Exam

Card Set Information

Author:
jessiekate22
ID:
158652
Filename:
Exam
Updated:
2012-06-13 18:50:49
Tags:
Week Nine
Folders:

Description:
Lsp
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user jessiekate22 on FreezingBlue Flashcards. What would you like to do?


  1. How many people will experince lower back pain in their life?
    • - 80% the majority of people recover in 4-8 weeks
    • - 3-10% will develop chronic
    • - 10% o flbp t use 70-80% of finances for mm pain in health care system
    • - cost LBP is 600 mill/yr in 1996
  2. Lumbar spine anatomy
    • - two adj vertebrae
    • - intervertebral disc
    • - ligaments
    • - mm
  3. Describ the intervertebral disc
    • - each disc consists of two basic components; a central nucleus pulposus surrounded by peripheral annulus fibrosus
    • - the nucleus pulposus is a semi fluid mass of mucoid material- deforms under pressure to transmit applied pressure in all directions
    • - the annulus fibrosus consists of concentric layers of collagen fibres called lamellae- orientation of the fibres in lamella 65-70* from vertical. The direction changes with each lamella
  4. What is the function of the lumbar spine?
    • - functionally, the adult vertebral column is a segmented, jointed, flexible rod
    • - support loads of WB in stnading
    • - portects the spinal cord, cauda equina, meninges and vessels and the emerging spinal nerves
    • - provides levers for mm
    • - guidance and restraint of movement
    • - allows a considerable range of movement in all directions
    • - sagital plane movement, rot limited
  5. How many jts are in the lsp?
    • - 3 pronged structures:
    • - 1 ant (interbody)
    • - 2 posterior jts
    • - this is the articular triad
    • with a disc in between
    • - each level allws a few degrees of movement
  6. Where does movement occur in the spine?
    - superior vertebra on inferior vertebra
  7. What does the amount of movement avilable to a mobile segment dpend on?
    • - the thickness of each intervertebral disc
    • - the compliance of its fibrocartilage
    • - the dimensions and shape of adj vertebral end plates

