seen on what film? | lateral |
| Chance fx: MOI | MVA: lap belt immobilizes pelvis & thorax is forcefully flexed forward |
| Chance fx: Seen on AP = | crack thru eyes (pedicles), or open beak (crack through spinous process) |
| Burst fx: Unstable = | Collapse of vert body |
| Burst fx: Unstable: seen on lateral view as: | smaller vertebral body |
| Burst fx: Unstable: on AP = | inc distance btw pedicles |
| Burst fx: MOI: | fall from a ht, landing on feet or buttocks |
| Burst fx: Fragments: | may extend into spinal canal causing neuro S/S |
| Wedge fx: Stable = | Collapse of ant vert body w/ an intact posterior wall |
| Wedge fx: Stable: result of: | hyperflexion injury and / or osteoporosis. |
| Spinous Process fx: Stable: on lateral view = | Lucency thru spinous process |
| Most common Spinous Process fx found in: | C-spine (Clay Shovelers fx) |
| Spinous Process fx: MOI: | sudden forceful ligamentous traction on spinous process, or a direct blow to the process |
| Coccyx fx: MOI | Fall on coccyx |
| Coccyx fx: PE: Do: | rectal to R/O hematoma, displaced fx |
| Coccyx fx: mild trauma: xray = | Radiographs not indicated |
| Lower Back Rehab to: | Ctrl pain; Reduce inflame; relative rest; Pain free ROM; correct inflexibilities & strengthen core mx; aerobic conditioning; wt reductn; correction of biomechanics; prevent recurrence |
| LBP Prevention | Regular strength/ flexibility exer; correct lifting & moving tech; posture standing/ sitting; proper body wt |
| LBP tests | xrays if pain >4 wks; MRI/CT sens > xray for infxn, ca, hern disk, stenosis; CBC, ua, Ca, PO4, ESR, alk phos |
| LBP: anemia, ESR | anemia w/MM, high ESR in malig, infxn, CTD |
| most common hip problems | Trochanteric & gluteus medius bursitis, OA, femur fx |
| Lateral hip pain that is aggravated by direct pressure = | trochanteric bursitis |
| Meralgia paresthetica affects the _____ nerve | lateral femoral cutaneous nerve |
| LBP: most common site of disk herniation | L5-S1 (also L4-L5) |
| Osteoporosis: prevalence in LBP | Causes 4% of LBP |
| Disc degeneration MOA: | degeneration overloads facet joints in verts |
| Sciatic nerve neurapraxia: | with L-S spine, pelvic, hip Fx, or HNP |
| Disc herniation MOA: | herniation impinges nerve roots |
| Coccyx fx: PE: Do: | rectal to R/O hematoma, displaced fx |
| Coccyx fx: mild trauma: xray = | Radiographs not indicated |
| Bragard test: | Foot dorsiflexion increases pain |
| Cross SLR test: | Raising contralateral leg causes radicular pain on ipsilateral leg |
| Waddell Signs = | Non-organic Physical Signs in LBP; TTP, axial load, flip test, Pain out of proportion |
| Lumbar Strain: PE: | Tender paravertebral or erector spinae mx; min radiation |
| HNP = | Herniated Nucleus Pulposus |
| HNP: most common = | L4-5, L5-S1 |
| HNP: MOI: | Flexion & rotation; Tears in annulus |
| HNP: Sx: | Sciatica (radiating pain, numbness & weakness to LE) |
| HNP: Signs: | Pos SLR, Flip sign, Pain worse on back ext |
| Pharma Tx of Acute LBP: Pain relief: | NSAID; Cox-2, Celebrex; Narcotic; Lidoderm patch; Anti-inflammatory; mx relaxants; Steroids |
| Female exam, asymmetric posterior chest wall or uneven scapula height with forward bending | Scoliosis (> 25 degree Cobb angle = surgery) |
| Subluxation of vertebral body = | Spondylolisthesis |
Created by:
Abarnard
Popular Medical sets