Term
| define lumbar spinal stenosis |
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Definition
| narrowing of spinal canal caused by degeneration of bony and soft tissues |
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Term
| what are the 2 ways of classifying lumbar spinal stenosis |
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Definition
|
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Term
| what are the 2 types of lumbar spinal stenosis |
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Definition
|
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Term
| what are the 3 locations of lumbar spinal stenosis |
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Definition
| central, lateral, foraminal |
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Term
| what are 4 things that cause lumbar spinal stenosis |
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Definition
| degenerative disc disease, disc protrusion, facet hypertrophy, ligamentum flavum thickening |
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Term
| if you have DDD causing lumbar spinal stenosis, will flexion or extension feel better |
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Definition
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Term
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Definition
|
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Term
| what causes facet hypertrophy |
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Definition
| ossification from wear and tear. Body responds to use and repeated aggravation with bone suprs and calcium deposits |
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Term
| who is likely to have a thickened ligamentum flavum |
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Definition
| someone who has a high flexion job or uses bad body mechanics |
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Term
| what does the ligamentum flavum do |
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Definition
| helps body pull back up after flexion |
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Term
| what happens if you use your ligamentum flavum a lot |
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Definition
| it will thicken and take up space in the spinal canal |
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Term
| what is the general age of patients with lumbar spinal stenosis (old or young) and why |
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Definition
| old; nucleus pulposus is gooier when you're younger |
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Term
| what is the common presentation of patients with lumbar spinal stenosis |
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Definition
| severe lower extremity pain; relief with sitting/flexion |
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Term
| what is neurogenic intermittent claudication |
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Definition
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Term
| when is pain worse with lumbar spinal stenosis |
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Definition
| with standing, walking, and lumbar extension activities. |
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Term
| could you feel leg pain/numbness/tingling with neurogenic intermittent claudication |
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Definition
|
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Term
| is the central canal area increased or decreased with flexion |
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Definition
|
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Term
| is the central canal area increased or decreased with extension |
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Definition
|
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Term
| is the foramen increased or decreased by flexion |
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Definition
|
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Term
| is the foramen increased or decreased by extension |
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Definition
|
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Term
| what are clinical observations of a patient with lumbar spinal stenosis |
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Definition
| poor posture, wide base gait, neuromuscular deficits, dull ache |
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|
Term
| what poor posture characteristics are observed in patients with lumbar spinal stenosis |
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Definition
| forward head, delordosed spine, posterior pelvic tilt |
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Term
| what neuromuscular deficits might be exhibited by a patient with lumbar spinal stenosis and why |
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Definition
| if they have pressure on a nerve, they could have weakness or sensory changes |
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Term
| could a patient with lumbar spinal stenosis feel relief when walking with a grocery cart |
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Definition
|
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Term
| what is the result of delordosed, forward head, posterior pelvic tilt posture with lumbar spinal stenosis |
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Definition
| causes balance issues posteriorly; fall back on their heels; reason for wide based gait |
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Term
| what are differential diagnoses for lumbar spinal stenosis |
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Definition
| hip OA, trochanteric bursitis, vascular disease, herniated disc, osteoporotic compression fracture |
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|
Term
| what are symptoms of vascular disease |
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Definition
| leg pain that is worse with walking. Not affected by posture |
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Term
| If someone has vascular disease, will they get relief by walkign with the grocery cart |
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Definition
|
