Lec 4: Lumbar Outcome Tools, Lec 6: Pathoanatomic Diagnosis, Dutton Lumbar + . . .

The lumbar spine is more vulnerable to instability in its ______ positions at low load.

neutral

pts who report a dominance of leg pain over back pain whose symptoms are worsened by flexion of the lumbar spine most likely have . . .

nerve root irritation caused by an IVD herniation

a patient has bilateral root pain, you would suspect they have a ____ ____ _____ among other things

central disk protrusion

what is Dejerines triad?

pain caused by coughing, sneezing, or abdominal straining

what does pallaitve measures refer to?

attempts taken to relieve symptoms

when a disk herniation is lateral to the nerve root, the patient may deviate the back _____ form the side of the irritated nerve. why

awy, it draws the nerve root away fromt he disk fragment.

when the herniation is medial to the nerve root, the patient spine may go______ the side of the lesion, why?

toward, to decompress the nerve root. (leaning away)

Gluteus medius: Origin

between the ant. and post. gluteal lines of the illium

Gluteus medius: Insertion

greater trochanter of the femur

Gluteus medius: Action

abduction, flexion, medial rotation of the hip

Gluteus medius: innervation

Superior gluteal nerve, L4-S1

Gluteus Maximus - Origin

dorsal sacrum, illium behind the posterior gluteal line, thoracolumbar fascia, sacrotuberous ligament

Gluteus Maximus- Insertion

gluteal tuberosity of femur, iliotibial tract

Gluteus Maximus- action

hip extensor, lateral rotation of hip, abduction

Gluteus Maximus- innervation

inferior gluteal nerve L5-S2

reliability

how well a measurement provides consistent results

validity

how well a test measures what it’s intended to measure

intraclass correlation coefficient

how consistent the scores are when measured on the same patient multiple times

sensitivity is a _____ _____!!!

true positive!

specificity

test is so good at finding negatives that when it’s positive you know its for sure a positive

Snout and SPin

sensitive test, negative rule out, positive specificity test rule in

minimal detectable change

change that exceeds expected measurement error

minimally clinically importatn difference

represents the smallest amount of change in an outcome that might be considered important by the pt or clinician

Numeric Pain Rating Scale

numeric version of the VAS

What outcome tool is most often used for LBP function?

Oswestry Low Back Disability Questionnaire

how do you calculate a score from the OSWESTRY?

count the total boxes, double, and get percent from 100

Oswestry scoring : 0-20%

minimal disability

Oswestry scoring : 21-40%

moderate

Oswestry scoring : 41-60%

severe

Oswestry scoring : 61-80%

crippled

Oswestry scoring : 81-100%

bed ridden/symptom magnification

What tool is easier and quicker to use than Oswestry?

Functional Rating Index

This tool is a health status measure of LBP:

Roland Morris Disability Questionnaire

what tool is a single item tool to rate change over a week of treatment?

global rating of change

patient specific functional scale

rates the patients ability to perform functional activites on an 11 point scale

what tool is a functional and psychological assessment tool that measures multiple health domains?

PROMIS - patient reported outcomes measurement information system

what tool is optimal screening for prediction of referral and outcome and yellow flag assessment?

OSPRO

how often did skin or compressed nerve root cause pain in the study?

always

how often did the outer annulus, vertebral end plate, dura, PLL cause pain?

Often

how often did that supr/infraspinatous ligs, facet capsule, mm/bone attatchment cause pain?

Rare

how often did ligamentum flavum, thoracolumbar fascia, facet synovium, facet cartilage, un-inflamed nerve root/dura cause pain?

Never

referred pain

pain perceived in the lower extremities owing to involvement of the lumbopelvic tissues of viscera

radicular pain

pain from involvement of the nerve root complex itself

referred pain would cause more ___ pain and radicular pain would cause more ____ pain.

back, LE

nerve root pathologies: chemical irritation caused by

nucleus pulposis

intraneural inflammation can be caused by:

ischemia, edema, fibrosis, emyelination

loss of nerve function causes:

mm weakness or sensory deficit

hyperexcitability and pain can cause

ectopic impulse generation

constant pain indicates _____ ____ and _____ _____

mechanical deformation, chemical irritation

chemical pain is always ____

constant

constant pain can be _____ or ______

mechanical, inflammation

movements can increase _____ pain by adding mechanical forces

chemical

can movement reduce or abolish chemical pain?

Nope!

intermittent pain is always produced by . . . .

mechanical deformation

intermittent pain appears only when _____ is applied

load

nerve root irritation presents as what symptoms . . .

pain below knee, SLR produces pain, leg pain greater than back pain, excessive pain with gentle spinal motions

nerev root compression symptoms:

reflex changes, mm weakness, mm atrophy, sensory loss over a defined dermatome

Upper motor neuron lesion signs

increased DTRs, spasticity, + babinski/clonus, ataxia, incoordination, dysthesia,

lower motor neurons symptoms

decreased DTR, flaccid, - babinski/clonus, loss of bowel/bladder control, dermatomal/myotomal pattern

what are the most common levels for discogenic pathologies?

L4-L5, L5-S1

presence of radiculopathy is 95% sensitive for ___ _____.

disc herniation

what 3 things exacerbate symptoms?

coughing, snezing, valsalva maneuver

bulging disc

material extends 3 mm or less beyond vertebral apophyses

protruding disc (herniation)

width of disc sticking out is narrower than the area connecting it to the disc

extruded disc (herniation)

the area displaced is larger than the with of the material at the base

sequestration (herniation)

displaced disc material that has lost all contact with disc nucleus

if a herniated disc is causing nerve root issues, there are 4 things that occur? ¾ have to occur to be signigficant

dermatomal pain distribution, sensory deficits, reflex change, motor weakness, further support by Crossed SLR

what test is best to confirm the diagnosis of a large central disc?

Crossed SLR

the most common nerve root involved with the L4-L5 disc is the ____ nerve root

L5