Term
In the back which back structures represent:
The forestay?
The stern stay
The mast cross-bracing/rigging? |
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Definition
Abdominal muscles
Sacrospinales
Rotator muscles of the spine |
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Term
Which muscle stabilize the spine posteriorly?
Anteriorly?
Note about anterior and posterior spinal ligaments |
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Definition
Erector spinaes
Anterior abdominals
The anterior spinal ligament is strong and the posterior is weak; that is why disc herniations happen posteriorly |
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Term
When a disc bulges, which nerve will it impinge on?
Describe trefoil canal and what it is assoc w/ |
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Definition
Will catch the nerve below it
Diamond-shape spinal canal (instead of round), found with spinal stenosis pts |
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Term
Describe the ligament of flavum
What goes wrong with it and what condition it can cause |
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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. |
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Term
| Difference b/w comfortable positions people w/ spinal stenosis vs. disc problem |
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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. |
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Term
Two main parts of the disc and where they are joint
What can happen with a degenerated disc |
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Definition
The nucleus pulposus jelly is inside the round band of the annulus fibrosus
The fibrosus infiltrates the pulposa and they get mixed up |
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Term
What happens in disc herniation
Three forms of this with descriptions
What the problem with this is
Worst form and why |
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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 |
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Term
| Note about sinu vertebral nerve in the spine, with s/s it can cause |
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Definition
| These nerves in the spine have sympathetic ganglion; therefore, with spinal nerve impingement, you may have NVD or other autonomic s/s |
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Term
| Major spinal artery and pathology associated with it |
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Definition
| Adamkiewicz: if experiences arteriorsclerotic changes, can give rise to pain (found especially in lumbar/lower back) |
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Term
6 major categories of back injury
Note about first one |
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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 |
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Term
| 5 mechanical injuries or mechanical injury types found in back injury |
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Definition
Soft tissue injury (myofascial syndromes, lumbosacral strain)
Degenerative disc disease
Vertebral fracture
Spinal stenosis (central vs foramenal)
Spondylolisthesis |
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Term
2 kinds of injections that can cause back pain
Two inflammatory conditions that can cause back pain |
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Definition
Epidural abscess
Vertebral osteomyelitis
Sondyloarthropathy (ie Reiter's Syndrome)
Crystal-induced arthropathy (CPPD) |
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Term
4 metabolic causes of lower back pain
3 neoplastic causes of LBP |
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Definition
Osteoporosis
Osteomalacia, renal osteodystrophy, hyperparathyroidism
Onchronosis
Paget's disease
Cord compression syndromes and cauda equine
Metastatic disease
Multiple myeloma |
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Term
| 4 neoplastic origin types that often go to spine |
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Definition
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Term
| 5 visceral or adjacent organ pathologies that can cause lower back pain |
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Definition
Abdominal aortic aneurysm
Pancreatic disease/tumor pseudocysts
Retroperitoneal malignancy
Ovarian, renal or uterine disease
Prostatic disease |
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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 |
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Definition
Cord compression secondary to disc disease
Tumor metastasis
Discogenic disease
Spinal stenosis: flexion decreases pain, extension increases it |
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Term
| 2 conditions that cause back pain that increases at night |
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Definition
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Term
What band-like back pain suggests
Dermatomes involved in LBP (4)
What numbness/tingling below the knee suggest |
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Definition
Cord compression syndrome
L3,L4,L5,S1
Nerve root involvement |
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Term
| 4 causes of back pain that stem from other organ systems |
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Definition
GU (menses, endometriosis)
CV (claudication)
Neuromuscular (other weakness, tremor, dysesthesias)
Complaints suggesting other illnesses: fever, wt loss, arthralgia, rash, etc. |
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Term
| 6 components of back physical exam |
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Definition
Inspection
Palpation
ROM
Maneuvers
Neuro
Vascualar |
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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 |
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Definition
Cord compression
It is a notch that is found at the location of severe spondylolisthesis
Rotation: is mostly hips, not back |
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Term
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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) |
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Term
What does clonus in a back exam usually indicate?
