What characteristics determine a quick recovery time for acute back from?(3)
- Lower than average initial pain
- shorter duration of symptoms
- Fewer previous episodes
What is the Brighton scale?
Beighton scale measure benign joint hyper mobility syndrome. A score of 4/9 or greater is considered hyper mobile
Beighton Scoring criteria?
1.Patient can bend and put hands flat on floor without bending knees.(1pt) 2.Knees can hyperextend past 0°(1pt ea) 3. Elbows can hyperextend past 0° (1pt ea) 4.Thumbs can be bent backwards to touch forearm (1pt was) 5. Little finger can be bent backwards beyond 90°(1pt ea)
Myotomes of the lower limb?(6)
- L1-L2 hip flexion
- L3 knee extension
- L4 ankle DF
- L5 toe extension
- S1 ankle PF & ankle EV, hip extension
- S2 hip extension
Reflexes of the lumbar spine?(5)
- Patella (L3-L4)
- Posterior Tibial (L4-L5)
- Medial hamstring(L5-S1)
- Lateral hamstring (S1-S2)
- Achilles(S1–S2)
What are the clinical features of herniated lumbar nucleus at L3 L4 disc, Fourth lumbar nerve root?
1.Pain- low back, hip, posterior lateral thigh, and Anterior tight. 2.Numbness-anterior medial thigh and knee 3.Weakness-quadricep and atrophy 4.Reflex-knee-jerk diminish
What are clinical features of herniated lumbar nucleus at L4 L5 disc/L5 nerve root?
1.Pain-over sacral joint, hip, lateral thigh, and leg 2.Numbness-lateral leg web of great toe 3.Weakness-DF of great toe,foot difficult walking on heels, and foot drop may occur 4.Reflex changes uncommon but may affect posterior tibial
What are clinical features of herniated lumbar nucleus for a massive midline protrusion?
1.Pain-lower back, thighs, legs and or perineum depending on level of lesion 2.Numbness-thighs, legs, feet, and or perineum depending on level of lesion 3.Weakness-variable paralysis or paresis upper legs and or Baller bladder incontinence 4.Reflexes-Achilles jerk diminished or absent
Pain pattern of L3-L4 disc/4th lumbar nerve root herniated disc?
Lower back, hip, posterior lateral thigh, anterior leg.
Pain pattern for L 4-L5 disc/5th lumbar nerve root for herniated disc?
Over Sacro iliac joint, hip, lateral thigh, and leg
Pain pattern for L5-S1disc/1st sacral nerve root for herniated disc
Over sacroiliac joint, hip, posterior/lateral thigh, and leg to heel.
What red flags may increase the likelihood of metastatic cancer?(4)
1.History for cancer 2.Night pain or pain at rest 3.unexplainable wt loss 4.Age>50y.o or <17y.o
What red flags may suggest the presence of a infection within the disk or vertebrae?(4)
1.Patient is immuno suppressed 2.A prolong fever with a temperature over 100° 3.History of IV drug use 4.History of a recent urinary track infection, cellulitis, or pneumonia
What red flag suggest an undiagnosed vertebral fracture?(6)
1.Prolonged use of corticosteroids 2.Mild trauma age greater than 50y.o 3.Age greater then 70y.o 4.A known history of osteoporosis 5.Recent major trauma at any age(MVA of fall greater then 5ft) 6.Bruising over the spine following trauma
What red flag may indicate a dangerous abdominal aortic aneurysm?(4)
1.A pulsating mass in the abdomen 2.A history of atherosclerotic vascular disease 3.A throbbing pulsing back pain at rest or with recumbency 4.Age >60y.o
What are yellow flag for lumbar spine and examples? (3)
Patient’s personal beliefs about pain and injury. Examples 1.High levels of emotional stress 2.Hyper vigilant (preoccupation with pain) 3.Pain catastrophizing (Over estimating the negative affects of pain)
What are blue flag for lumbar spine and examples? (3)
Related primarily to be good workers, patient perception of work and work conditions that may impair return to work. 1.Low job satisfaction 2.Personal conflict with employers and or fellow worker
What are black flag for lumbar spine and examples?(2)
1.Social or financial issues 2.Reimbursement incentives to remain disabled
What are two outcome assessments when treating back pain patients?
1.Rolling Morris disability questionnaire. Important clinical change 5 points out of 24. 2.Oswestry Disability Index. Important clinical change 10 points out of 100.
What is the clinical prediction rule for using lumbar manipulation? (5)
1.No symptoms distal to knee 2.Duration of symptoms less than 16 days 3.Score on fear avoidance believe questionnaire work subscale less than 19 4.At least one hypo mobile segment in lumbar spine 5.At least one hip with greater than 35° of internal rotation
What are the questions for The Clinical Instability Measure? (15)
- I feel like my back is going to “give way” or “give out” on me.
- I feel the need to frequently pop my back to reduce the pain.
- I have frequent times when my pain occurs throughout the day.
- I have a past history where my back catches or locks when I twist or bend my spine.
- I have pain when I sit to stand or stand to sit.
- I have a lot of pain when I sit up from lying down if I don’t rise up the right way.
- My pain is increased with quick, unexpected, or mild movements.
- I have difficulty sitting without a back support such as a chair and feel better with a supportive backrest.
- I cannot tolerate prolonged positions when I can’t move.
- It seems like my condition is getting worse over time.
- I have had this problem a long time.
- I sometimes get temporary relief with back brace or corset.
13, I have many occasions when I get muscle spasms.
- I sometimes am fearful to move because of my pain.
- I have had a back injury from trauma in the past.
Which lumbar segments support most of body and are therefore prone to suffering injuring? (2)
L4-L5 and L5-S1
- What positions increase pressure on facet joint?
- Decrese pressure on facet joint?
- Standing and extending backwards
- Sitting bending forward
What comfirms of refutes the presence of ISJ pain?
Fluoroscopically guided diagnostic injection
