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Lecture 4
Medical/Pathoanatomic Diagnoses Related to the Orthopedic Spinal Pathology
215
Medical
Graduate
10/08/2015

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Cards

Term
components of a neurological examination (3)
Definition
motor, sensory, reflex
Term
types of neurlogical reflexes assessed (3)
Definition
dtr, superficial, pathological (babinski, clonus, hoffman sign)
Term
these tissues when compressed produced a response: always (2)
Definition
skin, compressed nerve root
Term
these tissues when compressed produced a response: often (4)
Definition
outer annulus, vertebral end plate, dura, PLL
Term
these tissues when compressed produced a response: rare (4)
Definition
supraspinous ligaments, infraspinous ligaments, facet capsule, muscle attachment to bone
Term
these tissues when compressed produced a response: never (6)
Definition
ligamentum flavum, thoracolumbar fascia, facet synovium, facet cartilage, uninflamed nerve root/dura
Term
why does facet cartilage never cause pain?
Definition
made up of hyaline cartilage which is not innervated
Term
describe referred pain
Definition
pain percieved in the LE owing to involvement of the lumbopelvic tissue or viscera
Term
which pain is worse in referred pain? back or LE?
Definition
Back pain
Term
describe radicular pain
Definition
pain from involvement of the nerve root complex itself
Term
which pain is worse in radicular pain? back or LE?
Definition
LE
Term
mechanics of nerve root pathology: 3 step process simply
Definition
irritation, inflammation, functional changes
Term
mechanics of nerve root pathology: types of irritation (2)
Definition
mechanical, chemical
Term
mechanics of nerve root pathology: types of mechanical irritation(2)
Definition
compression, traction
Term
mechanics of nerve root pathology: types of chemical irritation
Definition
nucleus pulposus (thought to have chemotactic substances)
Term
mechanics of nerve root pathology: intraneural inflammation presentatoin (4)
Definition
ischemia, edema, fibrosis, demyelination
Term
mechanics of nerve root pathology: functional changes categories (2)
Definition
loss of nerve function, hyperexcitability
Term
mechanics of nerve root pathology: loss of nerve function would present how? (2)
Definition
muscle weakness, sensory deficit
Term
mechanics of nerve root pathology: hyperecitability would present how?
Definition
pain (ectopic impulse generation)
Term
Nerve root irritation presents as (5)
Definition
pain below knee, SLR produces leg pain, excessive pain radiation with gentle spinal motion, leg pain greater than back pain, leg pain is clearly demarcated region
Term
nerve root compression would present how (4)
Definition
reflex changes, muscle weakness, muscle atrophy, sensory loss over defined dermatome
Term
nerve root compression signs are also known as...
Definition
hard neural signs
Term
intervention for a pt with hard neural signs
Definition
consult to a neurosurgeon/orthopedic surgeon
Term
UMN vs LMN Lesions: increased DTRs
Definition
UMN
Term
UMN vs LMN Lesions: decreased DTRs
Definition
LMN
Term
UMN vs LMN Lesions: spasticity
Definition
UMN
Term
UMN vs LMN Lesions: flaccidity
Definition
LMN
Term
UMN vs LMN Lesions: (+) Babinski/clonus
Definition
UMN
Term
UMN vs LMN Lesions: (-) Babinski/Clonus
Definition
LMN
Term
UMN vs LMN Lesions: ataxia/incoordination
Definition
UMN
Term
UMN vs LMN Lesions: Dysthesias into both lowers or all foure extremities
Definition
UMN
Term
UMN vs LMN Lesions: non-dermatomal pattern
Definition
UMN
Term
UMN vs LMN Lesions: loss of bowel/bladder control (cauda equnia)
Definition
LMN
Term
UMN vs LMN Lesions: dermatomal/myotomal pattern
Definition
LMN
Term
most common spinal levels for discogenic pathology
Definition
L4-L5, L5-S1
Term
why are L4-S1 disc mosts likely to be the source for discogenic pathology
Definition
most load bearing, most mobility
Term
discogenic pathology of the lumbar spine occurs between what ages
Definition
20 and 60
Term
presence of radiculopathy is 95% sensitive for what?
