Lumbar Spine 2 Spring 2012 KT voice over ppt

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Lumbar Spine Part 2: 

Lumbar Spine Part 2 Musculoskeletal I Orthopaedics

Medical Diagnoses Affecting the Spine: 

Medical Diagnoses Affecting the Spine

Compression Fracture: 

Compression Fracture Fracture vertebral body due to compressive force Thoracic or lumbar spine Fall on buttocks in flexed position Osteoporosis Usually stable fracture Unstable – brace or surgery Vertebroplasty

Spina Bifida: 

Spina Bifida Incomplete bony closure of posterior neural arch Lumbosacral region – last part to form Neurological deficit most significant aspect Mild weakness, imbalance, sensory deficit Complete parapalegia, bowel/bladder

Spina Bifida Occulta: 

Spina Bifida Occulta No external manifestations 10% population Neurological deficit rare Patch of hair, pigment area May be neurological deficits at birth May develop later

Meningocele: 

Meningocele Meniges extrude through defect Meningocele formed – contains CSF and nerve roots Covered by skin Neurological deficit at birth or develop later

Myelocele: 

Myelocele Spine and dura fail to close Spinal cord and nerve roots completely exposed Infection may result in death

Scoliosis: 

Scoliosis Lateral curvature of spine with rotational deformity Deformity rather than disease Structural abnormalities – vertebrae, thoracic cage and pelvis Non-structural type can be reversed Structural scoliosis is irreversible

Scoliosis: 

Scoliosis Typically in adolescent females Malformation of vertebra and pelvis progresses with skeletal growth May not be noticed until 30 degree curve Cobb method – radiographic diagnosis

PowerPoint Presentation: 

40° Cobb angle: Measurement of Scoliosis

Scoliosis: 

Scoliosis 10 degrees – WNL 10-20 degrees – mild 20-40 degrees – moderate Early structural changes 40-50 degrees – severe Significant rotational deformity 60-70 degrees – significant cardiopulmonary changes

Scoliosis - Examination: 

Scoliosis - Examination Structure Rib hump, S curve (L lumbar, R thoracic) Active movements SB limited to side of convexity Muscle length Muscle strength Muscles weak on side of convexity

Scoliosis - prognosis: 

Scoliosis - prognosis The worse curve is the more likely it is going to progress Amount of growth child has to go through is important factor 10 y/o with 15 deg. worse prognosis than 15 y/o with 15 deg. curve

Scoliosis – Treatment: 

Scoliosis – Treatment Goals Prevent progression if mild Correct/stabilize severe curve Non-operative Exercises braces Operative Harrington Rods

Milwaukee Brace: 

Milwaukee Brace

Boston Brace: 

Boston Brace

Harrington Rods: 

Harrington Rods

Lumbar Sprain/Strain/Synovitis: 

Lumbar Sprain/Strain/Synovitis History Awkward movement, overstretch, trauma Pain worsens over next 2-3 days Pain unilateral Pain may also be in buttock or posterior thigh

Lumbar Sprain/Strain/Synovitis: 

Lumbar Sprain/Strain/Synovitis Problems/Impairments Posture Limited AROM QL and posterior lateral muscles tight Tenderness and increased tone in lumbar paraspinals, QL, posterior lateral hip muscles Decreased endurance No neurological signs

Evaluation and Treatment: 

Evaluation and Treatment

Important to Rule Out: 

Important to Rule Out Problem of non-mechanical or systemic origin Red flags Neurological signs Psychosocial issues that may affect pt presentation Yellow flags Waddell’s Behavioral Signs

History Questions: 

History Questions General questions – no different than any other anatomical area Certain questions specific to spine Lumbar Cervical

Function - Oswestry: 

Function - Oswestry Page 505 Magee 10 categories Disability is score out of 100 Lower score = less disability

Neck Functional Index: 

Neck Functional Index Similar to Oswestry 10 categories – up to 5 points in each Score out of 100 Lower number = less disability

Lumbar Examination: 

Lumbar Examination

Posture: 

Posture Standing Check landmarks Lateral shift or scoliosis Lateral view

AROM: 

AROM Normal movement Smooth, full range, pain free, PROM > AROM, muscles normal length Forward bending Reversal of lumbar curve Deviation to one side Shaking, catching, juttering - instability

AROM: 

AROM Side bending Symmetry of curve Sharp angulations Rotation Look at spinous processes Should SB to opposite side

Sitting: 

Sitting Posture – recheck iliac crests Neurological Reflexes Dermatomes Myotomes

Supine: 

Supine Hip ROM Special tests ASIS/iliac gapping SLR Kernig Bilateral knees to chest Lumbar distraction Leg length Leg lowering test Functional testing

Prone: 

Prone Special tests Prone on elbows or repeated extension Palpation Bony landmarks Soft tissue

Waddell’s Behavioral Signs: 

Waddell’s Behavioral Signs Inappropriate Overreaction Simulated axial compression Simulated rotation Regional weakness disturbance Regional sensory disturbance Distracted SLR Superficial tenderness to palpation Non-anatomical tenderness to palpation

Functional Capacity Evaluation or “FCE”: 

Functional Capacity Evaluation or “FCE”

Cervical Examination: 

Cervical Examination

Objective Examination: 

Objective Examination Observation Muscle guarding, speak/swallow, eyes Posture Forward head/shoulders Occipital tilt, prominent C2 spinous process Active movement screen UE

AROM: 

AROM Sitting or standing Subcranial – occiput on the neck Midcervical/upper thoracic FB BB Rotation Right and left Sidebend right and left

Special tests: 

Special tests Compression Spurling Neurovascular Dermatomes Myotomes Reflexes Upper motor neuron

Supine: 

Supine Muscle length Special tests Palpation – cervical spine

Prone: 

Prone MMT Palpation – thoracic spine

Conclusion: 

Conclusion