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Premium member Presentation Transcript Lumbar Spine Part 2: Lumbar Spine Part 2 Musculoskeletal I OrthopaedicsMedical Diagnoses Affecting the Spine: Medical Diagnoses Affecting the SpineCompression 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 VertebroplastySpina 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/bladderSpina 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 laterMeningocele: Meningocele Meniges extrude through defect Meningocele formed – contains CSF and nerve roots Covered by skin Neurological deficit at birth or develop laterMyelocele: Myelocele Spine and dura fail to close Spinal cord and nerve roots completely exposed Infection may result in deathScoliosis: 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 irreversibleScoliosis: 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 diagnosisPowerPoint Presentation: 40° Cobb angle: Measurement of ScoliosisScoliosis: 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 changesScoliosis - 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 convexityScoliosis - 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. curveScoliosis – Treatment: Scoliosis – Treatment Goals Prevent progression if mild Correct/stabilize severe curve Non-operative Exercises braces Operative Harrington RodsMilwaukee Brace: Milwaukee BraceBoston Brace: Boston BraceHarrington Rods: Harrington RodsLumbar 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 thighLumbar 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 signsEvaluation and Treatment: Evaluation and TreatmentImportant 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 SignsHistory Questions: History Questions General questions – no different than any other anatomical area Certain questions specific to spine Lumbar CervicalFunction - Oswestry: Function - Oswestry Page 505 Magee 10 categories Disability is score out of 100 Lower score = less disabilityNeck Functional Index: Neck Functional Index Similar to Oswestry 10 categories – up to 5 points in each Score out of 100 Lower number = less disabilityLumbar Examination: Lumbar ExaminationPosture: Posture Standing Check landmarks Lateral shift or scoliosis Lateral viewAROM: 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 - instabilityAROM: AROM Side bending Symmetry of curve Sharp angulations Rotation Look at spinous processes Should SB to opposite sideSitting: Sitting Posture – recheck iliac crests Neurological Reflexes Dermatomes MyotomesSupine: Supine Hip ROM Special tests ASIS/iliac gapping SLR Kernig Bilateral knees to chest Lumbar distraction Leg length Leg lowering test Functional testingProne: Prone Special tests Prone on elbows or repeated extension Palpation Bony landmarks Soft tissueWaddell’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 palpationFunctional Capacity Evaluation or “FCE”: Functional Capacity Evaluation or “FCE”Cervical Examination: Cervical ExaminationObjective Examination: Objective Examination Observation Muscle guarding, speak/swallow, eyes Posture Forward head/shoulders Occipital tilt, prominent C2 spinous process Active movement screen UEAROM: AROM Sitting or standing Subcranial – occiput on the neck Midcervical/upper thoracic FB BB Rotation Right and left Sidebend right and leftSpecial tests: Special tests Compression Spurling Neurovascular Dermatomes Myotomes Reflexes Upper motor neuronSupine: Supine Muscle length Special tests Palpation – cervical spineProne: Prone MMT Palpation – thoracic spineConclusion: Conclusion You do not have the permission to view this presentation. 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