Term
| What are 2 primary pathophysiology causes of LBP |
|
Definition
Trauma
DJD of the Z joints |
|
|
Term
| What are secondary pathophysiology causes of LBP |
|
Definition
Disc Herniation
Congenital-Spondylolisthesis
Spinal Stenosis
Spinal Infection
Vertebral Fracture
Malignant Neoplasia
Ankylosing Spondylitis
Referred pain |
|
|
Term
| What are 3 places referred pain can come from with LBP |
|
Definition
GI- pancreatitis
GU- pyelonephritis
Vascular problem- AAA |
|
|
Term
| What is the definition of LBP |
|
Definition
| discomfort or stiffness between the costal margin and the gluteal folds with or without sensorimotor deficits in the leg |
|
|
Term
| What is the most common complaint of the primary care setting |
|
Definition
|
|
Term
| What percentage of people have backache sometime in their lives |
|
Definition
|
|
Term
| How much of the costs of disability is due to LBP |
|
Definition
|
|
Term
| What percentage of LBP is due to serious spinal pathology |
|
Definition
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|
Term
| Prolonged steroid use is a red flag for |
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Definition
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|
Term
| Progressive or severe neurological deficit IV drug use and or fever is a red flag for |
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Definition
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|
Term
| Young male, backache worse with rest |
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Definition
|
|
Term
| Lower back pain worse on extension |
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Definition
|
|
Term
| Older man with pain mainly at night |
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Definition
|
|
Term
| Older man, backache and headaches |
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Definition
|
|
Term
| Middle-aged woman, fatigue, headaches |
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Definition
|
|
Term
| Young football player pain after game |
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Definition
|
|
Term
| LBP worse with walking, pulsatile mass |
|
Definition
|
|
Term
| 60 year-old with pain and urinary retention |
|
Definition
|
|
Term
| 35 year-old, left backache, fever, chill |
|
Definition
|
|
Term
| Worsening LBP, pain in PM, urinary changes |
|
Definition
|
|
Term
| 65 year-old female, pain worse on walking |
|
Definition
|
|
Term
| Local pain at SI joint after prolonged sitting |
|
Definition
| SI sprain/strain subluxation |
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|
Term
| Sciatica with tight piriformis and +Bonnet |
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Definition
|
|
Term
| Prolapse of the nucleus pulposus of an affected lumbar intervertebral disc with compression or irritation of lumbar spinal nerve roots. Current data suggests that the nerve root is inflamed, but not always compressed. |
|
Definition
|
|
Term
| Etiology of lumbar disc lesion |
|
Definition
|
|
Term
| Low back pain radiating into the back of the thigh and leg, worse with bending and twisting |
|
Definition
| Lumbar disc lesion clinical picture |
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|
Term
| Orthos for Lumbar disc lesion |
|
Definition
SLR (35-75)
Braggards sign-dorsiflex with slr |
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|
Term
| Investigation of a lumbar disc lesion is |
|
Definition
Xray-narrowing of joint space and osteophytes
MRI- posterolateral disc bulge |
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|
Term
| Management of a lumbar disc lesion |
|
Definition
Chiropractic for 4 weeks unless evidence of cauda equina
Avoid rotation-flexion and distraction |
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|
Term
|
Definition
|
|
Term
| What muscles are tested with L4 |
|
Definition
Tibialis Anterior
(resist dorsiflexion and inversion) |
|
|
Term
| What is the sensory of L4 |
|
Definition
| medial leg and medial foot |
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|
Term
|
Definition
|
|
Term
| What muscles are tested with L5 |
|
Definition
| extensor hallicus longus (resis dorsiflexion of big toe) |
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|
Term
