Term
| emergency physicians see more than ___ million cases annually |
|
Definition
|
|
Term
about ____ of adults are affected by mechanical low back pain in their lives
it is the ____ most common complaint in ambulatory medicine |
|
Definition
2/3
second most common complaint |
|
|
Term
| low back pain is the ____ most expensive disorder surpassed only by ____ and ____ |
|
Definition
third
cancer and heart disease |
|
|
Term
| Low back pain reportedly occurs at least once in ___% of adults younger than __ years |
|
Definition
|
|
Term
it affects men and women _____
the onset most frequently is in people _____ to ____ |
|
Definition
|
|
Term
| Chronic low back pain in adults is _____ |
|
Definition
|
|
Term
| Chronic low back pain in the adolescent young athlete is ______ |
|
Definition
|
|
Term
| when low back pain is a complaint in children it more likely is |
|
Definition
| a serious etiology like infection or malignancy |
|
|
Term
|
Definition
| annulus fibrosis and nucleus pulposus |
|
|
Term
| Anterior group of muscles of back |
|
Definition
abdominal muscles
psoas muscles |
|
|
Term
| posterior group muscles of back |
|
Definition
paraspinal muscles
iliocostalis
longissimus
spinae
multifidi
intersegmental |
|
|
Term
| ____ and _____ muscles can strongly affect the stresses transferred to the back from any activity |
|
Definition
|
|
Term
| most commonly reported histories of low back pain include |
|
Definition
lifting or twisting with a heavy object
operating a machine that vibrates
prolonged sitting
motor vehicle collisions falls |
|
|
Term
| 4 things you want to cover on your review of systems |
|
Definition
bladder function - serious causes of back pain - tumor, infection, fracture
history of cancer, arthritis, infection systemic disease - increases susceptibility to infection, nocturnal pain, fever, drug use, depression
history of headaches, peptic ulcer disease, prior cancer, unexplained weight loss |
|
|
Term
|
Definition
more common in females
more common in certain sports like ballet with low upper-to-lower body ratio |
|
|
Term
|
Definition
more common in females
more common in certain sports like ballet with low upper-to-lower body ratio |
|
|
Term
|
Definition
more common in females
more common in certain sports like ballet with low upper-to-lower body ratio |
|
|
Term
|
Definition
more common in females
more common in certain sports like ballet with low upper-to-lower body ratio |
|
|
Term
|
Definition
|
|
Term
| risk factors of low back pain |
|
Definition
unfitness
tall and fat
smoking
workplace sresses
psychological issues |
|
|
Term
| most common causes of low back pain are age related _______ and _______ and muscle or ligament related injuries |
|
Definition
| degerative disc and facet processes |
|
|
Term
| musculoskeletal causes are divided into: |
|
Definition
nerve root syndromes
musculoskeletal pain syndromes
skeletal causes |
|
|
Term
| Strength tests of physical exam for back pain |
|
Definition
| crunch, reverse crunch, hip flexion/extension, abduction/adduction |
|
|
Term
|
Definition
| positive test supprot spondylolysis |
|
|
Term
Gait testing:
Heel walking
Toe walking |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| quad flexibility -rectus femoris |
|
|
Term
| chest expansion less than ____ can be specific for _____ _____ |
|
Definition
2.5 cm
ankylosing spondylitis |
|
|
Term
| calf circumferences at mid calf can normally vary by __ cm |
|
Definition
|
|
Term
|
Definition
| lumbar range of motion in forward bending while standing |
|
|
Term
| measure leg lengths from ____ to _____ |
|
Definition
| anterior superior iliac spine to medial malleolus |
|
|
Term
| neurological examination of back |
|
Definition
| tests 2 muscles and 1 reflex representing each lumbar root to accurately distinguish betweem focal neuropathy and root problems |
|
|
Term
| scale for testing muscle strengths of lower lim |
|
Definition
0 = absent strength
1 - trace movement
2 - poor movement (less than antigravity)
3 - fair muscle strength ( antigravity strength through normal arc)
4 - good strength
5 - normal strength |
|
|
Term
|
Definition
extend quadriceps
squat down and rise |
|
|
Term
|
Definition
