selected lumbar pathology II

OA is most common in patients age __________

-45

Patients with OA often have a history of

-LBP

T/F a person with AO will be stiff in the PM

-F

-stiff in the AM

-pain increases during the day

Is OA pain well localized

-no

does OA pain radiate to the leg

-no

T/F with OA you often see a movement toward flexion (in posture) to decrease load

-T

With OA you will see postural changes consistent with

-overall degeneration

Are they normally neuro findings with OA

-no

-there's no encroaching on the foraminal space with just OA

what functional differences will you see with OA

-reduced overall motion EXCEPT flexion

Patients with OA may require__________to provoke symptoms if not in acute exacerbation

-repeated motions

what might you palpate in OA pts

-bony degenerative changes

-may feel more bone than normal

segmental mobility is

-consistently reduced throughout region in OA

degenerative spinal stenosis is most common in people ___________yo

-65+

people with degenerative spinal stenosis often have a hx of

-LBP

symptoms of degenerative spinal stenosis are often

-preceded by activities that involve extension

degenerative spinal stenosis is aggravated by _____________and relieved by ___________

-walking (anterior tilt from fast walking especially)

-sitting (posterior tilt creates more space in the spinal canal)

T/F standing for long periods may relieve sxs of degenerative spinal stenosis

-F

-it may worsen sxs

neurogenic claudication

-activity creates anterior tilt-->cord compression-->pain in legs

What observations may you make in a patient with degenerative spinal stenosis

-flattened lumbar lordosis accompanied by adaptive changes

what neuro findings may you see with degenerative spinal stenosis

-neurogenic claudication

-other neuro sxs consistent with compression of spinal cord or nn roots depending on severity

what positions will reproduce sxs in degenerative spinal stenosis

-extension

-sometimes side bend

what position relieves sxs of degenerative spinal stenosis

-flexion

what might be noted on palpation with degen spinal stenosis

-degenerative changes: stiffness, too much bony mass

what does van gelderens test differentiate

-vascular vs neurogenic claudication

with van gelderens test if sxs resolve when pt flexes forward what does that indicate

-neurogenic claudication

-if it were vascular claudication the pain in the regs would remain due to cardio demand

segmental mobility in degen spinal stenosis

-globally reduced mobility

segmental instability

-inconsistent sxs

-repeated episodes of feeling unstable

-minor aching after these episodes

-clicking or clunking

observation in segmental instability

-hingeing or wedging may be present

function in segmental instability

-excessive AROM

-inability to return from flexion normally (will walk up legs with hands or manually reduce lordosis before coming up)

pressure during palpation for segmental instability may

-generate sxs

segmental mobility testing in segmental instability

-shearing may be present

-may note hypermobilities

facet joint dysfunction is often described as

-locking up

facet joint dysfunction is often associated with what activity

-flexion

there is an onset of acute pain when _________________ in facet joint dysfunction

-returning to upright

T/F pain with facet joint dysfunction is

-constant and severe after onset

-slowly decreasing with time

what does hx with facet joint dysfunction look like

-similar episodes in the past

MOI for facet joint dysfunction

-hypermobile segment stretches facet joint capsule

-during flexion facet joint capsule is fully elongated

-on returning to standing capsule doesn't retract with sufficient elasticity to reposition capsular structures

-structures that extruded are trapped

observation of facet joint dysfunction

-possible spasm

-lack of willingness to move

neuro sxs with facet joint dysfunction

-not usually present

-pseudo-radiculopathy may be present

function with facet joint dysfunction

-all movements painful

-pattern may be varied

-resisted motions may increase pain

Spasms in facet joint dysfunction often present in

-paraspinals

-multifidi

segmental mobility in facet joint dysfunction

-hypomobility due to spasm followed by hypermobility when spasm resolves

spodylolisthesis is most common at

-L5/S1

spondylolisthesis is commonly found in

-adolescents 15-20

-women > men

in spondylolisthesis

-step may be palpated

-extension exacerbates

-may have neuro signs if neural structures are compromised

-shearing may be excessive