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Cadogan back
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56
Nursing
Graduate
05/17/2013

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Cards

Term
In the back which back structures represent:

The forestay?
The stern stay
The mast cross-bracing/rigging?
Definition
Abdominal muscles

Sacrospinales

Rotator muscles of the spine
Term
Which muscle stabilize the spine posteriorly?
Anteriorly?

Note about anterior and posterior spinal ligaments
Definition
Erector spinaes

Anterior abdominals

The anterior spinal ligament is strong and the posterior is weak; that is why disc herniations happen posteriorly
Term
When a disc bulges, which nerve will it impinge on?

Describe trefoil canal and what it is assoc w/
Definition
Will catch the nerve below it

Diamond-shape spinal canal (instead of round), found with spinal stenosis pts
Term
Describe the ligament of flavum

What goes wrong with it and what condition it can cause
Definition
Yellow ligament that connects the laminae of the vertebrane on the posterior side of the vertebral canal

It tends to thicken with aging and can impinge on the spinal cord, causing pain. Makes spinal stenosis worse.
Term
Difference b/w comfortable positions people w/ spinal stenosis vs. disc problem
Definition
Pts w/ spinal stenosis are more comfortable sitting; bending backward of forward further narrows the vertebral canal, causing pain.

Those with disc problems prefer to stand, sitting causes pain.
Term
Two main parts of the disc and where they are joint

What can happen with a degenerated disc
Definition
The nucleus pulposus jelly is inside the round band of the annulus fibrosus

The fibrosus infiltrates the pulposa and they get mixed up
Term
What happens in disc herniation
Three forms of this with descriptions
What the problem with this is
Worst form and why
Definition
The pulposa impinges outward on the annulum

Protruded: pulposa impinging but not broken through annulus
Extuded: part of pulposa breading through annulus
Sequesterd: some pulposa broke off and is free floating in spinal canal

The displaced pulposa can press on the spinal cord, causing pain

Sequestered: the free pulposa can float up and down, irritating multiple nerves
Term
Note about sinu vertebral nerve in the spine, with s/s it can cause
Definition
These nerves in the spine have sympathetic ganglion; therefore, with spinal nerve impingement, you may have NVD or other autonomic s/s
Term
Major spinal artery and pathology associated with it
Definition
Adamkiewicz: if experiences arteriorsclerotic changes, can give rise to pain (found especially in lumbar/lower back)
Term
6 major categories of back injury

Note about first one
Definition
Mechanical
Infectious
Inflammatory
Metabolic
Neoplastic
Visceral or adjacent organ pathology

Majority of lower back injuries are to soft tissue, and there is not a lot you can do about it
Term
5 mechanical injuries or mechanical injury types found in back injury
Definition
Soft tissue injury (myofascial syndromes, lumbosacral strain)
Degenerative disc disease
Vertebral fracture
Spinal stenosis (central vs foramenal)
Spondylolisthesis
Term
2 kinds of injections that can cause back pain

Two inflammatory conditions that can cause back pain
Definition
Epidural abscess
Vertebral osteomyelitis

Sondyloarthropathy (ie Reiter's Syndrome)
Crystal-induced arthropathy (CPPD)
Term
4 metabolic causes of lower back pain
3 neoplastic causes of LBP
Definition
Osteoporosis
Osteomalacia, renal osteodystrophy, hyperparathyroidism
Onchronosis
Paget's disease

Cord compression syndromes and cauda equine
Metastatic disease
Multiple myeloma
Term
4 neoplastic origin types that often go to spine
Definition
Prostate
Ovary
Lung
Breast
Term
5 visceral or adjacent organ pathologies that can cause lower back pain
Definition
Abdominal aortic aneurysm
Pancreatic disease/tumor pseudocysts
Retroperitoneal malignancy
Ovarian, renal or uterine disease
Prostatic disease
Term
2 causes of back pain that increases with straining (Valsalva)

One cause of back pain that increases with sitting

One cause of back pain that increases with standing, with explanation
Definition
Cord compression secondary to disc disease
Tumor metastasis

Discogenic disease

Spinal stenosis: flexion decreases pain, extension increases it
Term
2 conditions that cause back pain that increases at night
Definition
Tumor
Abscess
Term
What band-like back pain suggests
Dermatomes involved in LBP (4)
What numbness/tingling below the knee suggest
Definition
Cord compression syndrome

L3,L4,L5,S1

Nerve root involvement
Term
4 causes of back pain that stem from other organ systems
Definition
GU (menses, endometriosis)
CV (claudication)
Neuromuscular (other weakness, tremor, dysesthesias)
Complaints suggesting other illnesses: fever, wt loss, arthralgia, rash, etc.
Term
6 components of back physical exam
Definition
Inspection
Palpation
ROM
Maneuvers
Neuro
Vascualar
Term
What back disorder assoc w/ loss of bladder and bowel

What is a step off, and what it is associated with?