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Term
| why does it hurt your legs to grocery shop with no relief from grocery cart if you have vascular diseae |
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Definition
| when you walk and have to stop and stand, you've increased demand for blood in your legs but it's harder for blood to get through |
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|
Term
| what is the general clinical picture of a patient with lumbar spinal stenosis |
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Definition
| neurogenic intermittent claudication; poor posture; muscular weakness; impared balance/gait |
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Term
| what is the common age range for intervertebral disc lesions |
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Definition
|
|
Term
| what are the 4 typs of intervertebral disc lesions |
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Definition
| herniated nucleus (protrusion), prolapsed nucleus, extruded disc, sequestration of nuclear material |
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|
Term
| what is a herniated nucleus |
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Definition
| protrusion: tear in the inner layers of the posterior annulus fibrosus allowing nucleus pulposus to bulge into the annulus a bit while not pushing all the way through |
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Term
| what does a herniated nucleus apply pressure to, and what is the result |
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Definition
| posterior longitudinal ligament or outer annular fibers, resulting in pain |
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|
Term
| what is a prolapsed nucleus |
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Definition
| outer annulus and ligamentous fibers are the only thing that restrain the nucleus from entering into the neural canal |
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|
Term
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Definition
| disc material pushes out all the way through the annular fibers and through the posterior longitudinal ligament, perforating them |
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|
Term
| what is sequestration of nuclear material |
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Definition
| nuclear material in little pieces in the neural canal |
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Term
| of the 4 types of iv disc lesions, what is the progression from least entry of pulposus into the canal to most entry of pulposus into the canal |
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Definition
| herniated nucleus, prolapsed nucleus, extruded disc, sequestration of nuclear material |
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|
Term
| in which 2 types of iv disc lesions is there no entry of nucleus itself (without something around it) into the canal |
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Definition
| herniated nucleus, prolapsed nucleus |
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|
Term
| in which 2 types of iv disc lesions is the annulus perforated |
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Definition
|
|
Term
| what are each of the 4 types of iv disc lesions often referred to as |
|
Definition
|
|
Term
| what is the most common type of iv disc lesion |
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Definition
|
|
Term
| at what spinal levels are most disc prolapses |
|
Definition
| 98% of disc prolapses are at L4-5 and L5-S1 |
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|
Term
| are men or women more likely to have iv disc lesions and by how much |
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Definition
|
|
Term
| what are risk factors for iv disc lesions |
|
Definition
| high physical demand with low strength, repeated lifting of heavy objects, lifting with lateral bend and twisting, poor sitting posture, smoking, coughing, spend more than half of work day in car |
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|
Term
| why is smoking a risk factor for iv disc lesion |
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Definition
| negative impact on circulation affects the disc |
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Term
| what are aggs for iv disc lesions |
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Definition
| forward trunk flexion, cough/sneeze, laughing, small jumps, lift heavy weight, valsalva |
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|
Term
| what are eases for iv disc lesinos |
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Definition
| extension (standing or prone), lie down with feet up |
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|
Term
| if you have a posterolateral or central iv disc lesion, what does it affect |
|
Definition
|
|
Term
| when will you have bilateral symptoms with iv disc lesion |
|
Definition
| when the protrusion is central |
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|
Term
| if you have an iv disc lesion and you extend, what happens |
|
Definition
| we squeeze the material back in |
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|
Term
| if you have an iv disc lesion and you flex, what happens |
|
Definition
| the disc protrudes and causes symptoms |
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|
Term
| if you have a large lesion, will it hurt in extension or flexion |
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Definition
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Term
| if you have a central/medial herniation in the axilla/armpit of the nerve root (below where it comes off the spinal cord), and the patient flexes cervical/thoracic/lumbar, what will happen, and how will symptoms change |
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Definition
| this puts tension on the cord/nerves, pulling them up towards the head and away from the protrusion. Makes the patient feel better because it pulls the neural structures off th herniation |
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Term
| if you have a central/medial herniation in the axilla/armpit of the root (below where it comes off), and the patient straightens her leg out and pulls the foot, what happens |
