87 Questions
Which type of spondylolisthesis is more likely to present with neurologic compromise?
Dysplastic spondylolisthesis
What symptoms may be present in patients with severe traumatic spondylolisthesis?
Bowel and bladder dysfunction
What physical finding is observed in patients with slips equal to or greater than grade 2?
Palpable step-off
What treatment approach is recommended for most patients with low-grade spondylolisthesis?
Physical therapy
When should surgical intervention be considered for spondylolisthesis?
When the slip is severe enough to cause cauda equina compression
Which type of spondylolisthesis is almost always associated with the need for surgical stabilization?
Traumatic spondylolisthesis
What is the most common cause of low back pain?
Mechanical low back pain
Which of the following is a common cause of Cauda Equina syndrome?
Disc herniation
What are the typical symptoms of Cauda Equina syndrome?
Severe back pain and bilateral leg pain
Which type of spinal stenosis involves narrowing between the facet of superior articulating process (SAP) and posterior vertebral margin?
Lateral recess stenosis
What are the common symptoms associated with spinal stenosis?
Persistent pain in the buttocks and limping
Which of the following is NOT a treatment option for spinal stenosis?
Neutral-zone exercises
What is the neutral zone in the context of spinal stenosis?
The area of joint motion that is completely unconstrained and set by muscle tone
Which age group is most commonly affected by spinal stenosis?
Older adults (>50 years old)
Which of the following is a key clinical clue for the diagnosis of a compression fracture?
History of trauma
What is a common symptom of herniated nucleus pulposus?
Leg pain greater than back pain
What is a characteristic of lumbar strain/sprain?
Diffuse back pain with or without buttock pain
What is a key clinical clue for the diagnosis of spinal stenosis?
Leg pain greater than back pain
What is a characteristic of spondylolisthesis?
Leg pain greater than back pain
What is a characteristic of spondylolysis?
Can cause back pain in adolescents
What is a characteristic of spondylosis (degenerative disk or facet joint arthropathy)?
Similar to lumbar strain; disk pain often worsens with flexion activity or sitting
What is a key clinical clue for the diagnosis of systemic connective tissue disease?
Multiple joint arthralgias
What is a characteristic of inflammatory spondyloarthropathy?
Intermittent pain at night
Which subsystem is responsible for spinal stability in terms of the mechanoreceptors, spinal cord, afferent and efferent systems, and brain?
Control subsystem
What is the term used to describe excessive range of motion (ROM) as a result of injury to the inert structures of the spine?
Neutral Zone Instability
Which type of spondylolisthesis is characterized by the presence of dysplastic sacral or lower lumbar facet joints?
Congenital spondylolisthesis
What is the term used to describe the forward slippage of one vertebral body over the one inferior to it as a result of a defect in the pars interarticularis?
Spondylolisthesis
Which type of spondylolisthesis is caused by facet degeneration accompanied by disc degeneration, most commonly at L4-L5, and is commonly seen in older people?
Degenerative spondylolisthesis
Which type of spondylolisthesis is caused by the development of a stress fracture of the pars interarticularis and is commonly seen in young athletic individuals who engage in activities requiring lumbar hyperextension?
Isthmic spondylolisthesis
What is the term used to describe the defect in the pars interarticularis that may or may not be accompanied by forward translation (slippage) of one vertebra relative to another?
Spondylolysis
Which of the following is NOT one of the subsystems of spinal stability?
End Zone subsystem
What is the main cause of isthmic spondylolisthesis?
Development of a stress fracture
Which grade of spondylolisthesis represents a slippage of 76-100%?
Grade 4
What is the most common location for spondylolysis to occur?
L5
What is the main symptom of degenerative spondylolisthesis?
Pain in the low back and posterior thighs
What is the function of the neutral zone in spinal stability?
To determine the stability of the spine
Which of the following is NOT a possible cause of spondylolisthesis?
Facet degeneration
Which bones form each innominate bone of the pelvis?
Ilium, ischium, and pubis
Where do the innominate bones articulate with each other?
At the pubic symphysis
Which bone forms the concave bony partner of the hip joint?
Acetabulum
What is the purpose of the acetabular labrum?
To deepen the acetabulum
Which ligament is considered the strongest of the hip ligaments?
Iliofemoral ligament
What type of joint is the hip joint?
Ball and socket joint
What is the loose-packed position of the hip joint?