| What is the sensory of the L5 nerve root |
|
Definition
| Lateral leg and dorsum of the foot |
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|
Term
|
Definition
|
|
Term
| What muscles are tested with S1 reflex |
|
Definition
| Peroneus longus and brevis (resist plantarflexion and eversion) |
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|
Term
| Pain related to the zygapophaseal joint between adjacent vertebrae |
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Definition
|
|
Term
| Etiology of facet syndrome |
|
Definition
| Degenerative joint disease or trapped meniscoid tissue between the articular facets |
|
|
Term
| Unilateral back pain that is better on lying down and worse on extension or rotating the spine. |
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Definition
|
|
Term
| Where is the pain with facet syndrome |
|
Definition
Pain is usually localized but may radiate above the knee
Neurological tests and nerve root tension tests should be normal |
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|
Term
|
Definition
|
|
Term
| Investigations of facet syndrome |
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Definition
|
|
Term
| What lines are used on xray of facet syndrome |
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Definition
|
|
Term
| What is the treatment of facet syndrome |
|
Definition
|
|
Term
| Narrowing of the spinal canal with damage to the spinal cord |
|
Definition
|
|
Term
| What is the etiology of central canal stenosis |
|
Definition
| DJD (L4, C6), Intrathecal mass (abscess, hemorrhage or tumor) |
|
|
Term
| Extremity pain worse with activity; if located in the lumbar region, there will be “neurogenic” claudication-lower limb pain with activity, relieved by bending forward or sitting down |
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Definition
|
|
Term
| What test will be positive for central canal stenosis |
|
Definition
|
|
Term
| if there is LMN weakness in the upper limb what reflexes will you see |
|
Definition
| diminished or absent reflex |
|
|
Term
| What type of reflexia will you see in the lower limbs with an UMN lesion |
|
Definition
| hyperreflexia with babinski |
|
|
Term
| What orthos would be positive in central canal stenosis |
|
Definition
|
|
Term
| What is the investigations of central canal stenosis |
|
Definition
|
|
Term
| What lines are drawn on the xray to identify central canal stensosis |
|
Definition
|
|
Term
| What confirms central canal stenosis |
|
Definition
|
|
Term
| What is the management of central canal stenosis |
|
Definition
Chiropractic if there is no contraindication
Flexion distraction
Refer to neurologist if not helpful
Refer to the hospital if there is cauda equina syndrome |
|
|
Term
| Movement of a vertebral body in relation to the vertebral body below |
|
Definition
|
|
Term
| What is the etiology of spondylolisthesis |
|
Definition
| unknown; if isthmic it is related to repetitive hyperextension |
|
|
Term
|
Definition
|
|
Term
| Isthmic spondylo pars fracture |
|
Definition
|
|
Term
| What does type 2 spondylo fracture specifically |
|
Definition
|
|
Term
| Type 2 spondylo is more common in |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most common form or type 3 spondylo |
|
Definition
|
|
Term
| Who has type 3 spondylo more? |
|
Definition
|
|
Term
| Traumatic spondylo of the pedicles |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Iatrogenic spondylo from physician/surgery |
|
Definition
|
|
Term
| Often asymptomatic; may present with low backache worse with extension and a step sign if it is severe; there is no change in the muscle power, sensation |
|
Definition
|
|
Term
| Investigations of spondylolisthesis |
|
Definition
| lateral xray-ant slippage of L5 on S1 (MC) or L4/L5 |
|
|
Term
| What method is used to quantify the degree of slippage by dividing the A/P width of the base of the sacrum into fourths |
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Definition
|
|
Term
| If there is severe spondylolisthesis what will be present on xray |
|
Definition
| inverted napoleon hat sign |
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|
Term
| What is the management of spondylolisthesis |
|
Definition
Chiropractic management on the segment below (avoid on the unstable)