Definition
disc herniation
Term
what actiosn may exacerbate symptoms of discogenic pathology?
Definition
coughing, sneezing, valsalva maneuver
Term
possible deformities involved in discogenic pathology (2)
Definition
lateral shift, kyphosis
Term
sensitivity vs specificity.
Definition
sensitivity = true positive rate. specificity = true negative rate
Term
discogenic pathology: positive neurodynamic mobility tesitng: ipsilateral SLR before what angle
Definition
before 60 degrees
Term
discogenic pathology: positive neurodynamic mobility tesitng: Ispilateral SLR before 60 degrees sensitivity/specificity
Definition
.80 sensitive/.40 specific
Term
discogenic pathology: positive neurodynamic mobility tesitng: crossed SLR sensitive/specific
Definition
.25 sensitivity/.9 specific
Term
discogenic pathology: positive neurodynamic mobility tesitng: 1st MTp extensor weakness sensitivity/specificity
Definition
.50 sens/.70 specificity
Term
discogenic pathology: positive neurodynamic mobility tesitng: ankle plantar flexor weakness
Definition
.06 sens/.95 specificity
Term
if there is weakness without pain think...
Definition
neurlogical
Term
lumbar disc pathology and resulting nerve root compression depends on what
Definition
level and the direction of the disc pathology.
Term
discogenic pathology: 50% had recovery in how many weeks
Definition
2 weeks
Term
discogenic pathology: 70% had recovery in how many weeks
Definition
7
Term
discogenic pathology: CT scanning has shown that what % of disc herniations may normalize or recover partially or completely with time?
Definition
66%
Term
discogenic pathology: interventions (5)
Definition
posture correction, specific exercise, stabilization, traction, surgery
Term
discogenic pathology: when is surgery indicated?
Definition
after 6 mos without progress or earlier if presence of hard neurlogical signs
Term
what is schmorl's node
Definition
end plate fracture with hernation of nucleus into adjacent vertebral body
Term
Schmorl's node is thought to be related to what?
Definition
compressive forces and associated with degeneration of the spine
Term
schmorl's node: symptomatic or asymptomatic
Definition
usually asymptomatic
Term
Degenerative Spinal Stenosis (DSS)/Neurogenic Claudication: What is it?
Definition
narrowing of spinal canal, nerve root canal (lateral recess), or intervertebral foramina
Term
Degenerative Spinal Stenosis (DSS)/Neurogenic Claudication: primarily associated with what population
Definition
elderly (>65 yrs)
Term
Degenerative Spinal Stenosis (DSS)/Neurogenic Claudication: causes (4)
Definition
facet hypertrophy, loss of IVD height, IVD bulging, spondylolisthesis
Term
claudication/pseudoclaudication is caused by what
Definition
nerve compression with compromise of arterial supply or venous return
Term
Degenerative Spinal Stenosis (DSS)/Neurogenic Claudication: degenerative changes could be a result of what?