30 degrees flexion, 30 degrees abduction, & slight external rotation
What is the closed-packed position of the hip joint?
Extension with slight adduction and internal rotation
What is the purpose of the femoral neck?
To transmit ground reaction forces
Which ligaments reinforce the hip joint capsule?
Iliofemoral, pubofemoral, and ischiofemoral
Which of the following factors enhances stability in the hip joint?
Atmospheric pressure
What is a common mechanism for hip flexor and adductor strains?
Slipping of the foot during cutting
Which of the following is a common site for avulsion fractures in the hip joint?
ASIS
What is the main symptom of Legg-Calve-Perthes Disease?
Pain in the hip or groin
What is a common complication following hip dislocations, fractures, and chronic synovitis?
Avascular necrosis of the femoral head
What is the term used to describe the inflammatory process at the hip characterized by chronic irritation and excess secretion of synovial fluid within the capsule?
Chronic synovitis
What is a characteristic of a hip pointer?
Pain, swelling, and ecchymosis
What is the term used to describe avascular necrosis of the proximal femoral epiphysis in children?
Legg-Calve-Perthes Disease
What is a characteristic of avulsion fractures in the hip joint?
Common sites include ASIS, AIIS, lesser trochanter, and ischial tuberosity
What is a common symptom of chronic synovitis in the hip joint?
Pain and decrease in ROM
Which of the following factors can compromise stability in the hip joint?
All of the above
Which of the following injuries is characterized by avascular necrosis of the proximal femoral epiphysis?
Legg-Calve-Perthes disease
Which of the following injuries commonly occurs as a result of a violent contraction or tractioning of the attaching muscle?
Avulsion fracture
Which of the following injuries is characterized by an inflammatory process at the hip, resulting in chronic irritation and excess secretion of synovial fluid within the capsule?
Chronic synovitis
Which of the following injuries commonly results from overstretching or a rapid, forceful contraction of the muscle?
Hip joint strain
Which of the following injuries is characterized by a contusion to the iliac crest?
Hip pointer
Which of the following injuries is a common complication following hip dislocations, fractures, and chronic synovitis?
Avascular necrosis of the femoral head
Which of the following injuries is characterized by pain in the hip or groin that radiates to the knee, limping, decreased ROM, and hip flexor tightness?
Legg-Calve-Perthes disease
Which of the following factors enhances stability in the hip joint?
All of the above
Which of the following injuries is characterized by excessive forcible exertion of the extremity that stretches or tears the surrounding ligaments?
Hip joint sprain
Which bones form the innominate bone of the pelvis?
Ilium, ischium, and pubis bones
What is the shape of the femur designed for?
Bearing body weight and transmitting ground reaction forces
Where is the acetabulum located in the pelvis?
Lateral aspect
Which ligament is considered the strongest of the hip ligaments?
Iliofemoral ligament
What is the joint type of the hip joint?
Ball and socket joint
What are the three ligaments that reinforce the hip joint capsule?
Iliofemoral, pubofemoral, and ischiofemoral ligaments
What are the angular characteristics of the femoral neck that can affect joint stability?
Angle of inclination and angle of declination
What is the closed-packed position of the hip joint?
Extension with slight adduction and internal rotation
What is a common symptom of chronic synovitis in the hip joint?
Excess secretion of synovial fluid within the capsule
What is the term used to describe the forward slippage of one vertebral body over the one inferior to it as a result of a defect in the pars interarticularis?
Spondylolisthesis
Which bones form each innominate bone of the pelvis?
Ilium, ischium, and pubis
Where do the right and left innominate bones articulate with each other?
At the pubic symphysis
What is the shape of the femur designed for?
Bearing body weight and transmitting ground reaction forces
Where is the acetabulum located in the pelvis?
Lateral aspect
What is the purpose of the acetabular labrum?
To deepen the acetabulum
Which ligament is considered the strongest of the hip ligaments?
Iliofemoral ligament
What type of joint is the hip joint?
Ball and socket joint
What are the three degrees of freedom of the hip joint?
Flexion, abduction, and rotation
What is the loose-packed position of the hip joint?
30 degrees flexion, 30 degrees abduction, and slight external rotation
What is the closed-packed position of the hip joint?
Extension with slight adduction and internal rotation
Study Notes
Spondylolisthesis
- Neurologic compromise is more common in lateral spondylolisthesis.
