Lumbar And Dorse Assessment .pdf

TOPIC 14: Assessment of the dorso-lumbar spine Low back pain Pain and discomfort localized below the costal margins and above the inferior gluteals folds, with o without referred leg pain. Global diagnostic triage (International guidelines) **** Serious pathology (red flags) Radicular synd...

TOPIC 14: Assessment of the dorso-lumbar spine Low back pain Pain and discomfort localized below the costal margins and above the inferior gluteals folds, with o without referred leg pain. Global diagnostic triage (International guidelines) **** Serious pathology (red flags) Radicular syndrome “Non-specific”? / Mechanical low back pain: Not attributable to a objectively recognisable, known specific pathology (e.g, infection, tumour, osteoporosis). Different underlying causes ? Myofascial, discogenic, sacroiliac Red flags Spinal fractures Major trauma Osteoporotic fracture Osteoporosis Cancer History of cancer, multiple cancer risk factors, strong clinical suspicion. Infection Immunocompromised status Urinary tract infection Intravenous drug use Neurophatic pain Pain arising from injury or disease directly affecting the nerve roots that innervate the spine and lower limbs. Subjective assessment: No gold-standard approach for the diagnosis of neuropathic LBP Distribution of the pain Associated sensory or motor signs within that distribution. -Sensory loss -Hyperalgesia, allodynia -Weakness -Numbness, tingling, electricity type pain… Nerve Roots disorders Dorsal flexion worsens the pain, plantar flexion makes it better. Flexion of head worsens pain and extension relieves it. Mechanical low back pain Sacroiliac joint pain SI joint is suggested when 3 or more of 6 positive tests (Gaenslen’s left and right, thigh thrust, sacral thrust, distraction and iliac compression) Three or more positive test , with estimated sensitivity of 93.8%, specificity of 78.1%. Discogenic pain 26%-42% of patients with low back pain. Disc regeneration Annular disruption and inflammatory response. Centralization of symptoms: Progressive resolution, reduction or retreat of pain toward midline. Centralization Is defined in the classification system of occurring when a movement or position results in abolishment of pain or causes migration of symptoms from an area more distal or lateral in the buttocks and lower extremity to a location more proximal to midline of the lumbar spine. Good prognosis. Myofascial pain A contributing factor to other sources LBP or a primary cause by itself. No gold standard for evaluating myofascial pain. Presence of trigger points. Lumbopelvic instability Dysfunction in one or more of the stabilizing subsystems leading to an increase in the size of neutral zone: -Passive subsystem -Active subsystem Clinical instability is defined as the clinical signs and symptoms created by dysfunction of or more of the stabilising subsystems of the spine. Functional instability Associated pathology is altered intervertebral discs and ligament out support of the spine. Positive passive lumbar extension test (Prone instability test)