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Definition
| this puts tension on the cord/nerves, pulling them down towards the feet and into the protrusion. This causes pain because it pulls the neural structures into the herniation |
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Term
| if you have a central/medial herniation in the axilla/armpit of the root (below where it comes off), and the patient lifts her head at the end of the slump test (after it was initially flexed), will she feel better or worse and why |
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Definition
| worse because she is now bringing tension back caudally on the cord/nerves, pulling them down twards the feet and into the protrusion |
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Term
| if a patient has a more lateral herniation and we flex their head, does it get better or worse and why |
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Definition
| worse. The herniation is now above the protrusion, so when the patient flexes and pulls the neural structures toward the head, they hit the protrusion, causing pain |
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Term
| if a patient has a more lateral herniation and we lift her head and the end of the slump test (from flexion to normal), does it get better or worse and why |
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Definition
| gets better because it slackens neural structures, allowing them to move below the protrusion and they feel better |
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|
Term
| if you have a reduction in symptoms when you lift your head at the end of the slump test, is the herniation more lateral or more medial |
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Definition
|
|
Term
| if you have an increase in pain when you left your head at the end of the slump test (lift it out of flexion), is the lesion more medial or more lateral |
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Definition
|
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Term
| can the affected side hurt in SLR when the opposite leg is raised and why |
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Definition
| if you have a left herniation and you raise your R leg, raising the R leg will pull the L structures medially and into a medial herniation |
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|
Term
| what is another term for mechanical low back pain |
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Definition
|
|
Term
| what 3 things cause mechanical low back pain/lumbago |
|
Definition
| muscle strain, facet joint, sacroiliac joints |
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|
Term
| what are characteristics of mechanical low back pain |
|
Definition
| morning stiffness, pain to low back/butt/thigh but not below knees, pain is cyclic |
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|
Term
| what are aggs for mechanical low back pain |
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Definition
| turnk motion (flex/ext/SB/rot); stiff or painful when motion is initiated |
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|
Term
| what are eases for mechanical low back pain |
|
Definition
| change positions. Lying down - usually better in fetal position |
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|
Term
| if you push on it/stretch them/move them and it causes back pain, what is probably the problem |
|
Definition
|
|
Term
| why is morning stiffness common in mechanical low back pain |
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Definition
|
|
Term
| how to determine treatment for mechanical low back pain |
|
Definition
| depends on cause: hypomobile, muscle strain, or SIJ |
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|
Term
| how to treat if mechanical LBP is caused by hypomobility |
|
Definition
| joint mobilization, stretching, posture, strengthening, core stabilization |
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|
Term
| how to treat if mechanical LBP is caused by muscle strain |
|
Definition
| reduce inflammation; restore mobility; posture; strengthen core; PPIVMs- move them while flexing/extending |
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|
Term
| how to treat if mechanical LBP is caused by SIJ |
|
Definition
| address asymmetry and muscle imbalance if present. Joint mobilization/stretching. Posture. Strengthen core |
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|
Term
|
Definition
| fracture of vertebrae at pars interarticularis |
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|
Term
| what is spondylolisthesis |
|
Definition
|
|
Term
|
Definition
| slipping of veterbal body anteriorly |
|
|
Term
| what are the 2 cuases of spondylolisthesis |
|
Definition
|
|
Term
| what is the most common cause of spondylolisthesis |
|
Definition
|
|
Term
| what is the most common region of degenerative spondylolisthesis |
|
Definition
|
|
Term
| what are symptoms of spondylolisthesis |
|
Definition
| LBP, muscle tightness (tight hamstrings), pain in thighs and butt, stiffness, tenderness in the area of the slipped disc, may cause paraesthesia and/or motor weakness |
|
|
Term
| how to assess for spondylolisthesi |
|
Definition
|
|
Term
| describe the stork standing test |
|
Definition
| patient stands on one leg and extends spine. Then patient stands on opposite leg and extends spine. |
|
|
Term
| what is a positive stork test |
|
Definition
| pain in the back when standing on the ipsilateral leg (that has the fracture). If I've fractured the pars interarticularis on just one side, it wont separate but will be painful when I load that side and extend. Positive = reproduction of symptoms on one side but not the other |
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|
Term
| how to treat spondylolisthesis |
|
Definition
| avoid hyper extension, strengthen, core stabilization |
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|
Term
| what is the difference between spondylolysis and spondylolisthesis |
|
Definition
| both are fractures of pars interarticularis. In spondylolisthesis, the vertebra has shifted forward due to instability from the pars defect |
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