    THe shape and orientation of the articular facets with lig and mm of the arch and its processes guide the types of movement possible and provide restraints against excess movement
  8. Lumbar movements
    • - combination of translation and rot in a 3 dimersion space
    • - flex, rot (horizontal plane), side flexion
    • anatomical planes sagittal, coronal andhorizontal
  9. Flexion occurs where in the LSP?
    - happens at L4-L5
  10. What happens with the vertebra with flesion?
    • - flex- upper vert rot ant- up and forward
  11. Extension of the Lsp
    • - post rot down and back. Movement stopped via a bony block
    • Multifidus is un in both flex and ext
  12. Lateral flexion of the Lsp
    • - upper vert tips ipsilaterally- same side down and back. Contralateral side up and forward
    • - coupled- rot and lat flexion
  13. Movement in Lsp- the younger you are the more movement you have.
    - rot is minimal
    - collagen will fail once it exceeds 4% more than resting length
    Lsp- about 10*
    Bend twist and lift- you flexed- tear anulus
  14. What are extrinsic disorders can cause Lsp pain
    • - thoracic spine
    • -SIF
    • - hip jt
    • - visceral
  15. Intrincis disorders that can cause lower back pain
    • - mechanical LBP- mulitfactural causation- cant pin a speific cause
    • - vertebral instability
    • - disc prolapse
    • - tear of annular laminae
    • - locking of an arthrotic facet
    • - lumbar spondylosis
    • - cauda equina involvement
  16. Mechanical causes of LBP
    • - may occur with/out referred leg pain
    • - can be multifactorial
    • - about 70%
    • - not possible to estabilsh the pathological basis for 80-90%
    • - non specific LBP
    • - knowledge of anatomy still being discovered
  17. Vertebral instability cause of LBP
    • - follows the early stages of disc degeneration
    • - more common in males 30-40 yrs old
    • - instability increases the strain on the surrounding soft tissue and ligaments
    • - dull, dep pain- brought on with proonged position
    • - punctuated by attacks of severe pain
    • - examination
    • - xray changes
    • - L4-5 most common
    • - locking feeling
    • - rom normal
    • - gas at disc and boney prominences
  18. Intervertebral disc prolapse cause of LBP
    • - typically, pts is 20-45 yrs
    • - L5-S1 46% L4/5 40%
    • - clinical presentation depends on pathological inter-relationship netween disc, spinal canal and neural elements
    • - pain descrined as dull, aching or knife like in the back. Increases with movement, sitting and sudden strains eg cough. Usually severe and disturbs sleep. Assciated with paraesthesia, numbness, weakness
    • - examination
    • - more males than female
    • - depends on size and direction
    • - nerve rot pain
    • - lateral shift pelvis
    • - dont like to flex laterally to effected side
    • - sore on aplpation
  19. Tear of annular laminae
    • - immediate cause is either a rot bending stress, coughing or sneezing while bending or a jolt when carrying a load
    • - effect is more pronouned in flex since the facet planes are less engages and rot movement is likely to be greater
    • - pain may be so sudden and csevere that the pt collaspses
    • - examination- ever movement will be painful
    • - can occur without the nucleus being involved
  20. Lumbar spondylosis
    • - degenerative diseace
    • - resentation; low back or buttock pain- dull aching and stiffness, increases as day progresses, pronounced after night rest but eases when mobile
    • -degenerative changes involving both ant and post portions of intervertebral jt complex
    • - back pain uni/bilateral
    • - some neuro
    • - canal stenosis- inside canal is narrowed
    • - leg pain may be due to somatic referral into leg, direct nerve root pressure, resence of canal stenosis
  21. Cauda equina involvement
    • - usually associated with intervertebral disc prolapse
    • - multisegmental with frequent bilateral
    • - pain in perineum
    • - paraesthesia- in saddle area
    • - paralysis of anal and urethral sphincters
    • derease of power in S2 distribution with possible involvement of severl segments
    • - immediate referral for surgical assess
    • - good prognosis if early
  22. Medical management of LBP?
    • - advice
    • - meds
    • - bed rest- 2 days or more depends
    • - multidisciplinary assessment- complex pt
    • - invasive procedures
    • - surgery
  23. Physio management of LBP?
    • - thorough Ax
    • - edu
    • - mos and manip
    • - traction
    • - exercise- mckenzie
    • - modalities
    • - CBT
  24. What are the classifications of spinal fractures?
    • - stable or unstable
    • - stability does not depend on the fracture itself but the integrity of the lig, particularly the posterior lig complex
  25. What is avulsion?
    • this is when a # occurs from lig/ tendon pulling bone off
    • - can be from twisting or flexion w violent mm spasm
    • - pain and mm spasm can last for 6-8 weeks
    • - treatment- analgesion and gradual mobilisation
  26. What can compression forces result in?
    • - crush fractures
    • - burst fractures
  27. What is a crush #?
    • - mostly at the thoracolumbar area
