Term
| Serious conditions to screen for in LBP |
|
Definition
infection
neoplasm
vascular
inflammatory disease (seronegative spondyloarthropathy)
cauda equina compression
fx |
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Term
| Non-spinal symptom sources in LBP |
|
Definition
hip
peripheral nn compression
abdominal screen |
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Term
| Infections of lumbar spine |
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Definition
pyogenic vertebral osteomyelitis
tuberculous vertebral osteomyelitis |
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Term
| Pyogenic Vertebral Osteomyelitis: pathogenesis |
|
Definition
attacks disc 1st, spreads
disc narrowing |
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Term
| Pyogenic Vertebral Osteomyelitis: dx tools |
|
Definition
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Term
| Tuberculous Vertebral Osteomyelitis: pathogenesis |
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Definition
| attacks vertebral body (not disc) |
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Term
| Tuberculous Vertebral Osteomyelitis: constitutional symptoms |
|
Definition
intermittent fever
swetas
anorexia
wt loss
fatigue |
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Term
|
Definition
| benign, blood-filled lesion of cortical bone |
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Term
| Osteoid osteoma: population |
|
Definition
young (15-25 yo)
M>F (2:1) |
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Term
|
Definition
| gradual progressive backache |
|
|
Term
|
Definition
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|
Term
|
Definition
benign, painful, vascular tumor in bone
marked by formation of osteoid tissue & primitive bone
large >> neuro signs |
|
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Term
| Osteoblastoma: population & site |
|
Definition
80% in younger pts (<30yo)
M>F
40% in spine |
|
|
Term
|
Definition
|
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Term
| Primary Malignant Tumors: population |
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Definition
|
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Term
| Chordoma: S/Sx, progression |
|
Definition
slow growing
bladder/bowel ∆s
pain not relieved by rest |
|
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Term
|
Definition
consitutional symptoms (weakness, backache)
sudden pain (pathological fx)
lytic lesions visible on XRay |
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Term
| MOST COMMON 1º tumor of spine |
|
Definition
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|
Term
|
Definition
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Term
| Most common site of skeletal metastases |
|
Definition
| spine (esp lumbar vertebrae) |
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Term
|
Definition
2º tumors from breast, prostate, lung
form new primitive bone >> space-occupying lesions |
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|
Term
|
Definition
2º tumors from hypernephroma, thyroid, large bowel
dissolve bone >> calcium loss |
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Term
| 2º malignant tumors: neuro signs, Px |
|
Definition
25% have neuro signs
long hx of neuro/sphincter involvement >> poor Px |
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|
Term
| Vascular conditions of lumbar spine |
|
Definition
|
|
Term
|
Definition
pulsating feeling in abdomen
abdominal/thoracolumbar pain
rupture >> severe pain c nausea, light headedness, hypotension (<100 mmHg), tachycardia (>100bpm) |
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|
Term
|
Definition
|
|
Term
| AAA: indication for surgery |
|
Definition
|
|
Term
|
Definition
| cramping pain in LE comes on c walking; relieved c LE in dependent position |
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|
Term
| Seronegative Spondyloarthropathies |
