Cheatography
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Presentation, Management etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Anatomy
- Sagittal orientation of upper facets help to limit rotation
- Frontal orietation of lower facts resist forward displacement
- Richly innervated by medial branches of dorsal rami + mechanorecetors + nociceptors (can be hypersensitised by inflammatory process
Causes
- Repetitive capsular stress/ low level trauma |
- Compression and extension of lumbar spine (causes inferior articular procces to pivot about the pars and stretch the capsule) |
- Causes inflammation and joint dysfunction + intraarticular adhesions + degeneration of the facet joints |
- OA |
- Hx of trauma |
- Systemic arthropathy |
- Obesity |
Presentation
- Nociceptive stimulation causes back/leg pain |
- LBP radiating to flank, hip and thigh |
- Consider other pathology if there are radicular complaints |
- Ipsilateral fashion due to the medial branch of dorsal ramus does not cross the midline |
- Stiffness/morning stiffness common (degenerative changes) |
- Relief with recumbancy |
- -ve Valsalva, normal gait with no muscle spasm |
- Localised tenderness over the affected facet joint |
- Muscle guarding |
- ROM - ext |
- +ve Kemps test |
- Check for postural imbalances and gluts (extra pressure on facet joints) |
- +ve Spinal percussion |
- Neurological exam normal |
- VAS, ROBDI, RMBDI, RAND 36, BDQ
Imaging
Only if red flags: |
Severe/progressive neurological deficits |
Hx of cancer |
Unexplained Weight loss |
Bone Disease |
Systemic Disease |
Inflammatory Arthropathy (AS) |
Steroid use |
Immune Suppression |
Fever |
Nocturnal Pain |
Prior Lx surgery |
Severe congenital defect/instability |
Pain is severe, progressive, prolonged or unaffected by positiion |
DDx
- Intersegmental joint dysfunction |
- Myofascial Pain |
- Spondylolysis |
- Spondylolisthesis |
- Sprain/Strain |
- Disc lesion |
- F#/compression f# |
- DJD/DDD |
- Stenosis |
- Neoplasm |
- Infection |
- Inflammatory Arthopathy |
- SI Dysfunction |
- Hip OA/pathology |
- AAA |
- GI, GU referred pain |
Management
- SMT Tx, Lx, EMT for SI and Pelvis - produces facet joint gapping and breaks up adhesions (12 visits over 6 weeks) |
- Criteria for effectiveness for SMT:
pain lasting >16 days
No symptoms distal to knee
Low fear avoidance (FABQ <19)
Hip internal rotation >35 degrees
Hypomobility of at least one lx segment |
- Myofascial release of Lx Erectors, QL, Hip flexors, hip rotators, gluteal muscles, piriformis, hamstrings , iliolumbar ligament |
- Flexability exercises - knee to chest and hamstring stretch |
- Rehab = neutral spine posture + Spinal stabilisation exercises (side bridge, dead bug, bird dog, hip abductor strengthening) |
- Postural correction |
- Heat/Ice |
- Ultrasound |
- Limits on heavy activity (lifting mechanics, work activites, sleep positions, shoe wear) |
- Consider Radiofrequency ablation if: failure to show improvement with conservative care |
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