    • - vertical force just in front of the middle of spine- compress ant part of vertebra
    • - most comon in oldie with OP bone
    • - pt is mobilised within limits of pain
    • - if more than 50% of the ant vertebral height is lost = surgery
  28. What is a burst fracture
    • - result of pure axial force
    • - side of vertebra aare pushed outwardly and disc may be force in vertebral body or spinal canal
    • - stable or unstable
    • usually with neuro damage
    • - stable # can be mobilised as soon as pain allows
    • - unstable # may be treated by bed rest and brace or fixation
  29. Hinging forces of the spine
    • - backward hinging force may be damaged the neural arch but doent tear the posterior lig - lumbar injuries may result in # of the parts of interarticularis
    • - flexion hinging is more common is Lsp- post lig remain intact so the injry is stable
    • - treatment is usually analgesia, bracing and graduated return to activity
  30. Shearing forces in the spine
    • - tear ligaments and cause instability
    • -often have a rot component and this is commonly associated with flexion
    • - spinal fusion or extended immobs may be used
    • - seat belt fractures- flexion distraction injury, treatment usually involves bed rest and a plaster jacket
  31. What is a kyphosis
    • - thoracic spine
    • - classified as mobile, fixed or anngular
    • - fixed kyphosis includes scheurmanns disease (adolescent kyphosis), ankylosing spondylitits and senile kyphosis
  32. What is senile kyphosis?
    • - old people
    • - senile osteoporosis
    • -true degeneration of the disc and vertebra becomes wedged- doesnt cause pain. Not reversible. Vertral body becomes biconcave. Bones are easily fractures. Wlaking stick can help spread load
    • - treatment is symptomatic with exercise, heat and analgesia
  33. Prolapsed intervertebral disc
    • - frequently managed conservatively
    • - bcome symptomatic as the annulus fibrosis softens and the degenerate disc buldges the annular ligament backwards
    • - if the disce presses on a nerve root, SLR limited about 30* and flexed changes symptoms
  34. When do u do an op for prolapsed disc?
    • - laminectomy or disectomy done if:
    • there is no improvement in signs and symptoms after 6 weeks
    • - there is increaseing neurological deficit
    • - symptoms of cauda equina
    • - thereis intratible ain
  35. Back op- disc
    • - 75% of pt relief from neuro symoptoms
    • - back pain persists in 30-60% of pts
  36. Post op care for pt with disc ops
    • - varies depending on surgical treamtnet
    • - typical:
    • dvt prophylaxis and respiratory maintenance
    • - log rolling
    • - recruitment of mm stabilisers
    • - progressive mobs
    • - bracing
    • - neuro mobs exercises
  37. Spinal stenosis
    • - narrowing of the spinal cannal and exit foramina due to hypertrophy at the posterior disc margin at the facet jts
    • - pt often complains of heavy aching numbness PNs in thighs and legs that comes on after standing 5-10 min or walking
    • - relieved by sitting, squatting or flexing the lumbar spine
    • - neurological signs and CT scans
  38. How do you manage spinal stenosis?
    • - conservative management
    • - surgical decompression- wide, multilevel laminectomy, relieves the leg but not the back pain
  39. What is spondylolisthesis?
    • - forward shift of the spine
    • - usually between L4/5 or L5/S1
    • - movemeing forward of vertebra- slip graded 1-4
  40. What are the different types of spondylolisthesis?
    • - dysplastic- congenital anomaly at the lumbarsacral junction
    • - isthmic- fatigue fracture of the pars inetraticularis
    • - degenerative- OA
    • - traumatic- acute trauma
    • - pathological- weakening of the pars interarticularis by a tumour, OP, TB or pagets diease
  41. What is the most common type of spondylisthesis?
    • - slipping at a spondylosis of the pars interarticularis casued by a FATIGUE FRACTURE
    • - most common in active pts, particularly those who hyperext
  42. What does degenerative slipping result form with spondylolistheses?
    - mechanical wear of the facet jts in the presence of degenrative jt disease- common in women over 55
  43. What does spondylolisthesis usually present as?
    - dull back pain radiating into the buttocks- may be pressure on the dura mater and cauda equina or on the emerging nerve roots.Nerve roots may be compressed in the narrowed intervertebral foramina

    - on examination- flat but, lumbar ext painful, a step palpated, xrays
  44. Treatment for spondylolisthesis
    • conservative- symptomatic, training of the stabilising muscles of the abdominal region in concert with multifidus
    • - operative may be lumbar spine fusion, often disc is material is removeed and bone grafts are used to fuse together
  45. Post op care for spondylilosthesis
    • - maintain other jts
    • - depending on how surgeon does it depends if pt will be prevented from sitting for 6 weeks
  46. Ankylosing spondylitis
    - early 20s- jts pain in hip, ribs. Posture stuff need to be done
  47. What is pagets #- can be seen on obliquw angle- look for dog
    occurs in gymnists

What would you like to do?

Home > Flashcards > Print Preview