Which maneuver is less valuable in back exam and why
Definition
Cord compression

It is a notch that is found at the location of severe spondylolisthesis

Rotation: is mostly hips, not back
Term
Explain Stinchfield test
Definition
Pt lies supine and raises straightened leg 1-2 inches off table. Pain in hip suggests hip pathology; if radiates, consider referred back problem (eg sciatica)
Term
What does clonus in a back exam usually indicate?

What does simian position imply and why
Definition
Upper motor neuron issue

Spinal stenosis: more comfortable stooping over
Term
Pain configuration with S1 nerve compression
Configuration with spinal stenosis
Config with drug seeking
Definition
1) Will hurt from lower back down single affected leg
2) Will hurt from lower back down both legs
3) No pattern--hurts everywhere
Term
Kind of tool used to measure differences in back heights when bending over in scoliosis

Describe Cobb angle and troubling degree
Definition
Scoliometer

Angle of curve in spine in scoliosis. 35-40 degrees or greater may require surgical intervention
Term
Describe Schober test

2 conditions that limit this
Definition
W/ pt standing, examiner makes a mark at L5. The examiner then places one finger ~5 cm below this mark, and another, second, finger, ~10 cm above this mark. The pt touches his toes w/out flexing the knee joints. The distance between the two fingers of the examiner increases. A restriction in the lumbar flexion of the pt reduces this increase; if the distance increases less than 5 cm, then there is an indication that the flexion is limited.

Muscle spasm
Spondyloarthropathy: fused vertebrae
Term
Explain rib-pelvis distance
Definition
In most people, width is 2-3 finger's breadth. With fracture and osteoporosis, becomes smaller.
Term
Define cauda equine syndrome
What often found
Location of disc herniations that can cause
Definition
Acute loss of function of the lumbar plexus, nerve roots of the spinal canal below the termination (conus medullaris) of the spinal cord.

Bowel/bladder symptoms

L5-S1
Term
Cauda equine syndrome:

Where pain found
Where numbness found, with special conditions
Where weakness found
Where atrophy found
Where paralysis found
Definition
Backs of thighs and legs

Butt, back of legs and soles of feet. Saddle numbness.

Paralysis of legs and feet

Calves

Bladder and bowel (incl incontinence)
Term
Why is the straight leg/ Lasegue test performed?
How to perform
How to interpret
Definition
To determine whether a pt w/ LBP has a herniated disc, often at L5

With pt supine, passive raise straightened leg

If sciatic pain at angles b/w 30 and 70, positive for herniation
Term
What the ham/ bowstring test tests for
Describe
Definition
Sciatic nerve impingement

Patient is supine with knee flexed 90 and his leg placed on examiners shoulder. Place fingers in the popliteal space behind the knee and apply pressure. If test is positive there should be a tingling, burning sensation in the hip and buttocks.
Term
Describe femoral stretch test
How to interpret
Specific nerve implicated
Definition
Pt lies prone; the knee is passively flexed to the thigh and the hip is passively extended (knee is flexed and leg is pulled upward)

The test is positive if the patient experiences anterior thigh pain. This test is strongly positive in patients with protrusions at L2-L3 and L3-L4, slightly positive or negative in L4-L5 disk protrusions and negative in cases with a lumbosacral protrusion.

L3
Term
Vascular vs neural claudication manifestations:

Exercise
Stationary bicycle
Lying flat
Standing
Definition
Worse w/ vascular, variable w/ neurogenic

Worse w/ vascular, comfortable w/ neurogenic

Relieves vascular pain, variable result with neurogenic

Relieves vascular claudication, makes neurogenic worse
Term
Vascular vs neural claudication:

Sensory variations
Pulses
Back motion
GU involvement
Definition
Vascular has stocking deficits; neurogenic is poorly localized

Pulses decreased with femoral bruits with vascular; normal in neurogenic

No change w/ vascular, pain worse w/ hyperextension in neurogenic

Impotence with vascular, retention and frequency with neurogenic
Term
Describe Hallux extension test and what result means
Definition
Pt dorsiflexes great toe while examiner resists it. Poor strength means L5 palsy or impingement.
Term
Motor, reflex and sensation for:
L4
L5
S1
Definition
L4:
Anterior tibialis (dorsiflexing front of foot)
Reflex: patellar tesnsion
Sensation: dorsal and plantar surface of great toe

L5:
Motor: extensor hallus: raising great toe
Reflex: none
Sensation: dorsal and plantar surfaces of middle three toes

S1:
Movement: gastroc soleus (repetitive toe raises)
Reflex: Achilles tendon
Sensation: little toe, top and bottom
Term
5 parts of Waddel's sign, which is used to ID malingering
Definition
1. Superficial and non-anatomic tenderness: tested by lightly pinching over a wide area of lumbar skin. Excessive pain reaction to this is considered positive. Nonanatomic pain is described as deep tenderness felt over a wide area rather than localized to one structure.

2. Simulation test: eg. axial loading: light pressure is placed on standing patient's skull by the examiner's hands. This is positive if low back pain is reported. The second simulation test is rotation. Back pain is reported when the shoulder and pelvis are passively rotated in the same plane, as the patient stands relaxed with feet together.