Definition
buckling and ossification of the ligamentum flavum
Term
Degenerative Spinal Stenosis (DSS)/Neurogenic Claudication: s/s (4)
Definition
myelopathy, bilateral pain and paresthesias in back, buttock, thighs, calves, and feet, pain that is decreased with flexion and increased with extension. pain increase with walking and releived with prolonged rest
Term
how to test for neurogenic vs intermittent vascular claudicaiton on a bike
Definition
seated upright vs slouched tolerance to biking. increased tolerance in slouched position = neurogenic
Term
how to test for neurogenic vs intermittent vascular claudicaiton on a treadmill
Definition
ambulation on level surface vs incline. if ambulation tolerance increases with incline = neurogenic
Term
neurogenic vs vascular claudicaiton: bilateral pain
Definition
both
Term
neurogenic vs vascular claudicaiton: unilateral pain
Definition
may be neurogenic. neurogenic usually bilateral
Term
neurogenic vs vascular claudicaiton: no burning dysthesias
Definition
vascular
Term
neurogenic vs vascular claudicaiton: burning/dysthesia in back, buttock, legs
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: decreased pulses
Definition
vascular
Term
neurogenic vs vascular claudicaiton: normal pulses
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: skin changes in feet
Definition
vascular
Term
neurogenic vs vascular claudicaiton: normal skin nutrition
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: DTR's normal
Definition
vascular
Term
neurogenic vs vascular claudicaiton: DTR's decreased or absent
Definition
Neurogenic
Term
neurogenic vs vascular claudicaiton: appear in calf first
Definition
vascular
Term
neurogenic vs vascular claudicaiton: positive SLR/sciatica
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: appears in LB, buttock, and leg
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: pain present in all positions, increases by activity
Definition
vascular
Term
neurogenic vs vascular claudicaiton: increased pain with extension and walking
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: increased with up hill walking
Definition
vascular
Term
neurogenic vs vascular claudicaiton: decreased with uphill walking
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: relieved by standing still, sitting down, or rest 105 minutes
Definition
vascular
Term
neurogenic vs vascular claudicaiton: relieved by sitting, lying down, or flexion movements
Definition
neurogenic
Term
neurogenic vs vascular claudicaiton: 40-60+ years old
Definition
both
Term
neurogenic vs vascular claudicaiton: caused by athersclerosis of peripheral aa
Definition
vascular
Term
neurogenic vs vascular claudicaiton: d/t neoplasm, disc protrusion, osteophyte formation, ligamentous thicking (ligamnetum flavum)
Definition
neurogenic
Term
Stenosis Interventions: directional exercises
Definition
flexion
Term
Stenosis Interventions: posture modificaitons
Definition
posterior pelvic tilt
Term
Stenosis Interventions: stretching of what mm
Definition
hip flexors, rectus femoris, lumbar paraspinals
Term
Stenosis Interventions: lumbar stabilization focusing on what mm (2)
Definition
abdominals, gluts
Term
Stenosis Interventions: 2 dx categories
Definition
traction, hip mobilization
Term
Stenosis Interventions: if PT interventions fail what is next for the pt?
Definition
nerve root injection/epidural or surgical decompression/laminectomy
Term
Peripheral neuropathy: where would pain be present
Definition
pain and numbness in feet and hands stocking/glove pattern
Term
Peripheral neuropathy: types of changes that may be present
Definition
motor, sensory, autonomic changes
Term
Peripheral neuropathy: these palpabel sign may be decreased depending on the underlying cause
Definition
pulses
Term
Peripheral neuropathy: relieved by what
Definition
rest, medication, relaxation techniques
Term
Peripheral neuropathy: can be caused by what (9)
Definition
diabetes, meds, nerve compression, nutritional deficiency, RA, systemic lupus erythmatosis, AIDS, cancer, alcoholism
Term
Facet joint conditions: 2 types
Definition
degenerative joint disease, acute facet entrapment
Term
capsular pattern of the lumbar spine
Definition
sidebending, rotation, extension
Term
Facet joint conditions: degenerative joint disease is due to what
Definition
part of normal aging and d/t wt bearing properties of facets
Term
Facet joint conditions: degenerative joint disease can look like this (5)
Definition
bone hypertrophy, capsular fibrosis, hyper mobility, hypo mobility, proliferation of synovium
Term
Facet joint conditions: DJD symptoms (3)
Definition
reduce mobility (capsular pattern), pain, possible nerve root impingement
Term
Facet joint conditions: dx of DJD
Definition
pain, film imaging in an oblique view
Term
Facet joint conditions: DJD clinical examination
Definition
quadrant test, foraminal closure, movmeent restriction (A and P same directions) SSMT (+), hx
Term
Facet joint conditions: DJD can present as this condition as well
Definition
stenosis
Term
Facet joint conditions: djd mgmt (4)
Definition
meds, manipulaiton, stabilizaiton, address mm imbalances
Term
Facet joint conditions: djd mgmt meds (4)
Definition
NSAIDS, muscle relaxants, trigger point injections, oral or injeciton of steriods
Term
Facet joint conditions: DJD manipulations
Definition
non thrust and thrust manipulations
Term
why can unilateral damage hurt bilaterally?
