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Flashcards in Spine clinical correlations Deck (16)
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1

femoral nerve stretch test

-upper lumbar root pathology at L2-L4

-pt prone. bend knee to 90 degrees, then lift thigh to elicit pain in anterior thigh.

1

cervical myelopathy

-hx

-etiology

-exam

-tx

1. varied: loss of fine motor skills, gait disturbance, B/B dysfunction, weakness, numbness, etc

2. spinal cord compression (many causes)

3.  increased reflexes in both extremities (if UMN lesion high enough). Also, positive Lhermitte's sign, Hoffman's sign, Romberg sign, Babinski, ankle clonus

4. surgery

2

Lumbar spine tests:

(2)

1. straight leg raise (L5, S1)

2. femoral nerve stretch test (L2-L4)

3

lumbar strain

-hx

-etiology

-exam

-tx

1. low back pain worse with movement and exertion, better with rest. Usually acute onset

2. excessive stretch of muscle

3. tenderness on palpation of lumbar muscles. normal neural exam

4. NSAIDs, PT, self-limiting

4

disk herniation

-when is pain worse/better?

-pain is worse when sitting/bending forward. better standing/walking

-usually L5-S1 for lumbar

4

ankylosing spondylitis

-hx

-exam

-labs

-tx

1. gradual onset of low back pain/stiffness. (worst in morning)

2. reduced ROM, tender over SI joints

3. increased CRP, sedimentation rate. HLA-B27 positive

4. similar to RA. NSAIDs, and TNF-alpha blockers

6

straight leg raise test

-lumbar nerve root pathology at L5, S1

-raise pt's leg with leg straight. pain is reproduced at 30-70 degrees

7

cauda equina syndrome

-hx

-etiology

-exam

-tx

1. sudden onset, saddle anesthesia, bowel/urinary incontinence, leg pain

2. central disk herniation

3. loss of anal wink, saddle anesthesia, reduced leg reflexes

4. surgical emergency

8

compression fracture

-what associated with?

-if pt younger than 55, suspect what?

-associated with osteoporosis and prolonged corticosteroid use

-suspect multiple myeloma or other malignancy

9

lumbar stenosis

-hx

-exam

-etiology

-tx

-pain worse with extension, better with flexion. (shopping cart sign, and pt able to say how far they can walk before pain starts)

-no focal findings, normal neuro exam

-narrowing of spinal cord canal

-NSAIDs, PT, possible surgery

10

Spurling's test

-test for cervical root pathology

-have pt extend neck and adduct toward suspected side of pathology, while physician presses down on head

-+ sign is reproduction of radicular symptoms

10

Hoffman's reflex

-test for UMN pathology

-tap 3rd finger--positive sign is reflex flexion of index/thumb

12

cervical spine tests:

(3)

1. Lhermitte's sign--pain (down spine or in arms) upon flexion of neck

2. Spurling's test--pain on moving head towards suspected cervical injury

3. Hoffman's reflex--tapping of 3rd finger makes index and thumb flex

14

ankylosing spondylitis

-early vs late symptoms

early: widening of SI joints, adjacent sclerosis

late: fusion of SI joints and vertebral bodies. (bamboo spine)

15

Lhermite's sign

-test for cervical myelopathy

-flexion of neck produces pain down spine or extremities

16

Facet joint arthropathy

-hx

-etiology

-exam

-tx

1. pain is relieved with back flexion, worse with back extension. (similar to lumbar stenosis)

2. facet joints rub against each other (arthritis)

3. pain provoked by extension, relieved by flexion

4. NSAIDs, PT, injections