3. Distraction straight leg raising (supine vs. sitting): the straight leg raise is done while the patient is lying fiat and then, while distracting the patient, in the sitting position. This may be positive if there is positive pain response while the patient is lying down, but no pain when the test is done while the patient is sitting.

4. Regional disturbances: involve a widespread area, such as an entire quarter or half of the body. The essential feature of this sign is the divergence of the pain beyond the accepted neuroanatomy. Examples include give-way weakness in many muscle groups and diminished sensation to light touch, pinprick or vibration that do not follow a logical dermatomal pattern. Example: The patient may have nerve root compression at L5 but claims numbness "in the entire leg".

5. Overreaction to examination: may be the use of disproportionate verbalization, facial expression, muscle tension, tremor, collapsing, and even profuse sweating. This is the single most important physical sign.
Term
What is the piriformis muscle?
What is pyriformis syndrome?
Definition
The piriformis is a muscle in the gluteal region of the lower limb. It is one of the six muscles in the lateral rotator group.

Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.
Term
How do you test for piriformis syndrome?
Definition
With patient sitting on table, adduct knees and externally rotate leg. Will cause piriformis pain.
Term
What does Vacume Sign indicate?
What does it look like?
Definition
Degenerative disc disease

The presence of a linear radiolucency in the disk space--is air replacing disc and making spaces between discs
Term
How does spondolithiasis appear on xray?

What kind of views do you want to see with this disorder, and why?
Definition
Will see a vertebrae move anterior or posterior in r/t the discs around it.

Want to see flexion and extension xrays--will increase the displacement and make it more obvious
Term
Meyerding classification: what it measures, and classes with explanations
Grades that may require surgery
Definition
Measures slippage for spondylolsthesis

Grade 1: 25%
Grade 2: 26-50%
Grade 3: 51-75%
Grade 4: 76-100%

Grades 3 and 4
Term
Disorders in which you see the Rutgers Jersey imaging sign
Definition
Renal osteodystrophy
Term
Management of LBP:

Note about rest
Two to reduce, and how
3 things to improve
Definition
Rest or diminish activity for 7-10 days

Reduce spasm (moist heat, muscle relaxants)
Reduce pain (analgesics but avoid narcotics)

Improve ROM
Improve muscle range/flexibility
Improve endurance
Term
Management of LBP:

One thing to manage
One to discourage
What to modify
Definition
Manage obesity/overweight

Discourage smoking

Modify work habits and environment
Term
3 kinds of meds to use for LBP
What you need before starting
Definition
Analgesics, muscle relaxatants, antidepressants (like SSRIs)

Current urine, blood, liver, kidney panel
Term
What PT in LBP should focus on
2 interventions that involve medicine
5 surgeries for LBP
Definition
Focus on flexibility, strengthening, and stretching

Epidural block/ steroids
Implantable pump

Laminectomy
Fusion
Instrumentation vs. noninstrumented
Discectomies
Kypho/vertebroplasty
Term
Population in which multiple myeloma found
How may present, with what deserves
One imaging method vs another
Definition
More common in older people

Anemia plus back pain can be multiple myeloma; deserves imaging

Xray not so good; MRI will actually show lesions
Term
Note re: opiate use and back pain
Note re: corsets and back pain
Note re: exercise and LBP
Definition
Avoid

Avoid; can weaken ab muslces

Avoid extreme stretching
Term
2 ex of exercises that are OK to do with LBP
Definition
Pt laying on back; raises knees to chest

Extension exercise: lying prone, lifts up upper body as a bed with arms
Term
5 causes of lumbar surgery
Definition
1) Nerve root injury: from inadequate nerve exposure
2) Dural injury: small fold of dura pinched by surgical instruments. CSF fistula can form leading to subarachnoid cyst.
3) Cauda equina syndrome from injury to artery Adamkiewicz which provides blood supply to lower spinal cord
4) Scar tissue formation: arachnoiditis, dxd w/ MRI w/ contrast
5) Lumbar instability: dxds by flexion/ extension xrays
Term
What crescent sign looks like

What it indicates, process behind it, and how best shot
Definition
It appears as a curved subchondral radiolucent line that is oftentimes found on the proximal femoral or humeral head.

Avascular necrosis. Usually, this sign indicates a high likelihood of collapse of the affected bone. The crescent sign may be best seen in an abducted (frog-legged) position
Term
Describe Thomas test for quad contracture
Definition
Pt is supine. Flexes one leg to chest. If the leg/knee lifts from the floor, the hip flexors are rigid.
Term
Indications for total hip arthroplasty:

Pain note
Associated loss
Loss
Clearance required
How long does avg prosthesis last?
Definition
Intractable pain

Functional status: inability to put on socks/ shoes

Greater than 50% loss of internal and external rotation

Medical clearance for a 2 to 2.5 hour surgical procedure

10-20 yrs
Term
What is heterotopic bone formation?
Definition
Formation of bone outside of skeleton
Term
What often causes avascular necrosis
What quad contracture usually means
Definition
Steroids, ETOH
Time for a new hip
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