Avoid extension exercises
Anti lordotic brace
Grade 3 or 4 refer to ortho surgeon |
|
|
Term
| What test will show the early stress reactions in the bone |
|
Definition
|
|
Term
| Piriformis muscle compression of the sciatic nerve |
|
Definition
|
|
Term
| What is the etiology of piriformis syndrome |
|
Definition
| Trauma, prolonged sitting or anatomical; 15% of the population has sciatic nerve running through two muscle bellies of the piriformis muscle; |
|
|
Term
| What is the ratio of female to male of piriformis syndrome |
|
Definition
|
|
Term
| Buttock and posterior leg pain |
|
Definition
| clinical picture of piriformis syndrome |
|
|
Term
| What are the orthos for piriformis syndrome |
|
Definition
Bonnet test (SLR with internal rotation of foot and adduction of leg)
MRS normal
Trigger points on piriformis |
|
|
Term
| What are the investigations of piriformis syndrome |
|
Definition
| no neurological findings; xray normal |
|
|
Term
| What is the managment of piriformis syndrome |
|
Definition
Adjustments, myofacial release techniques and stretching
If neurological signs appear order MRI for possible disc herniation |
|
|
Term
| Stretch, rupture or separation of the muscles and ligaments of the SI joint; strain refers to muscular injury and sprain refers to ligamentous injury |
|
Definition
|
|
Term
| What is the etiology of sacroiliac sprain/strain |
|
Definition
| Trauma; overuse; pregnancy |
|
|
Term
| Pain over the SI region that may radiate down the back of the leg; usually made worse when getting up from a bent or stooped position; made better by sitting or lying down |
|
Definition
| clinical picture of sacroiliac sprain/strain |
|
|
Term
| What ortho tests are positive for si sprain/strain |
|
Definition
Gaenslen test
Yeoman's test
MRS will be normal
(pain may increase or decrease with compression or distraction) |
|
|
Term
| What are the associated neurological findings of SI sprain/strain |
|
Definition
|
|
Term
| What are the xray findings of SI sprain/strain |
|
Definition
|
|
Term
| What is the treatment management of SI sprain/strain |
|
Definition
chiropractic adjustments are superior to medical treatment
Acute- light adjusting with possible support brace |
|
|
Term
| Progressive neoplastic plasma cell disease characterized by excessive immunoglobulin production |
|
Definition
|
|
Term
| What is the etiology of multiple myeloma |
|
Definition
|
|
Term
| What is the peak incidence of multiple myeloma |
|
Definition
|
|
Term
| Multiple myeloma is the most common primary bone tumor primarily in |
|
Definition
|
|
Term
| Fatigue, nocturnal backache, recurrent infections, constipation, blurred vision, constipation, nerve root compression and mental changes |
|
Definition
| clinical picture of multiple myeloma |
|
|
Term
| What ortho tests will be positive for multiple myeloma |
|
Definition
| tenderness on percussion of spinous |
|
|
Term
| What will a CBC show with multiple myeloma? |
|
Definition
| normocytic normochromatic anemia |
|
|
Term
| What will a CMP show in multiple myeloma |
|
Definition
| hypercalcemia, elevated serum proteins, reversed albumin/globulin ratio (1:2) |
|
|
Term
| In multiple myeloma what will be found in the urine |
|
Definition
| Bence Jones proteins (IgG) |
|
|
Term
| What will a serum electrophoresis show in a multiple myeloma patient |
|
Definition
|
|
Term
| What will xrays show with multiple myeloma patients |
|
Definition
70% show multiple lytic bone lesions in skull, long bones, and vertebrae
osteoperosis
blastic lesions |
|
|
Term
| What test confirms multiple myeloma |
|
Definition
| bone marrow biopsy shows malignant plasma cells |
|
|
Term
| Who manages a multiple myeloma patient |
|
Definition
|
|
Term
| Secondary malignant deposits far away from the primary site |
|
Definition
|
|
Term
| What are the common sites from metastatic cancers |
|
Definition
| breast, lung, thyroid, kidney, prostate |
|
|
Term
| What is the most common site of metastasis in males |
|
Definition
|
|
Term
| what is the most common site of metastasis in females |
|
Definition
|
|
Term
| What bone tumors are most common |
|
Definition
|
|
Term
| What is the main clinical picture of primary metastasis |
|
Definition
| nocturnal bone pain with or without unintentional weight loss |
