Lumbar2

Question 1

What are clusters of signs and symptoms of Ankylosing Spondylitis?(5)

Answer 1

1. Age of onset < 40 years old
2. Insidious onset
3. Improvement with exercise
4. No improvement with rest
5. Pain at night with improvement on getting up

Question 2

What is scoliosis?

Answer 2

A greater than 10° of lateral deviation of the spine from it’s central access.

Question 3

When should scoliosis be braced?

Type of brace?

Answer 3

For greater than 30° should be braced.

Boston Brace(TLSO) good outcomes

Question 4

What treatment approaches are there for scoliosis? (4)

Answer 4

1.Observation, Orthosis and operative intervention

2Observation for curves less than 20° with follow up x-rays at regular intervals

3. Bracing curves 25-40 and for curves 40-50 degrees based on spine flexibility
4. Surgical intervention for inflexible curves that exceed 40° or any curve that exceeds 50°

Question 5

What does a step deformity indicate?

Answer 5

Spondylolisthesis (McGee pg 569)

Question 6

What does a Cafe au Lait indicate? (2)

Answer 6

Neurofibromatosis or collagen disease (McGee pg 569)

Question 7

What is spondylosis?

Answer 7

Degeneration of the intervertebral disk.

Question 8

What is spondylolysis?

Answer 8

Defect in the pars interarticularis or the arch of the vertebra.

Question 9

What is spondylolisthesis?

Answer 9

A forward displacement of one vertebra over another.

Question 10

What is retrolisthesis?

Answer 10

A backward displacement of one vertebra on another.

Question 11

What does research say about lumbar extension strengthening?

Answer 11

More effective than no treatment but no clear benefit when compared to other exercises approaches for LBP. (Mayer and Mooney)

Question 12

Program that stress aerobic fitness and weight training appear to do what?(2)

Answer 12

1. Valuable in reducing the increase awareness of neural stimulus (central sensitization) that often present in patients with CLBP.
2. Weight training has been shown to reduce the frequency of acute episode of LBP

Question 13

What does research say about intervention based on directional preference to promote centralization of symptoms(McKinzie)?(2)

Answer 13

1. McKenzie approach is likely to lead to better outcomes then passive treatments w/ acute LBP
2. McKenzie approach for CLBP effect was small, efficacy and effectiveness was not clear from literature

Question 14

What uses operant condition to reinforce healthy behaviors and progress the patient through different levels of functional activity?

Answer 14

Graded activity

Question 15

What is graded exposure?

Answer 15

Pt with LBP to generate a hierarchy of activities and gradually progress an attempt to reduce activity related anxiety.

Question 16

What does research say about spinal manipulative therapy for LBP?(3)

Answer 16

1. SMT moderate support for the use of patients with acute LBP
2. SMT minimal to moderate the part for the use of chronic LBP
3. SMT was more effective than the combination of HEP and advice

Question 17

Patients are likely to benefit from the intervention of motor control and graded activity if they score what on the clinical instability questionnaire? (2)

Answer 17

1.Patients with high scores on the clinical
instability questionnaire (≥ 9) did substantially better with motor control exercises.  

2.Patients with low scores on the clinical
instability questionnaire (< 9) did better with a
graded activity approach

Question 18

What is Kemp’s test?

Answer 18

1. This test assess lumbar spine pain. Non specific test
2. Provocation test
3. Pain down leg suggests N. root irrigation, especially below knee
4. Sensitivity 50-70% and Specificity 67%

Question 19

Sensation levels of lumbosacral?(7)

Answer 19

1. L1 Anterior tight
2. L2 Anterior tight, groin
3. L3 Anterior and lateral tight
4. L4 Medial leg and foot
5. L5 Lateral leg and dorsal foot
6. S1 lateral and planter foot
7. S1-S4 Perianal

Question 20

What is Stenosis clinical predication rule?(5)

Answer 20

1. Bilateral symptoms.
2. Leg pain more than back pain. 3.Pain during walking/standing. 4.Pain relief upon sitting.
3. Age greater than 48.

Specificity=
3+= .88
4+= .98
5= 1.0

Question 21

Lumbar zygapophyseal clinical predication rule? (7)

Answer 21

1. Pain not relieved in the supine position.
2. History of surgery.
3. Occupational on set.
4. Abnormal gait.
5. Positive neurological exam.
6. No evidence of osteoporosis.

If 4 of 6 variables are present the patient would likely not respond to facet injections and therefore likely have another cause low back

Question 22

What are predictors of failure with stabilization? (5)

Answer 22

1. Lack of positive prone instability
2. Absence of aberrant motion
3. Absences of hypermobility
4. FABQ physical activity <9

5.presence of 3 highly predictive of poor outcomes

Question 23

What small subgroup of pt’s may receive optimal benefit form lumbar traction?(4) Or?(4)
Level of evidence?

