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3 - Lumbar Radiculopathy

Terms in this set (59)

what is radiculopathy?
DISEASE OF SPINAL NERVE ROOTS
PAIN FOLLOWS DISTRIBUTION OF 1 OR MORE ROOTS
where is common site?
LUMBAR SPINE
pain is due to what?
PRESSURE
INFLAMMATION
IRRITATIONS OF NERVE ROOT
causes of this?
RUPTURED OR HERNIATE DISK
BONE OR CORD TUMORS
EXOSTOSES (BONE SPURS)
SPINAL STENOSIS
INFECTION/INFLAMMATION
SYSTEMIC DISEASE (DIAB MEL)
spinal stenosis in what direction?
LATERAL AND/OR CENTRAL
what are signs/symptoms?
LOW BACK PAIN (RADIATES DOWN)
LE MUSCLE WEAKNESS/SPASM
PARESTHESIAS
LUMBAR SCOLIOSIS (FROM SPASM)
big cause of work related disability of men under 45 is
LBP
how much of their comp claims?
40%
what percent of people get at least 1 episode of lbp?
85%
how many will be back to normal in 2 weeks and in 6 weeks?
70%
90%
how many show disk herniation, how many need surgery
40%
2%
what does the pain feel like?
UNILATERAL BELOW KNEE (CAN BE BI)
DULL, BURNING, LANCING
RADIATING
POSTEROLATERAL
AGGRAVATED BY ACTIVITY
IMPROVED DURING REST (ACUTE)
in chronic syndrome when is the pain?
CONSTANT
what are mechanical causes of disk degen?
MICROTRAUMA (ROTATIONAL)
TRAUMA (SNEEZE, FALL, LIFTING, VIBRATION)
SMALL TEARS ON EDGE OF ANNULUS
WEAK ANNULUS = BULGES = INC PRESSURE IN N. PULPOSUS
what if you have repeated stress on the disk?
CIRC TEARS JOIN, MAKE LARGER RADIAL TEAR
HERNIATED MATERIAL PASSES THROUGH TEAR
LOSS OF DISK HEIGHT = DISRUPT NORMAL JOINT FUNCTION
PROGRESSIVE DEGEN, PAIN
why are herniations most common at L4-5?
MOST MOTION HERE
POST LONG LIGAMENT IS NARROWEST HERE
(1/2 WIDTH AT L1)
NARROW WIDTH GIVES POSTEROLAT WEAKNESS
which root is irritated by rupture of L4-5 disk?
L5 NERVE ROOT
other causes of nerve root irritation are:
INFECTION
NEOPLASTIC INVASION
INFLAMMATORY DEMYELINATION
CHEMOTHERAPY (METHOTREX)
MYELOGRAPHIC CONTRAST AGENTS.
VASCULAR INSUFFICIENCY
COMPRESSION FRACTURES
what are some infections that will hurt?
HERPES ZOSTER
SYPHILIS
what is an inflammatory demyelination?
GULAIN BARRE SYNDROME
what are some vascular insufficiencies?
VASCULITIS
DIABETES
RADIATION EXPOSURE
where does spinal cord end?
L2
a herniated disc will affect nerve root above or below?
BELOW
herniated L5-S1 disc will affect which nerve root?
S1
why common in lower lumbar region?
NARROWING OF POST LONG GIG
INC INCIDENCE OF DEGEN DISC DISEASE
INCREASED STRESSES
what are major differential diagnoses of radiculopathy?
ACUTE OR CHRONIC LUMBOSACRAL STRAIN
SPONDYLOSIS AND SPONDYLOLISTHESIS
SPINAL ARTHRITIS
BURSITIS
REFERRED HIP PAIN
CAUDA EQUINA SYNDROME
AB AORTIC ANEURYSM
what is spondylosis?
DEGEN OSTEOARTHRITIS B/W JOINTS OF VERTEBRAE (WIKI)
what is spondylolisthesis?
FORWARD SLIPPAGE OF ONE VERTEBRA
how does cauda equina happen?
LARGE CENTRAL DISC HERNIATION OR SPACE OCCUPYING LESION
what do you get with c. eq?
BILAT OR UNILAT SCIATICA
SADDLE ANASTHESIA
LE WEAKNESS
URINARY RETENTION AND/OR DEC SPHINCTER TONE
what do you need if you have c eq?
DECOMPRESSIVE SURGERY W/IN 12 HOURS OF INCONTIENCE TO STOP PERM DAMAGE
when do you need surgery for AAA?