- Severe traumatic spondylolisthesis may present with neurologic deficits such as weakness, numbness, and loss of bowel or bladder control.
- Physical findings for grade 2 or higher spondylolisthesis often include increased lumbar lordosis and possible neurological symptoms.
- Recommended treatment for low-grade spondylolisthesis typically involves conservative management, such as physical therapy and pain management.
- Surgical intervention should be considered for patients with severe pain, progressive neurological symptoms, or instability.
- Spondylolisthesis caused by congenital defects or instability is almost always associated with the need for surgical stabilization.
Low Back Pain and Cauda Equina Syndrome
- The most common cause of low back pain is muscle strain or ligament sprain.
- A common cause of Cauda Equina syndrome includes herniated discs that compress nerve roots.
- Symptoms of Cauda Equina syndrome include saddle anesthesia, bowel and bladder dysfunction, and lower extremity weakness.
Spinal Stenosis
- Central spinal stenosis refers to narrowing between the superior articulating process (SAP) and posterior vertebral margin.
- Common symptoms of spinal stenosis include pain, numbness, or weakness in the legs, especially with walking or standing.
- A treatment option not used for spinal stenosis is complete surgical removal of the spine.
- The neutral zone in spinal stability refers to an area of minimal stiffness in the spine during movement.
- The most commonly affected age group for spinal stenosis is typically 40 and older.
Diagnoses and Characteristics
- A key clinical clue for diagnosing a compression fracture is sudden onset of pain with a history of trauma.
- Common symptom of herniated nucleus pulposus is radicular pain in the extremities.
- Lumbar strain/sprain is characterized by localized tenderness and muscle spasm.
- Key clinical clues for spinal stenosis include pseudoclaudication symptoms (pain while walking relieved by sitting).
- Characteristics of spondylolisthesis include anterior slippage of a vertebra.
- Spondylolysis is characterized by a defect in the pars interarticularis without slippage.
- Spondylosis is characterized by degenerative changes in the disk or facet joints, often causing pain and stiffness.
Connective Tissue and Stability
- A key clinical clue for diagnosing systemic connective tissue disease includes symmetrical joint involvement and other systemic symptoms.
- Characteristics of inflammatory spondyloarthropathy include asymmetric joint involvement and back pain improving with exercise.
- The subsystem responsible for spinal stability encompasses mechanoreceptors, spinal cord, afferent and efferent pathways, and brain coordination.
Spondylolisthesis Types
- Congenital spondylolisthesis is due to dysplastic sacral and lower lumbar facets.
- Spondylolisthesis is defined as forward slippage of one vertebral body over another due to a defect in the pars interarticularis.
- Degenerative spondylolisthesis is common in older individuals and is primarily due to facet degeneration and disc degeneration.
- Isthmic spondylolisthesis results from stress fractures of the pars interarticularis, often seen in young athletes.
- Defect in the pars interarticularis may occur without slippage, referred to as spondylolysis.
- Spondylolisthesis of grade 4 represents slippage of 76-100%.
Pelvic Anatomy and Hip Joint
- Each innominate bone of the pelvis is formed by the ilium, ischium, and pubis.
- Innominates articulate with each other at the pubic symphysis.
- The acetabulum is the concave bony partner of the hip joint, enhancing stability.
- The acetabular labrum deepens the socket, increasing joint stability.
- The iliofemoral ligament is considered the strongest of the hip ligaments.
- The hip joint is a ball-and-socket joint allowing three degrees of freedom; flexion, extension, and rotation.
- The loose-packed position of the hip joint typically occurs in slight flexion, abduction, and external rotation; while the closed-packed position is full extension, medial rotation, and abduction.
Injuries and Conditions Related to the Hip
- Legg-Calve-Perthes Disease presents with hip pain, limping, and limited hip mobility.
- A common complication following hip trauma includes avascular necrosis or osteonecrosis.
- Chronic synovitis is characterized by excess synovial fluid and inflammation in the hip joint capsule.
- A hip pointer is a contusion of the iliac crest, usually resulting from direct trauma.
- Avulsion fractures in the hip joint typically manifest due to sudden vigorous muscle contraction or traction.
- Chronic synovitis commonly presents with pain and swelling within the hip joint.
Identifying Different Types of Spondylolisthesis: Test Your Knowledge!
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