Answer 23

1. Presence of sciatica
2. Signs and symptoms of nerve root compression
3. Peripheralization with extension movements
4. Postive crossed straight leg raise test

OR

1. FABQ-W Score <21
2. No neurological deficits
3. > 30 years old
4. Non-manual work job status

Level D evidence

Question 24

The Fear-avoidance beliefs( FABQ) is related to development of chronic low back pain. What indicates poor outcomes? (2)

Answer 24

1. 4 item physical activity scale (0-24 points) – cutoff score of 14 indicator of poor treatment outcomes
2. 7 item work scale (0-42 points) cutoff score of greater than 29 – indicates poor return to work status
   - –risk of prolonged work restriction increased from 29% to 58%

Question 25

What clusters of signs and symptoms can indicate Lumbosacral Radiculopathy? (8)

Answer 25

1. Dermatomal pattern (i.e. L4 or L5 distribution) 2. Pain on cough, sneezing, or straining 3. More pain with sitting 4. Muscle weakness 5. Subjective sensory loss 6. Paresis 7. +SLR 8. Unilateral ankle reflex – diminished

Question 26

What clusters of signs and symptoms can indicate Cauda Equina Syndrome? (8)

Answer 26

1. Rapid symptoms within 24 hrs– hallmark is rapidity of symptoms 2. Hx of back pain 3. Urinary retention 4. Fecal incontinence 5. Loss of sphincter tone 6. Saddle anesthesia/Sacral sensation loss 7. LE weakness – that happens very quickly 8. Gait loss

Question 27

What is a Schmorl’s node?

Answer 27

1.A herniation of the nucleus pulposus through the cartilaginous and boney endplate into the vertebral body. 2.

Question 28

L4 radiculopathy S/S?(6)

Answer 28

1. Produced most commonly by disk herniation, spinal stenosis also frequently involves this nerve root 2. Medial lower leg symptoms in the distribution of the saphenous nerve 3. Knee extension, hip adduction, and foot DF weakness (however less prominent than in L5 herniation) (quadriceps, hip adductors, tibialis anterior) 4. L4 Myotome: tibialis anterior 5. L4 Dermatome: medial calf and big toe 6. L4 Reflex: patellar tendon, knee jerk depressed or absent

Question 29

L5 radiculopathy S/S?(8)

Answer 29

1. Most common cause of L5 radiculopathy disc herniation 2. Foot drop is the salient clinical feature 3. Sensory symptoms lateral lower leg, dorsum foot, great toe 4. Weakness of ankle DF, toe extension and flexion, foot IV and EV, and hip abd (toe extensors/flexors, ankle everter/invertor, hip abd) 5. L5 Dermatome: anterolateral leg and dorsum of the foot 6. L5 Myotome: extensor halluces longus 7. L5 Reflex: internal hamstrings 8. Mimics common peroneal neuropathy, or lumbosacral plexopathy

Question 30

S1 radiculopathy S/S?(6)

Answer 30

1. Weakness of foot PF, knee flexion, and hip extension 2. Sensory symptoms lateral foot and sole 3. S1 Myotome: flexor halluces longus, gastrocnemius 4. S1 Dermatome: lower half of posterior calf, sole of foot, lateral 2 toes 5. S1 Reflex : Achilles 6. Ankle jerk is depressed or absent

Question 31

What did you use to diagnose lumbar stenosis? What is considered absolute lumbar stenosis?

Answer 31

1. myelography | 2. A/P diameter of less 10mm

Question 32

What is sign of buttock?

Answer 32

1. To determine the possibility of non-musculoskeletal causes for the patient's symptoms. 2. empty end feel-potentially serious pathology osteomyelitis, chronic septic SI arthritis, ischiorectal abscess, septic bursitis, neoplasm of the upper femur, or fractured sacrum

Question 33

How to preform sign of buttock?(5)

Answer 33

1. Preform SLT 2. If the SLR is positive, the end-feel is usually spasm or capsular, but definitely painful. 3. Return the patient to neutral. Passively flex the patient's hip, but this time with the ipsilateral knee flexed to end-range. 4. Assess for if further hip flexion was achieved. If no change in range of motion, the pathology is within the hip or buttock, and not the hamstrings or sciatic nerve. 5. The second part of the test usually has an empty end-feel and is more painful than the first part. 5. positive, the Sign of the Buttock must have all present: restriction of SLR concurrently with limited hip flexion and a non-capsular pattern of restriction of hip joint ROM.

Question 34

What nerves are more commonly affected in a patient with cauda equine syndrome?

Answer 34

S1-S4

Question 35

What are the Deep Muscles of the Back?(6)

Answer 35

I Love Spaghetti Some More Ragu : Iliocostalis, Longissimis, Spinalis, Semispinalis, Multifidus, Rotatores