What does simian position imply and why |
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Definition
Upper motor neuron issue
Spinal stenosis: more comfortable stooping over |
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Term
Pain configuration with S1 nerve compression
Configuration with spinal stenosis
Config with drug seeking |
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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 |
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Term
Kind of tool used to measure differences in back heights when bending over in scoliosis
Describe Cobb angle and troubling degree |
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Definition
Scoliometer
Angle of curve in spine in scoliosis. 35-40 degrees or greater may require surgical intervention |
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Term
Describe Schober test
2 conditions that limit this |
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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 |
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Term
| Explain rib-pelvis distance |
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Definition
| In most people, width is 2-3 finger's breadth. With fracture and osteoporosis, becomes smaller. |
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Term
Define cauda equine syndrome
What often found
Location of disc herniations that can cause |
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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 |
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Term
Cauda equine syndrome:
Where pain found
Where numbness found, with special conditions
Where weakness found
Where atrophy found
Where paralysis found |
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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) |
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Term
Why is the straight leg/ Lasegue test performed?
How to perform
How to interpret |
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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 |
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Term
What the ham/ bowstring test tests for
Describe |
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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. |
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Term
Describe femoral stretch test
How to interpret
Specific nerve implicated |
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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 |
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Term
Vascular vs neural claudication manifestations:
Exercise
Stationary bicycle
Lying flat
Standing |
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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 |
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Term
Vascular vs neural claudication:
Sensory variations
Pulses
Back motion
GU involvement |
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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 |
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Term
| Describe Hallux extension test and what result means |
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Definition
| Pt dorsiflexes great toe while examiner resists it. Poor strength means L5 palsy or impingement. |
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Term
Motor, reflex and sensation for:
L4
L5
S1 |
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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 |
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Term
| 5 parts of Waddel's sign, which is used to ID malingering |
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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. |
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Term
What is the piriformis muscle?
What is pyriformis syndrome? |
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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. |
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Term
| How do you test for piriformis syndrome? |
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Definition
| With patient sitting on table, adduct knees and externally rotate leg. Will cause piriformis pain. |
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Term
What does Vacume Sign indicate?
What does it look like? |
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Definition
Degenerative disc disease
The presence of a linear radiolucency in the disk space--is air replacing disc and making spaces between discs |
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Term
How does spondolithiasis appear on xray?
What kind of views do you want to see with this disorder, and why? |
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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 |
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Term
Meyerding classification: what it measures, and classes with explanations
Grades that may require surgery |
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Definition
Measures slippage for spondylolsthesis
Grade 1: 25%
Grade 2: 26-50%
Grade 3: 51-75%
Grade 4: 76-100%
Grades 3 and 4 |
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Term
| Disorders in which you see the Rutgers Jersey imaging sign |
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Definition
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Term
Management of LBP:
Note about rest
Two to reduce, and how
3 things to improve |
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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 |
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Term
Management of LBP:
One thing to manage
One to discourage
What to modify |
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Definition
Manage obesity/overweight
Discourage smoking
Modify work habits and environment |
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Term
3 kinds of meds to use for LBP
What you need before starting |
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Definition
Analgesics, muscle relaxatants, antidepressants (like SSRIs)
Current urine, blood, liver, kidney panel |
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Term
What PT in LBP should focus on
2 interventions that involve medicine
5 surgeries for LBP |
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Definition
Focus on flexibility, strengthening, and stretching
Epidural block/ steroids
Implantable pump
Laminectomy
Fusion
Instrumentation vs. noninstrumented
Discectomies
Kypho/vertebroplasty |
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Term
Population in which multiple myeloma found
How may present, with what deserves
One imaging method vs another |
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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 |
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Term
Note re: opiate use and back pain
Note re: corsets and back pain
Note re: exercise and LBP |
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Definition
Avoid
Avoid; can weaken ab muslces
Avoid extreme stretching |
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Term
| 2 ex of exercises that are OK to do with LBP |
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Definition
Pt laying on back; raises knees to chest
Extension exercise: lying prone, lifts up upper body as a bed with arms |
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Term
| 5 causes of lumbar surgery |
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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 |
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Term
What crescent sign looks like
What it indicates, process behind it, and how best shot |
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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 |
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Term
| Describe Thomas test for quad contracture |
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Definition
| Pt is supine. Flexes one leg to chest. If the leg/knee lifts from the floor, the hip flexors are rigid. |
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Term
Indications for total hip arthroplasty:
Pain note
Associated loss
Loss
Clearance required
How long does avg prosthesis last? |
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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 |
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Term
| What is heterotopic bone formation? |
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Definition
| Formation of bone outside of skeleton |
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Term
What often causes avascular necrosis
What quad contracture usually means |
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Definition
Steroids, ETOH
Time for a new hip |
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