Definition
inflammatory process
Term
Facet joint conditions: facet entrapment (acute locked back) is caused by what?
Definition
entrapment of fatty meniscoid in moving from flexion to extension
Term
Facet joint conditions: facet entrapment, which motion feels more comfortable?
Definition
flexion
Term
Facet joint conditions: facet entrapment: which motino feels painful
Definition
extension
Term
Facet joint conditions: clinical exam of facet entrapment (3)
Definition
lumbar quadrant test, movement restrictions, hx
Term
Facet joint conditions: facet entrapment mgmt
Definition
meds, thrust and non thrust manipulation
Term
slippage of on vertebral body and remainded of spinal column on segment below
Definition
spondylolisthesis
Term
defect/fracture of the pars "scotty dog deformity"
Definition
spondylolysis
Term
most common site for spondylolisthesis
Definition
L5 on S1 (isthmic type)
Term
why is an L5/S1 spondylolistehsis the most commmon site?
Definition
greatest shear forces
Term
most rapid slippage of a spondylolisthesis occurs between what ages
Definition
10 and 15 years of age
Term
gender more at risk for a spondylolisthesis
Definition
girls twice as common as boys
Term
how is a spondylolistehsis dx?
Definition
lateral, olbique, or flexion extension plain films
Term
what would a spondylolistehsis feel like palpation wise
Definition
step off deformity at segment above defect
Term
which direction specific exercises will releive sypmtoms of spondylolisthesis
Definition
flexion
Term
Nose of scotty dog
Definition
transverse process
Term
front leg of scotty dog
Definition
inferior facet joint surface
Term
neck of scotty dog
Definition
pars articularis
Term
back leg of scotty dog
Definition
superior facet joint surface/spinous process
Term
spondylolisthesis PT interventions (5)
Definition
stabilizatoin training, flexion exercises, bracing, stretching of RF and IlioP, traction
Term
if PT interventions fail for spondylolisthesis what is next for the pt?
Definition
surgical stabilization, fusion may be indcated
Term
5 types of spondylolisthesis
Definition
congenital, isthmic, dgenerative, traumatic, pathological
Term
Spondylolisthesis: congenital
Definition
result of dysplasia of 5th lumbar and sacral arches
Term
Spondylolisthesis: isthmic
Definition
d/t a defect (acute fracture,stress fracture, elongation in the pars interarticularis)
Term
Spondylolisthesis: degenerative
Definition
affects older individuals most common at l4-L5
Term
Spondylolisthesis: pathological d/t
Definition
disease process weakening the pars (tumor)
Term
Rheumatoid disease (6)
Definition
systemic lupus, ankylosing spondylitis, gout, psoriatic arthritis, RA, fibromylagia
Term
Rheumatoid Diseases: types of anylosing spondylitis (3)
Definition
marie-stumpell, bechterew, rheumatoid spondylitis
Term
Rheumatoid Diseases: fibromyalgia (2)
Definition
myalgia, myositis)
Term
slide 41
Definition
Term
systemic lupus erythematosis: what type of disease
Definition
rheumatoid, progressive inflammatory disease
Term
systemic lupus erythematosis: organ involvement
Definition
single or multiple organ involvement common
Term
systemic lupus erythematosis: causes
Definition
genetic, hormonal, environmental
Term
systemic lupus erythematosis: trademark sign
Definition
butterfly rash over nose and cheeks
Term
systemic lupus erythematosis: medical tx (3)
Definition
steroids, immunosuppresive agents, salicylates
Term
systemic lupus erythematosis: PT focuses on what (2)
Definition
strengthening and soft tissue dysfunction
Term
Ankylosing Spondylitis: type of disease
Definition
rheumatoid, progressive inflammatory disease
Term
Ankylosing Spondylitis: affects what part of the skeleton first?
