kin191 a.ch.10.lumbar.thoracic.injuries
Post on 22-Nov-2014
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KIN 191AAdvanced Assessment of Lower Extremity Injuries
THE THORACIC AND LUMBAR SPINEINJURIES
INTRODUCTION
• Erector spinae (paraspinal) muscle strain• Facet joint sprains/dysfunction• Intervertebral disc injuries• Sciatica• Spondylopathies– Spondylolysis– Spondylolisthesis
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Erector Spinae Strains
• Easily the most common lumbar spine injury• Commonly, a history of heavy or repetitive
lifting and complaining of aching pain centralized to the lower back
• Pain with trunk motions (especially flex/ext), typically no neurological symptoms
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Facet Joint Injuries• Dislocation/subluxation– “Locking” of segment/s (hypomobility)– Often associated with a specific movement pattern
• Facet joint syndrome– Repetitive stress from movement and/or loading– Usually no neuro symptoms unless inflammation
impinges upon nerve roots• Degeneration– Degenerative changes may cause impingement on
nerve roots and resultant radicular symptoms– Often presents with hypomobility of unknown origin
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Intervertebral Disc Injuries
• “Bulging” or herniated disc is extrusion of nucleus pulposus through weakened area of annulus fibrosus with resultant impingement on nerve root typically at level below disc bulge
• Often, annulus weakened by accumulative repetitive stresses and one event then causes final failure to contain nucleus
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Intervertebral Disc Injuries
• Condition typically associated with radiating neuro symptoms (dermatomes/myotomes)
• Often present with lateral shift away from impacted side to alleviate nerve root compression
• Changes in body position (sitting to standing, etc.) change loads on discs and often exacerbate symptoms
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Sciatica
• General term for any cause of inflammation and/or irritation of “sciatic” nerve
• Similar symptoms to nerve root compression but originate at peripheral nerve level instead of spinal level (sensory/motor function)
• Multiple potential causes – all encompassing term when specific pathology is difficult to identify
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Spondylopathies• Most common in hyperextension activities• Most common at L4-L5 or L5-S1• Spondylolysis– Pars interarticularis defect – “collared” Scotty dog
• Spondylolisthesis– Bilateral pars defect with anterior listhesis (slippage)
of one vertebrae on segment below – decapitated Scotty dog
– Severity determined by amount of anterior displacement
– Single leg stance test may assist in assessment– May have significant neuro sx with severe
displacement 8
“Scottie Dog”
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