|
|
Term
| What ortho test will be positive in metastatic cancers |
|
Definition
| tenderness on boney or spinal percussion will be positive if there are fractures |
|
|
Term
| What will xrays show in metastatic cancers |
|
Definition
osteolytic or osteosclerotic lesions in affected bones
60% will show owl winking sign (missing pedicles)
40% of the bone must be destroyed before changes on X-rays |
|
|
Term
| What blood levels will be elevated |
|
Definition
alkaline phosphatase
AST and ALT will be normal |
|
|
Term
| What will show hot spots in osteoblastic tumors |
|
Definition
| bone scans with technetium 99 |
|
|
Term
| Who manages metastatic cancers |
|
Definition
oncologist and chiropractic co management
do not adjust locally |
|
|
Term
| Infection of the bone and bone marrow |
|
Definition
|
|
Term
| History of recent infection such as respiratory, urinary tract infection, IV drug use or diabetes |
|
Definition
|
|
Term
| What is the organism of osteomyelitis |
|
Definition
|
|
Term
| What is the organism of osteomyelitis in sickle cell disease |
|
Definition
salmonella 4% in the spine
(60% lumbar, 30% thoracic, 10% cervical) |
|
|
Term
| What increases a patients incidence of having osteomyelitis |
|
Definition
| IV drug use with pseudomonas organisms |
|
|
Term
| What is the clinical picture of osteomyelitis |
|
Definition
| fever, chills, generalized malaise, nocturnal pain, swelling in the region |
|
|
Term
| If osteomyelitis affects an extremity what will be the clinical picture |
|
Definition
| joint pain, swelling and tenderness |
|
|
Term
| What orthos will be positive in osteomyelitis |
|
Definition
|
|
Term
| What does xray of osteomyelitis show initially |
|
Definition
|
|
Term
| What will the first initial changes seen on xray associated with osteomyelitis show? |
|
Definition
| subperiosteal elevation and soft tissue swelling |
|
|
Term
| After the initial changes there are lytic changes seen and what will appear 3-4 weeks later |
|
Definition
|
|
Term
| In osteomyelitis in later stages may have an |
|
Definition
|
|
Term
|
Definition
| sequestrum of dead bone appears within a rim of new bone |
|
|
Term
| If there is osteomyelitis in the vertebrae what will be seen on X-ray |
|
Definition
| loss of disc space and destruction of vertebral end plates |
|
|
Term
| What will a CBC show in osteomyelitis |
|
Definition
| elevated WBC and raised neutrophils |
|
|
Term
| What is the management of osteomyelitis |
|
Definition
| refer to hospital for admission and antibiotics |
|
|
Term
| Focal area of weakening of the abdominal aorta causing dilatation [>3.0 cm] |
|
Definition
| Abdominal Aortic Aneurysm |
|
|
Term
| What is the genetic predisposition for AAA |
|
Definition
| atherosclerosis in males (5:1) |
|
|
Term
| What is the common age and lifestyle of AAA |
|
Definition
|
|
Term
| Where is the most common location of AAA |
|
Definition
|
|
Term
| Often asymptomatic; however may present with backache or abdominal pain, perhaps with intermittent claudication in the lower limb or impotence |
|
Definition
|
|
Term
| What will abdominal palpation reveal with AAA |
|
Definition
| expansile pulsatile mass in the midline above the umbilicus with bruit in 50% of patients |
|
|
Term
| If an AAA ruptures what may the patient present with |
|
Definition
| sudden onset of severe bachache and hypotension (low BP and rapid pulse rate) |
|
|
Term
| What will a lateral lumbar xray reveal with AAA |
|
Definition
| curvilinear radio opaque densities located anterior to the anterior border of the lumbar vertebrae |
|
|
Term
| What size will the radioopaque densities be in AAA |
|
Definition
|
|
Term
| What may be shown in the vertebral column with AAA on xray |
|
Definition
| erosion of vertebral bodies |
|
|
Term
| What is the preferred imaging modality for AAA? |
|
Definition
|
|
Term
|
Definition
| vascular surgeon for opinion on surgery |
|
|
Term
| The risk of an AAA rupture increases expoentially after the diameter reaches |
|
Definition
|
|
Term
| Can you adjust a patient with AAA |
|
Definition
yes; but rotational adjusting is contraindicated
consider non force |
|
|
Term
| If a patient with AAA has pain, a pulsatile abdominal mass, and hypotension what is the management |
|
Definition
|
|
