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This Concept Map, created with IHMC CmapTools, has information related to: Case 12 Carla Dunlop, Treatment Surgeries ???? Why?, DJD ???? OA: stiffness in the am grinding of the joint bone on bone, limited mvt inter pain, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? Diagnosis: Sciatic nerve (lower lumbar, pain down posterior leg) femoral (upper lumbar Special Tests: SLR (DF the foot, pain before 45 degrees), quadrant screening, standing quadrant test slump test (whole spinal cord), muscle length test/reflexes, sensation, lumbar distraction/compression REIS: produced the back pain c movement, confirms it is a back issue; is not causing the same pain, not compressing the nerve RFIS: produced pain and falls into theory of disc moving posterior SR/Rnt: limited ROM s pain, side your laying on is "opening" or gapping VF Imaging: CT Scan, EMG, MRI, X-ray (bone, IVF and canal), Bone Scan, ultrasound, disography, Treatment Surgeries ???? Disability: what do we need to do to get her back to work??, Invervention for Herniated Disk ???? McKenzie Therapy, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? signs/symptoms, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? Prognosis CLBP will have a longer healing process/poor prognosis Posterior lateral HNP most common, L45 L5S1, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? nerve involvement Upper Lumbar: Femoral Nerve Lower Lumbar: Sciatic Nerve, Treatment Surgeries ???? Txt After Surgery, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? Risk Factors Unchangable: age, gender, family history, preganacy, height congenital spinal problems, DJD/OA, comorbidities, hypermobile Changable: obesity/weight mangement, exercise/physical activity, smoking, occupation, body mechanisms, long term use of cortiosteriods postural habits (driving), stress management, depression (emotions), Treatment Surgeries ???? Conservative Txt PT Medical, DJD ???? Osteophyte: bone on bone, bone spurs, can be asymptomic, can lead to stenosis, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? medications Hydrocodone: narcotic pain relivers, given in many forms ( solids and liquds) vicodone, indicated for sereve pain side effects: shallow breathing, fainting, confusion, nausa, loss of appetite, constipation, decrease heartrate allegric reactions SKELAXIN (metaxalone): msucle relaxant, blocking nerve impulses or pain sensations in the brain, 800 mg tabels 2-4 times a day, relieves pain caused by sprains/strains/MS conditions side effects: impaired thinking,clay colored (discolored) stools, low fever, jaundice, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? When does the person need imaging/referral? bladder problems or changes, saddle region changes decrease weight loss, intractable pain, no change in pain c treatment, MOI/trauma/compression fx, loss of sensation/muscle mvt weakness, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? dermatomes L1: Lower groin L2: Upper thigh L3: lower thigh/knee L4: medial leg L5: lateral leg/top of foot S1: digits 4-5 lateral mall, bottom of foot S2: posterior thigh myotomes: L1-2: Hip Flex L3: Knee Ext L4: Ankle DF L5: BIG TOE ext S1: Ankle E/PF/Hip / S2: Knee Flex S3: Intrinsic FOOT Reflexes Patella L4 Achilles: S1 Normal: 2+ Hyper: 3+ (UMN, CNS) Clonus: 4+ Hypo: 1+, Examination of Herniated Disk ???? special tests/exams, Treatment Surgeries ???? Prognosis, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? Stages: 1. Disc degeneration:no pain present; weaken the chemicals, AF comp 2. Prolapse: changing of the disc, no weaking of NP 3. Extrusion: break thru AF, tears occur and the NP will break thru; shear and compression forces repeated (combined mvt) 4. Sequestation: break thru the AF and move outside of the disc, Herniated Disk: HNP, places pressure on nearby nerves roots and spinal cord, cauda equida, vert bodies to slide on one another pressure on ligaments breaks thru the fibers forminal encroachment: stenosis of formina space, d disc is taking up space ???? disability (desk job), Treatment Surgeries ???? Complications