Screening of lumbar region and common injuries

Common injuries if Lumbar spine

1. THE UNIVERSITY OF FAISLABAD Screening of Lumbar spine Prepared By: Esha Dilawar Muhammad Umar

2. @reallygreatsite [phone] The lumbar spine consists of five vertebrae (L1-L5) in the lower back, supporting the upper body and providing flexibility and movement. Here's a brief overview of its structure: Vertebrae (L1-L5) Body: Weight-bearing anterior portion. Spinous Process: Posterior bony projection. Transverse Processes: Lateral projections for muscle and ligament attachment. Facet Joints: Articulations allowing movement. Intervertebral Discs Annulus Fibrosus: Tough outer layer. Nucleus Pulposus: Gel-like inner core for shock absorption. Structure:

3. @reallygreatsite 3- Spinal Cord and Nerves: Cauda Equina: Bundle of nerves at the end of the spinal cord. Nerve Roots: Exit between vertebrae to innervate lower body regions. 4- Ligaments: Ligaments: Anterior and posterior longitudinal ligaments, ligamentum flavum , interspinous and supraspinous ligaments. 5 -Muscles: Erector spinae, multifidus, and quadratus lumborum for support and stabilization. 6 -Functions: Support: Bears upper body weight. Flexibility: Enables various movements. Protection: Shields spinal cord and nerves. Shock Absorption: Discs cushion impacts. The lumbar spine's robust structure is essential for stability, support, and flexibility in daily activities.

4. Screening of lumbar spine 1-Patient History: Symptoms: Pain location, intensity, duration. Medical History: Previous injuries, surgeries, chronic conditions. Lifestyle: Occupation, physical activity, habits. 2-Physical Examination: Inspection: Visual check for abnormalities. Palpation: Feeling for tenderness or swelling. Range of Motion: Assessing flexibility. Neurological Exam: Checking for sensory deficits, muscle weakness. Special Tests: Specific maneuvers like the straight leg raise test.

5. Screening of lumbar spine 3-Imaging Studies: X-rays: Visualize bone structures. MRI: Detailed images of soft tissues, discs, nerves. CT Scan: Detailed bone images. Bone Scans: Detect infections, fractures, tumors. When to Seek Screening? Persistent or severe back pain. Radiating pain to the legs. Weakness, numbness, or tingling in the legs. Difficulty standing or walking. Loss of bowel or bladder control (emergency).

6. @reallygreatsite [phone] Lumbar Spine: Excellence in Patient Care: Low back pain (LBP) is very prevalent in the adult population, affecting up to 80% of all adults sometime in their lifetimes. In most cases, acute symptoms resolve within a few weeks to a few months. Individuals reporting persistent pain and activity limitation must be given a second screening examination.

7. Causes Diseases Systemic causes of low back pain Cancer Metastatic lesions Prostate cancer Testicular cancer Lymphoma Pancreatic cancer Colorectal cancer Multiple myeloma Cardiovascular Abdominal aortic aneurysm Endocarditis Myocarditis Peripheral vascular: Renal/Urologic • Acute pyelonephritis • Perinephritic abscess • Nephrolithiasis • Ureteral colic (kidney stones) • Urinary tract infection • Dialysis (first-use syndrome) • Renal tumors

8. Causes Diseases Gastrointestinal Gynecologic Other 1-Small intestine: • Obstruction (neoplasm) • Irritable bowel syndrome • Crohn's disease 2-Colon: • Diverticular disease Pancreatic disease 3-Appendicitis • Retroversion of the uterus • Uterine fibroids • Ovarian cysts • Endometriosis • Pelvic inflammatory disease (PID) • Incest/sexual assault • Rectocele, cystocele • Uterine prolapse Normal pregnancy Multiparity Infection: • Vertebral osteomyelitis • Herpes zoster • Spinal tuberculosis • Candidiasis (yeast) • Psoas abscess • HIV Ankylosing spondylitis Fibromyalgia Osteoporosis Psychogenic (nonorganic) Fracture Cushing's syndrome Type III Hypersensitivity disorder (back/flank pain) Post-regional anesthesia

9. Cause Type Key Symptoms and Signs Differentiation Tests Muscular Localized pain, muscle spasms, tenderness on palpation Palpation, ROM tests Organ-Related Non-movement related pain, systemic symptoms, abdominal involvement Blood tests, urinalysis, ultrasound, CT scan Neurological Radiating pain, neurological deficits, positive straight leg raise MRI, CT scan, neurological exam Summary Table for Differentiation

10. Differential Diagnosis of Lumbar Spine

11. Diseases Causes Symptoms Differentiating Point Muscles Area Involved Radiating Point Physiotherapy Test Image 1 Lumbar Strain/Sprain Overuse improper lifting sudden movements Localized lower back pain, muscle stiffness spasms. Pain is usually confined to the lower back without radiating to the legs. Paraspinal muscle, ligaments in the lumbar region. Pain does not typically radiate. Palpation and range of motion (ROM) assessment. 2 Degenerative Disc Disease (DDD) Aging wear and tear of intervertebral discs Chronic lower back pain worse with sitting or bending Disc space narrowing visible on X-rays or MRI. Intervertebral discs, vertebrae. Possible pain radiating to the buttocks or thighs Straight leg raise test (pain may be aggravated) 3 Herniated Disc Disc material protrudes compresses nerve roots. Sharp, radiating pain to the leg. sciatica numbness tingling Positive straight leg raise test, MRI confirmation Intervertebral disc, nerve roots. Pain radiates down the leg (sciatica) Straight leg raise test, slump test.