|
Definition
ankylosing spondylitis
psoriatic arthritis
reactive arthritis (Reiter's)
juvenile ankylosing spondylitis
arthropathies that complicate IBD (regional enteritis, ulcerative colitis) |
|
|
Term
| Common features of spondyloarthropathies |
|
Definition
predilection for inflammatory lesions of axial skeleton
oligoarticular peripheral jt arthritis
enthesitis/enthesopathy
frequent extra-art inflammation (uveitis, aortitis)
affects mainly young Males
strong assoc c HLA-B27
(-) rheumatoid factor |
|
|
Term
| Ankylosing Spondylitis: population |
|
Definition
M>F (M more severe)
20-35yo (rare p 40yo)
affects 1-2% population |
|
|
Term
| Ankylosing Spondylitis: pathology |
|
Definition
affects synovial AND fibrous jts via chronic synovitis >> cartilage destruction >> erosion/sclerosis of subchondral bone
fusion of C spine >> sublux @ C1-2 |
|
|
Term
| Ankylosing Spondylitis: clinical features |
|
Definition
predominant AM stiffness
insidious onset of LBP c exacerbations & remissions
presents like HNP or SI strain
earlier onset assoc c peripheral jt involvement & greater severity
often symmetrical |
|
|
Term
| Ankylosing Spondylitis: physical findings |
|
Definition
limitation in ALL planes
loss of chest expansion (<2cm @ 4th intercostal space)
(+) SI testing (Gaenslens, SL compression)
tenderness over bony prominences (e.g. gr troch, sp pr)
kyphotic T spine (>> decr pulmonary fxn) |
|
|
Term
| Ankylosing Spondylitis: less common findings |
|
Definition
fatigue, wt loss
chest pain (2º to costosternal involvement)
uveitis
extra-articular tenderness (enthesopathy) |
|
|
Term
| Ankylosing Spondylitis: lab tests |
|
Definition
(-) for rheumatoid factor
90% (+) for HLA-B27 |
|
|
Term
| Ankylosing Spondylitis: radiographs |
|
Definition
early SI jt blurring
erosion @ corners of vertebral bodies
(-) XRay: use bone scan/CT OR repeat films in 6mos |
|
|
Term
| Ankylosing Spondylitis: medical Rx |
|
Definition
|
|
Term
| Ankylosing Spondylitis: Px |
|
Definition
severity of symptoms in 1st decade predicts long term disability
severe disease = peripheral jt/extra-articular manifestations
complications: osteoporotic fx, AA sublux, spinal stenosis |
|
|
Term
| Ankylosing Spondylitis: PT Eval |
|
Definition
Respiratory (chest expansion, FVC, FEV1)
Posture
Trunk flexibility
Extremity flexibility (hip flexors, ankle, ITB, HSs, shoulder)
BP
BMI |
|
|
Term
| Ankylosing Spondylitis: PT Intervention |
|
Definition
aerobic ex (ø wt gain)
smoking cessation
ext ex (decr thoracic kyphosis)
diaphragmatic breathing
posture correction
abdominal strengthening (for posture; ø sit-ups)
flexibility of extremities
ø ex during exacerbations |
|
|
Term
| Psoriatic Arthritis: defn, S/Sx |
|
Definition
inflammatory jt disease
characterized by periarticular bone erosions
slow progressing
± extra-articular involvement (conjuntivitis, uveitis, iritis, mitral valve...) |
|
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Term
| Reiter's Disease: pathogenesis |
|
Definition
reactive arthritis; infective agent not isolated from jt
original infection from UG system |
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Term
| Cauda Equina Compression (central stenosis) |
|
Definition
multiple levels affected (incl S3-4)
urinary retention: sn90%, sp95%
EMERGENCY; treated c sx |
|
|
Term
| Lumbar spine Fx: spinal instability when... |
|
Definition
| instability when ≥2 columns damaged |
|
|
Term
|
Definition
compression
burst
flexion-distraction
fracture-dislocation
posterior arch |
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|
Term
| Compression fx: mechanism of injury |
|
Definition
axial loading; usually affects ant column
end-plate trauma involved |
|
|
Term
|
Definition
sudden axial loading >> endplate fx;
disc displacement >> v body fx
failure of ant/mid columns
retropulsion of bone fragments into canal |
|
|
Term
| Flexion-Distraction fx: mech of injury |
|
Definition