tibialis anterior dorsiflex ankle
wall on heels |
|
|
Term
|
Definition
extensory hallucis longus - dorsiflex great toe
walk on heels |
|
|
Term
|
Definition
stand on toes
walk on toes (plantarflex ankle) |
|
|
Term
sensory/reflex
L2/L3 - root L3 |
|
Definition
lateral thigh and medial femoral condyle
reflex: patellar tendon |
|
|
Term
sensory/reflex
L3/L4 - root L4 |
|
Definition
medial leg and medial ankle
reflex: patellar tendon |
|
|
Term
sensory/reflex
L4/L5 root L5 |
|
Definition
lateral leg and dorsum of foot
reflex: medial hanstring |
|
|
Term
sensory/reflex
L5/S1 root S1 |
|
Definition
sole of foot and lateral ankle
reflex: achilles tendon |
|
|
Term
| Supine straight leg raising test |
|
Definition
sciatic nerve tension
reproduction of pain caused by elevation of the contralateral limb raises probability of a disk herniation to 98%
can be negative in people with spinal stenosis |
|
|
Term
| sitting SLR (knee extension) test |
|
Definition
for lower roots
positive reproduces sciatica symptoms with pain that radiates below knee |
|
|
Term
|
Definition
reverse SLR/ femoral nerve stretch test
upper lumbar roots
less common site of radiculopathy |
|
|
Term
| all imaging studies have falst positive rates over |
|
Definition
|
|
Term
| Radiographs are reserved for... |
|
Definition
low back pain that doesn't resolve, worsens with time, or associated with:
cauda equina syndrome
radiculopathy with progressive neurologic deficit |
|
|
Term
|
Definition
bony overgrowths (osteophytes)
anterior, lateral and posterior (less common) parts of superior and inferior margins of vertebral bodies
increases with age |
|
|
Term
Lumbar spondylosis
__ - __% of population
more than ___ % over 40 |
|
Definition
usually asymptomatic
27-37% of asymptomatic population
more than 80% older than 40 have lumbar spondylosis |
|
|
Term
|
Definition
junction of pedicle and lamina
where articular and transverse processes of vertebrae arise
defect would functionally separate the vertebral body, pedicle, superior articular process from the inferior articular process and rest of vertebrae |
|
|
Term
| most cases of spondylolyis are thought to result from... |
|
Definition
minor over use trauma
repetitive hyperextension of the lumbar spine |
|
|
Term
| family history of spondylolysis increases prevalence from __% to __-__% |
|
Definition
|
|
Term
| activities related to spondylolysis |
|
Definition
high load: weightlifting, football, soccer, wrestling
extension: gymnastics, diving
rotational component: tennis golf baseball |
|
|
Term
| History and PE presentation of spondylolysis |
|
Definition
slow onset; increased pain with activity; can have night pain; rare neurological symptoms
extension and stork test positive |
|
|
Term
| Imaging for spondylolysis |
|
Definition
Xray - 50% sensitive - oblique images
CT more sensitive
MRI can show bone edema and disk
SPECT: good for sensitivity and useful for dating |
|
|
Term
| treatment for spondylolysis |
|
Definition
limit activities for 4-6 weeks then slowly advance
unable to achieve pain free after 2-3 weeks consider bracing
PT useful to work on hamstring flexibility |
|
|
Term
|
Definition
forward translation of a vertebral body with respect to the vertebra below
can occur at any level
most common in lower lumbar |
|
|
Term
| both spondylolysis and spondylolisthesis are often ____ |
|
Definition
|
|
Term
| does the degree of spondylolisthesis correlate with the incidence or severity of symptoms in a patient with spondylolisthesis? |
|
Definition
|
|
Term
| classic nerve root syndrome is characterized by ____ pain arising from nerve root impingement due to ____ ____. It can also be produced by ____ and ____. |
|
Definition
radicular pain
due to herniated disc
inflammation and irritation |
|
|
Term
| Impingement pain tends t be ____, ____ and can be associated with _____. Irritation pain tends to be ___, ____ and without ____. |
|
Definition
sharp, well localized with paresthesia
dull, poorly localized and without paresthesia |
|
|
Term
| Impingement associated with a positive straight leg raising sign |
|
Definition
| shooting pain down contralateral leg with leg raising |
|
|
Term
impingement syndrome
IV discs are found...