Definition
axial skeleton
Term
Ankylosing Spondylitis: initial complaints would be what (3)
Definition
mid/low back pain and AM stiffness and sacroilitis
Term
Ankylosing Spondylitis: spinal curvatures affected
Definition
TV kyphosis, decreased lumbar ROM
Term
Ankylosing Spondylitis: may affect which articulations
Definition
rib
Term
Ankylosing Spondylitis: which gender is mroe affected
Definition
men 3x more than woman
Term
Ankylosing Spondylitis: onset typically between what ages
Definition
15 and 40 years of age
Term
Ankylosing Spondylitis: meds
Definition
anti-inflammatory med management
Term
Ankylosing Spondylitis: PT intervention
Definition
increase back and rib motion, psoture correction
Term
Ankylosing Spondylitis: 1/5 questions to ask for dx
Definition
is there morning stiffness
Term
Ankylosing Spondylitis: 2/5 questions to ask for dx
Definition
there improvement in discomfort with exercise
Term
Ankylosing Spondylitis: question 3/5 to ask for dx
Definition
was the onset of back pain before the age of 40 years
Term
Ankylosing Spondylitis: question 4/5 to ask for dx
Definition
did the problem begin slowly?
Term
Ankylosing Spondylitis: question 5/5 to ask for dx
Definition
has the pain persisted for at least 3 months?
Term
ankylosing spondylitis: 5 questoins asked for dx, how many positive answers needed?
Definition
4/5
Term
ankylosing spondylitis: 5 questoins asked for dx, 4/5 postive answers. what is the sensitivity/specificity?
Definition
.95 sensitive/.85 specific
Term
Gout is what kind of disorder?
Definition
genetic
Term
describe gout
Definition
elevated serum uric acid with crystals and deposits into jts and systemic tissues
Term
gout tends to affect what joints?
Definition
knee and hallux
Term
medical mgmt of gout
Definition
nsaids
Term
PT intervention for gout
Definition
maintain jt function and pt education
Term
chronic inflammatory disorder associated with psoriasis
Definition
psoriatic arthritis
Term
psoriatic arthritis jt degeneration usually occurs in what?
Definition
fingers and axial skeleton
Term
psoriatic arthritis affects which population?
Definition
men and women equally
Term
psoriatic arthritis medical mgmt
Definition
gold compunds, nsaids, antimalarials
Term
psoriatic arthritis PT mgmt (3)
Definition
protect jt, maintain ROM, pt education
Term
Rheumatoid arthritis: pattern of dysfunction
Definition
symmetric
Term
Rheumatoid arthritis: affects which jts? (6)
Definition
knees, ankles, feet, hands, wrists, elbows
Term
Rheumatoid arthritis: MCP/PIP invovlement common with formation of what?
Definition
pannus
Term
Rheumatoid arthritis: MCP/PIP involvement common with what observation?
Definition
ulnar drift
Term
Rheumatoid arthritis: population more likely to be affected
Definition
women 3x more likely than men
Term
Rheumatoid arthritis: what must occur for ulnar drift and swan neck to occur in the fingers
Definition
destruction of the ligaments allows for tendons to pull into an ulnar direction
Term
Rheumatoid arthritis: diagnostic guidelines, how many s/s must be present? and how long?
Definition
4 must be present, with all 4 present a minimum of 6 weeks
Term
Rheumatoid arthritis: diagnostic guidelines for RA (6)
Definition
morning stiffness 1+hours, arthritis of 3 or more of the following jts (R/L PIP, MCP, wrist, elbow, knee, ankle, and MTP jts), arthritis of wrist, MCP or PIP jt, symmetric involvement of jts, rheumatoid nodules over bony prominences, or extensors surfaces, or in juxtaarticular regions, postive serum rheumatoid factor, radiographic changes including erosoinos or bony calcification localized in or adjacent to involved jts
Term
Rheumatoid arthritis: juvenile type is present prior to what age
Definition
16
Term
Rheumatoid arthritis: how many juvenile RA pt's go into complete remission?