SIZE > 5CM
INCREASING SIZE OF HEMATOMA
IMPENDING RUPTURE
INABILITY TO CONTROL PAIN
BLEEDING INTO PLEURAL SPACE
how to test for radiculopathy?
POSTURE AND GAIT ANALYSIS
SPINAL MOBILITY
HIP MOTION, SI JOINTS
ELECTRODIAGNOSTIC TESTING
RADIOLOGIC
what are radiology options for radic?
XRAY
MRI/CT
MRI IS BETTER
CT CONTRAST GOOD FOR MALIGNANCIES
what is in neuro exam?
DTR, PATIENT SEATED
PATELLAR (L4)
ACHILLES (S1)
SENSOR/DERMATOMAL EVAL
PIN PRICK, LIGHT TOUCH
what is in motor function test?
HIP FLEXORS L1-L2
HIP EXTENSORS L4-5
KNEE FLEXORS L5-S1
KNEE EXTENSORS L3-L4
DORSIFLEXION L4-L5
PLANTAR FLEXION S1-S2
GREAT TOE EXTENSION L5-S1
you have L4 radic. what do you find?
LOWER BACK, HIP, POSTEROLATERAL THIGH, ANTERIOR LEG PAIN.
ANTEROMEDIAL THIGH AND KNEE NUMBNESS
QUAD WEAKNESS
QUAD ATROPHY
KNEED JERK DIMINISHED
you have L5 radic. what do you find?
OVER SI JOINT, HIP, LATERAL THIGH, LEG PAIN
LATERAL LEG, WEB OF GREAT TOE NUMB
WEAKNESS OF DORSIFLEXION OF GREAT TOE AND FOOT: CANT WALK ON HEELS
MINOR MUSCLE ATROPHY
REFLEX CHANGE UNCOMMON (DIM POST TIB)
you have S1 radic. what do you find?
OVER SI JOINT, HIP, POSTEROLATERAL THIGH, AND LEG TO HEEL PAIN
BACK OF CALF, LATERAL HEEL, FOOT, AND TOE NUMB
CAN'T PLANTAR FLEX, HARD TO TALK ON TOE
GASTROC AND SOLEUS ATROPHY
ANKLE JERK DIMINISHED OR GONE
you can't dorsiflex, you have what level prob?
L4
you can't dorsiflex great toe. you have what level prob
L5
you cant point your toes, you have what problem?
S1
your little toe is numb, what level?
S1
your big toe is numb, what level?
L4
your middle toes and foot are numb, what level?
L5
what other tests can you do?
STRAIGHT LEG RAISE
SEATED LEG RAISE
SEATED KNEE EXTENSION
DISTRACTED STRAIGHT LEG RAISE (TRIPOD)
VALSALVA MANEUEVER
HOOVER'S TEST
BABINKSI TEST
what is hoover's test
YOU ASK THEM TO PULL UP WITH ONE LEG, HTE OTHER SHOULD PUSH DOWN
how to treat radic?
OMT
PHARM
CONSULTATION
SURGERY
what omt can you do?
MYFASCIAL RELEASE
COUNTERSTRAIN
ME
MAYBE HVLA
what pharm can you give them?
ANALGESICS
NSAIDS
CORTICOSTEROIDS
MUSCLE RELAXANTS
MILD SEDATIVES/ANTIDEP
NERVE BLOCK/EPIDURAL
what consults should they get?
NEURO/PSYCH
ORTHO SURGERY
NEUROSURGERY
ANESTHESIOLOGY
PAIN MANAGEMENT
PT
OM (NMM) SPECIALIST)
how many need surgery?
5%
when do you need surgery?
CAUDA EQUINA SYNDROME
PROGRESSIVE NEURO DEFICIT DSPITE CONSERVATIVE TREATMENT
INTOLERABLE PAIN, SEVERE POSTURAL TILT, MULTIPLE EPISODES OF RADICULOPATHY
radiculopathy is the irritation of...
NERVE ROOTS COMMONLY IN LUMAR AREA
patients experience dull...
,BURNING, OR LANCING POSTEROLATERAL PAIN, USUALLY BELOW THE KNEE
because low back pain is common, radiculopathy must be differentiated from more serious conditions such as...
CAUDA EQUINA SYNDROME OR AAA
perform an intensive physical eval with...
RADIOLOGIC PROCEDURES
manage patients with...
PHARM, OMT, CONSULTATION, AND SURGERY IF NEEDED.
DAS
FINISHED
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