thinnest... |
|
Definition
intervertebral discs - found between the bodies of adjacent vertebrae from the axis to the sacrum
thinnesh in the cervical area and progressively thicken as the vertebral column descends |
|
|
Term
| annulus fibrosis of IV disc |
|
Definition
outer ring
thin layer of dense collagenous tissue
internal wider layer of fibrocartilage |
|
|
Term
| nucleus pulposus of IV disc |
|
Definition
inner core
gelatinous consistency
glycosaminoglycans (mucopolysaccharides)
proteins |
|
|
Term
| what structures secure the IV discs in place? |
|
Definition
Anterior longitudinal ligaments
posterior longitudinal ligaments (thinner, weaker) |
|
|
Term
most common cause of impingment syndrome is
most common path of herniated disc |
|
Definition
herniated discs
posterolateral
posterior annulus fibrosus is weaker and the post longitudinal ligament is narrower and weaker |
|
|
Term
| impingement syndrome can also be caused by: |
|
Definition
spinal stenosis
spinal degeneration
cauda equina syndrome |
|
|
Term
| disc herniations frequently involve the discs in the ___ region |
|
Definition
lumbar
(L4/L5)
(L5/sacrum) more common |
|
|
Term
|
Definition
more common in adults
radicular symptoms
exam: pain or paresthesias of a specific root
flexion increases pressure and symptoms
straight leg raise - causes pain
corresponding muscle weakness |
|
|
Term
|
Definition
straight leg raise
positive finding with acute disc herniation |
|
|
Term
| presentation of herniated disc |
|
Definition
numbness in a dermatomal distribution corresponding to the level of disc involved, motor weakness, reflex loss
presentation depends on the location
positive straight leg raising test |
|
|
Term
| IV discs begin the degenerate by ___ decade of life |
|
Definition
|
|
Term
|
Definition
| pain along the front of the leg; weak extension of the leg at the knee; sensory loss above the knee; loss of knee jerk reflex |
|
|
Term
|
Definition
| pain along the side of the leg; weak dorsiflexion of the foot; sensory loss in the web of the toe; no reflexes lost |
|
|
Term
|
Definition
| pain along the back of the leg; weak plantar flexion of the foot; sensory loss along the back of the calf and the lateral aspect of the foot; loss of ankle jerk |
|
|
Term
| herniated disc at L5 and S1 |
|
Definition
| involved in almost 95% of all herniated discs |
|
|
Term
| Exam of Acute Disc Herniation: Deep tendon reflexes |
|
Definition
L4 - knee jerk absent
L5 - cannot dorsiflex foot and big toe; sensory loss over dorsum of foot
S1 - loss of plantar flexion of the foot; loss of sensory over the lateral aspect of foot/posterior callf; loss of ankle reflex |
|
|
Term
| Treatment for herniated disc |
|
Definition
if patient has weakness, decreased reflexes or bowel problems: MRI and refer
if not: decrease activity and start PT; oral steroid or injection for pain control possibly |
|
|
Term
| injections for herniated disc showed that __% of surgical candidates had resolution or decrease in pain that allowed them to avoid surgery. |
|
Definition
|
|
Term
|
Definition
as person ages and the discs become drier and start to shrink
bones and ligaments swell or grow larger from arthritis or inflammation |
|
|
Term
| Spinal stenosis is also caused by: |
|
Definition
arthritis of spine
bone diseases (paget's disease)
defect or growth in the spine that was present from birth
herniated disc
injury that causes pressure on the nerve roots or spinal cord
tumors in the spine |
|
|
Term
symptoms of spinal stenosis
more likely to get worse when...
lessen or disappear when...
most people with spinal stenosis cannot ____ for a long period of time. |
|
Definition
numbness, cramping, pain in the back, buttocks thighs or calves; weakness in leg
worse when you stand or walk
lessen when you sit down or lean forward
walk for a long period of time |
|
|
Term
| More serious symptoms of spinal stenosis include: |
|
Definition
difficulty or poor balance when walking
problems controlling urine or bowel movements |
|
|
Term
Patients with spinal stenosis complain of...
this results from _______ rather than actual arterial insufficiency
straight leg test is often _____ |
|
Definition
progressive pain down the lateral aspect of the leg during ambulation (pseudoclaudication)
from neurologic compression rather than actual arterial insufficiency
negative |
|
|
Term
the stoop test is used to distinguish
true claudication patients ______ when pain occurs
pseudoclaudication patients try to relieve pain by.... |
|
Definition
true claudication from pseudoclaudication
true claudication - sit down to rest
pseudoclaudication - keep walking by stooping or flexing spine to relieve stretch on sciatic nerve |
|
|
Term
Spinal degeneration is caused by..