12. Diseases Causes Symptoms Differentiating Point Muscles Area Involved Radiating Point Physiotherapy Test Image 4 Spinal Stenosis Narrowing of the spinal canal. compressing nerves. Pain, numbness weakness in legs worse with standing/walking Relief with sitting or bending forward. Spinal canal, nerve roots. Pain radiates to the legs, often bilaterally. Treadmill test (symptoms worsen with walking). 5 Spondylolisth-esis Vertebra slips forward over the one below it. Lower back pain stiffness leg pain. Visible on lateral X-ray. Vertebrae, surrounding ligaments. Pain may radiate to the thighs. Palpation for step-off deformity. 6 Ankylosing Spondylitis Chronic inflammatory disease. Morning stiffness pain improves with exercise Elevated inflammatory markers (ESR, CRP), HLA-B27 positive. Spine, sacroiliac joints Pain can radiate to the buttocks and thighs. Schober test (limited lumbar flexion)

13. Diseases Causes Symptoms Differentiating Point Muscles Area Involved Radiating Point Physiotherapy Test Image 7 Spinal Osteomyelitis Infection of vertebrae. Severe back pain, fever, weight loss. Elevated white blood cell count, MRI shows infection. Vertebrae Pain does not typically radiate. Not commonly diagnosed with physio tests; clinical and imaging findings are primary. 8 Vertebral Compression Fracture Osteoporosis, trauma. Sudden onset back pain, worse with movement. Loss of height, visible on X-rays. Vertebrae Pain does not typically radiate. Percussion test (tenderness over vertebra). 9 Facet Joint Syndrome Degeneration or inflammation of facet joints.. Localized back pain, worse with extension. Pain relief with facet joint injection. Facet joints. Pain may radiate to the buttocks and thighs. Extension-rotation test (pain provocation).

14. Diseases Causes Symptoms Differentiating Point Muscles Area Involved Radiating Point Physiotherapy Test Image 10 Cauda Equina Syndrome Compression of nerve roots in the lower spine. Severe back pain, saddle anesthesia bowel/bladder dysfunction. Medical emergency MRI confirmation. Nerve roots in the cauda equina. Pain radiates to the legs, perineal region. Not typically diagnosed with physio tests; immediate medical attention required. 11 Vertebral Compression Fracture Compression of the sciatic nerve by the piriformis muscle. Buttock pain, sciatic nerve pain radiating down the leg. Pain worsens with sitting or climbing stairs. Piriformis muscle, sciatic nerve. Pain radiates down the leg (sciatica). FAIR (Flexion, Adduction, and Internal Rotation) test.

15. Deformity Key Symptoms Differentiating Point Scoliosis Abnormal lateral curvature Visible curvature on physical exam and X-ray Spondylolisthesis Lower back pain, leg pain Forward vertebral slip on X-ray Spina Bifida Back pain, neurological deficits Vertebral gap and sac/hair tuft on imaging Scheuermann's Disease Rigid kyphosis, back pain, tight hamstrings Vertebral wedging on X-ray Summary Table for Genetic Lumbar Spine Deformities:

16. Scoliosis

17. Straight Leg Raise Test : Assesses for disc herniation and radiculopathy. Schober Test: Assesses for ankylosing spondylitis. Physiotherapy Tests Summary:

18. Treadmill Test: Assesses for spinal stenosis. Extension-Rotation Test: Assesses for facet joint syndrome. Physiotherapy Tests Summary:

19. FAIR Test: Assesses for piriformis syndrome. Percussion Test: Assesses for vertebral compression fractures. Physiotherapy Tests Summary:

20. Patient Profile: Name: Sarah Jones is 35 years old. she is office manager and she dont have any medical history Chief Complaint: Sarah presents with acute lower back pain that started yesterday while lifting a heavy box at work. She describes the pain as sharp and stabbing, radiating down her right leg to her foot. She also reports numbness and tingling in her right foot. History of Present Illness: Onset: Acute onset following heavy lifting. Duration: Since yesterday. Character: Sharp, stabbing pain. Radiation: Down the right leg to the foot. Associated Symptoms: Numbness, tingling in the right foot. Aggravating Factors: Movement, bending forward. . Case Study:

21. Physical Examination: Inspection: No visible deformities. Palpation: Tenderness over the lumbar spine. Range of Motion (ROM): Limited lumbar flexion due to pain. Neurological Examination: Motor: Weakness in right dorsiflexion. Sensory: Decreased sensation in the right L5 dermatome. Reflexes: Reduced right Achilles reflex. Special Tests: Straight Leg Raise Test: Positive on the right side, causing radicular pain. Slump Test: Positive for sciatic nerve tension on the right side. Diagnosis: ??