Definition
75%
Term
Rheumatoid arthritis: how many adults ahve rheumatoid factor present?
Definition
60-80%
Term
Rheumatoid arthritis: medical mgmt of RA
Definition
nsaids
Term
Rheumatoid arthritis: PT role
Definition
prevent deformities and maintain jt function
Term
Fibromyalgia: how is the differential dx from myofascial pain performed?
Definition
myofasical pain only affects one or 2 muscles
Term
Fibromyalgia: has a high association with what syndrome?
Definition
chronic fatigue
Term
Fibromyalgia: PT role
Definition
patient education and progressive exercise program
Term
ACR dx guidelines for fibromyalgia: 1
Definition
hx of widespread pain has been present for at least 3 months
Term
ACR dx guidelines for fibromyalgia: Pain is considered widspread when all of the following are present (3)
Definition
pain in both sides of the body, pain above and below the waist in addition, axial skeleton pain, low back pain is considered low segement pain
Term
ACR dx guidelines for fibromyalgia: 2) pain based on what digital palpation
Definition
11 of 18 tender point sites on digital palpation
Term
tightness/spasm of this muscle produces compression of the sciatic nerve
Definition
piriformis syndrome
Term
Piriformis Syndrome: symptoms include (5)
Definition
limited IR, tenderness of piriformis, pain, referral to thigh, weak external rotation, positive piriformis test
Term
Piriformis Syndrome: PT role
Definition
stretching modalities, pt education
Term
disease may be related to a viral infection
Definition
paget's disease
Term
metabolic bone disease with abnormal osteoclastic and osteoblastic activity
Definition
paget's disease
Term
Paget's disease: may result in (3)
Definition
spinal stenosis, facet hypertrophy, spinal fracture
Term
Paget's disease: med mgmt
Definition
drug therapy
Term
Paget's disease: PT role
Definition
postural training
Term
Types of bone tumors
Definition
primary, metastatic
Term
Primary types of bone tumors (6)
Definition
multiple myeloma, Ewing's sarcoma, malignant lymphoma, chondrosarcoma, osteosarcoma, chondromas
Term
metastatic types of bone tumors
Definition
lung, prostate, breast, kidney, thyroid
Term
Which type of bone tumor is highly unusual
Definition
primary types
Term
S/S of bone tumors (6)
Definition
unrelenting and progressive pain, night pain, unresponsive to intervention, rest, or analgesics, weight loss
Term
Spinal Infection/Osteomyelitis most often affects what?
Definition
vertebral body
Term
Spinal infection/Osteomyelitis: origins of infection may include (4)
Definition
other bones, skin lesions, respiratory infections, UTI's
Term
Spinal infection/Osteomyeltis: a history of what with an acute episode of low back pain should raise suspicisions?
Definition
Urinary infections
Term
Spinal infection/Osteomyeltis: what are risk factors for infection?
Definition
open wounds or post-op
Term
Spinal infection/Osteomyeltis: how could the pain be described?
Definition
deep centralized pain
Term
metabolic bone disease with depleted bone mineral density/mass sometime associated with fractures
Definition
osteoporosis
Term
Osteoporosis: which population is more likely to be affected
Definition
women 10x more than men
Term
Osteoporosis: fracture sites include (7)
Definition
thoracic spine, lumbar spine, femoral neck, proximal humerus, proximal tibia, pelvis, distal radius
Term
Osteoporosis: primary type
Definition
postmenopausal related to decrease in estrogen levels
Term
Osteoporosis: senile type
Definition
related to decreased bone cells activity d/t genetics or other abnormalities
Term
Osteoporosis: PT role (5)
Definition
postural reeducation, breathing ex, conditioning, stretching, abdominal strengthening
Term
mgmt of a compression fracture (4)
Definition
rest, posture correction, medications, bracing if unresponsive to rest
Term
surgical tx of compression fracture
Definition
vertebroplasty/kyphpoplasty
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