this progresses to...
if couled with progressive posterior face disease, this process leads to .... |
|
Definition
alterations in the hygroscopic quality of the nucleus pulposus
progresses to annular degeneration
leads to spinal canal or foraminal encroachment |
|
|
Term
| Spinal degeneration has 3 distinct stages |
|
Definition
dysfunction with complaints of pain only
instability with advanced degeneration, pseudospondylolisthesis, and neurological abnormalities
stabilization with morning stiffness and with prolonged standing or walking, radicular pain |
|
|
Term
|
Definition
| pain that radiates within the dermatome affected |
|
|
Term
| cauda equina syndrome is produced by... |
|
Definition
| massive midline extrusion of nuclear material or tumor into the spinal canal, which compresses the caudal sac |
|
|
Term
| classic presentation of cauda equina syndrome is |
|
Definition
bilateral sciatica with lower extremity, bowel or bladder dysfunction in 90% of patients.
urinary retentions initially observed and followed by overflow incontinence
perineal or perianal anesthesia is present in 60-80% of patients |
|
|
Term
Lumbosacral strain
more common in...
history presentation
PE presentation |
|
Definition
more common in adults
recent increase or new activity
pain off midline
aching, not radicular
muscle spasm or tenderness
normal or mildly decreased ROM
normal neurological |
|
|
Term
| Treatment for lumbosacral strain |
|
Definition
PT
tai chi
chiropractic manipulation possibly |
|
|
Term
Vertebral Fracture
History and exam presentation |
|
Definition
older patients with risks of osteoporosis; no trauma needed
normal neurological exam; tenderness over the spine |
|
|
Term
| Osteoarthritis of spine history and exam |
|
Definition
| older patients, worse with movement, morning stiffness, decreased ROM, may have nerve compression |
|
|
Term
Piriformis syndrome
history and exam presentation
treatment |
|
Definition
tight piriformis can irritate the sciatic nerve and cause symptoms
buttock pain with radicular pain
FADDIR position and hold
piriformis test positive for radicular pain
treatment: PT for stretching |
|
|
Term
| Musculoskeletal pain syndromes |
|
Definition
myofascial pain syndromes
fibromyalgia |
|
|
Term
| Myofascial pain syndromes are characterized by: |
|
Definition
pain and tenderness over localized areas (trigger points)
loss of ROM in the involved muscles
pain radiating in a characteristic distribution but restricted to a peripheral nerve
relief of pain often reported when the involved muscle group is stretched |
|
|
Term
| Fibromyalgia results in .... |
|
Definition
pain and tenderness on palpation of 11 of 18 trigger points
generalized stiffness fatigue and muscle ache |
|
|
Term
|
Definition
| results from infectious processes involving bones of the spine |
|
|
Term
sacroiliitis results from...
pain found where?
pain exacerabated by? |
|
Definition
inflammatory changes in the sacroiliac joints
pain over the joints and radiates to the anterior and posterior thigh
worse at night and prolonged sitting or standing |
|
|
Term
history and PE of sacroiliitis
treatment |
|
Definition
localized pain, buttock pain with possible radicular symptoms
point tender over SI joint
FABER positive; hip weakness common
treatment: rest and PT; consider cortico steroid injection |
|
|
Term
| malignant tumors of the spin |
|
Definition
primary or metastatic
0.5% of primary musculoskeletal tumors
most are benign but can be painful |
|
|
Term
most primary spinal tumors are found in patients
usually involve the... |
|
Definition
younger than 30 yo
posterior vertebral elements |
|
|
Term
metastatic tumors are found in patients over _____
occur in ______ parts of the vertebrae |
|
Definition
over 50 yo
anterior aspects of the bodies |
|
|
Term
| prevention of low back pain |
|
Definition
back muscle strengthening exercises
weight loss in overweight patients
proper lifting techniques
general overall improvement of physical conditioning |
|
|
Term
|
Definition
back pain has lasated for more than 1 month
is unrelieved by bed rest
occurs at night (interrupting sleep in patients over 50) |
|
|