flex around axis ant to ALL (lap belt)
usually horizontal lesion through disc/endplate/lamina |
|
|
Term
| Posterior Arch fx: mech of injury |
|
Definition
ext injury = rare (needs to be very severe)
transverse pr injured by blunt trauma
(L5 tr-pr fx assoc c pelvic fx) |
|
|
Term
|
Definition
assess cauda equina integrity
Rx depends on stability level |
|
|
Term
| Eval & Rx: STABLE lumbar fx |
|
Definition
| wraparound, non-rigid corset |
|
|
Term
| Eval & Rx: MIN-MOD stability lumbar fx |
|
Definition
TLSO;
include hip if L5 involved |
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|
Term
| Eval & Rx: MOD-SEVERE instability lumbar fx |
|
Definition
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|
Term
| Causes of hip jt referral to LBP (6) |
|
Definition
hip flexor dysfxn
iliopectineal bursitis
OA
trochanteric bursitis
stress fx
labral tears |
|
|
Term
|
Definition
ant hip pain
insidious onset
assoc c overuse |
|
|
Term
|
Definition
inflammation of bursa btwn
pubofemoral & iliofemoral ligt |
|
|
Term
| OA of hip (onset, pain, positive tests) |
|
Definition
insidious onset
groin pain, radiating to knee
(+) FABER
decr hip ext & rot
(+) sign of buttock |
|
|
Term
| Trochanteric bursitis: look-for |
|
Definition
|
|
Term
|
Definition
| affect sacrum, neck of femur |
|
|
Term
| Femoral neck stress fx: S/Sx |
|
Definition
groin pain
often runner/female |
|
|
Term
|
Definition
less common
runners
point tenderness
pain over sacrum, buttock
pain in ALL directions; pain @ night |
|
|
Term
| Hip stress fx: Sensitive test |
|
Definition
|
|
Term
|
Definition
groin pain
c/o catching
(+) FADIR
(+) MRA (magnetic resonance arthrogram) |
|
|
Term
| Peripheral nn compressions >> LBP |
|
Definition
piriformis syndrome
obturator n |
|
|
Term
| Piriformis Syndrome: S/Sx |
|
Definition
buttock/post thigh pain exacerbated by activity
± neuro signs (ø single myo-/dermatome)
tender piriformis on palpation |
|
|
Term
|
Definition
correct SI jt asymm
myofascial release
stretching |
|
|
Term
| Obturator n entrapment: S/Sx |
|
Definition
pain radiating down medial thigh; small area of numbness
caused 2º to tumor, child birth |
|
|
Term
| Obturator n entrapment: Rx |
|
Definition
|
|
Term
| Lateral Femoral Cutaneous nerve compression: AKA... |
|
Definition
|
|
Term
| Lat femoral cutaneous n compression: S/Sx |
|
Definition
burning pain on outside of thigh
pain c AROM/PROM hip ext
tender medial to iliac crest (near inguinal ligt) |
|
|
Term
| Lat femoral cutaneous n compression: Rx |
|
Definition
active rest
myofascial release (inguinal ligt)
modalities |
|
|
Term
| Pyogenic Vertebral Osteomyelitis: S/Sx |
|
Definition
result of staph infection of GU system
indistinguishable from mechanical pain early in course
pt appears sick; ± temp elevation |
|
|
Term
| Tuberculous Vertebral Osteomyelitis: S/Sx |
|
Definition
constitutional symptoms
assoc c neuro lesions >> paraplegia |
|
|
Term
| Tuberculous Vertebral Osteomyelitis: Site |
|
Definition
| common in upper lumbar/lower thoracic |
|
|
Term
| Primary Malignant Tumors: neuro signs |
|
Definition
|
|
Term
| Primary Malignant Tumors: dx detection |
|
Definition
MRI to detect
30% bone loss before detection on imaging |
|
|
Term
|
Definition
|
|
Term
| Ankylosing Spondylitis: risk factors |
|
Definition
HLA-B27 = predisposition
familial link (20% have 1st degree relative) |
|
|
Term
| Ankylosing Spondylitis: sites affected |
|
Definition
SI affected 100%
C spine affected 75%
L spine affected 50%
hips/shoulders affected 30%
heels affected 30% |
|
|
Term
| Psoriatic Arthritis: risk factors |
|
Definition
affects 5-10% psoriatic pts
familial link |
|
|
Term
| Psoriatic Arthritis: site |
|
Definition
|
|
Term
| Reiter's Disease: population |
|
Definition
|
|
Term
| Reiter's Disease: sites affected |
|
Definition
common in knees/ankles (asymm), unilat SI
SI involved 50% of time |
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|
