Lumbar Facet Syndrome. James J. Lehman, DC, DABCO University of Bridgeport

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1 Lumbar Facet Syndrome James J. Lehman, DC, DABCO University of Bridgeport

2 You are the chiropracbc physician of the future Mastering the diagnosis and treatment of these neuromusculoskeletal condibons will determine your success in school, clinic, and throughout your career as a chiropracbc physician.

3 724.8 Facet Syndrome

4 Mechanical Joint DysfuncBon DocumentaBon of the SubluxaBon: The P.A.R.T. System The P.A.R.T. documentabon system for Medicare has been a topic of much concern and discussion among chiropractors. Recall that the subluxabon may be documented by one of two methods: x- ray or physical examinabon, and that if the larer is used, it must be documented according to the P.A.R.T. system. The four components of P.A.R.T. are described below. CMS requires that at least two of the four components must be documented, and at least one of A or R. hrp://

5 Vertebral SubluxaBon Complex Textbook of Clinical ChiropracBc: A biomechanical approach Posi%onal dyskinesia (sprain/strain) Examples: Retrolisthesis or Anterolisthesis Fixa%on dysfunc%on Examples: Meniscoids, myospasia, adhesions, & inflammabon Compensatory hypermobility and instability Disc protrusions

6 DefiniBon of Orthopedic Test A provocabve maneuver (most oben) using stretching, compressing, and contracbng to duplicate the pain and idenbfy the involved Bssues.

7 Low Back Pain Involved Spinal Tissues Zygapophyseal joint Capsule Nerve Ligament Muscle Osseous

8 Lumbar Facet Syndrome InnervaBon Medial branch of the primary dorsal rami

9 Lumbar Spine Back Pain Back pain is common from the second decade on.

10 Back and posterior thigh pain arises from many areas of the spine Facet joints Longitudinal ligaments Periosteum of the vertebrae.

11 Mechanical Low Back Pain Spinal MoBon Segment As many as 90% of pabents with back pain have a mechanical reason for their pain secondary to overuse or trauma

12 Mechanical Low Back Pain Trauma A normal anatomic structure or pain secondary to trauma or deformity of an anatomic structure.

13 Mechanical Low Back Pain DeformiBes of anatomic structures Abnormal spine 1. Wedged vertebra 2. Hemivertebra 3. Congenital bar 4. Block vertebra

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15 Lumbar Facet Syndrome DegeneraBve joint changes at zygapophyseal joints Farfan

16 Lumbar Facet Syndrome DegeneraBon of carblage Meniscoid entrapment

17 Lumbar Facet Syndrome What specialized orthopedic tests would you perform to evaluate a low back pain pabent with this syndrome?

18 History Taking Process Chief complaint or chief concern History of present illness Past history

19 Neuromusculoskeletal History of Present Illness LocaBon Mechanism New condibon Onset PalliaBve/provocaBve Quality of pain Referred or radiabng Severity of pain Timing and treatment

20 Acute CondiBon Pain is the most outstanding feature Rubor Dolar Tumor Calor

21 Chronic CondiBon Pain is no longer the most outstanding feature but sbffness, weakness, and/or loss of sensabon.

22 Lumbar Facet Syndrome Low Back Pain Symptoms Constant dull ache IntermiRent sharp pain Catch with certain movement Increased pain with standing and extension

23 Lumbar Facet Syndrome PalpaBon may reveal PVM hypertonicity and pain

24 Myofascial Local Pain Pin point pain over paraspinal Bssue trigger point

25 Myofascial Trigger Point

26 Myofascial Trigger Point Localized pain with palpabon AcBve trigger point may produce referred pain

27 Scleratogenous or Myofascial Triggers Diffusely referred and hard to localize Deep and achey quality Kellgren & Feinstein

28 Lumbar Facet Syndrome Flexion should be WNL Extension should be reduced with localized pain

29 Lumbar Range of MoBon Flexion and Extension Flexion 80 degrees Extension 35 degrees

30 Lumbar Range of MoBon Lateral Flexion Lateral Flexion 25 degrees

31 Lumbar Range of MoBon Lumbar RotaBon

32 Lumbar Facet Syndrome Extension and rotabon increase pain Flexion reduces pain Kemp s produces localized pain

33 Kemp s Test May be performed in either a standing or siqng posibon A posibve test involves radicular pain

34 Kemp s Test Assessment Intervertebral nerve root encroachment Muscular strain Ligamentous sprain Pericapsular inflammabon

35 Valsalva s Maneuver Neuro- orthopedic applicabon Assessment for space- occupying lesion, tumor, intervertebral disc herniabon, or osteophytes

36 Straight- Leg- Raising Test Assessment for space- occupying mass in the path of a nerve root, sacroiliac inflammabon and lumbosacral involvement

37 Well- Leg- Raising Test Fajersztajn s Test Assessment for lumbar nerve root lesion caused by IVD syndrome or dural sleeve adhesion Contralateral LE SLR

38 Straight Leg Raise Test Nerve Root Tension Signs Pain reacbon 0-35 = extradural = disc lesion = lumbosacral lesion Dull pain in posterior thigh = hamstrings

39 Key to Success Diagnosis is the key to successful treatment!

40 DifferenBal Diagnosis Lumbar Facet Syndrome Localized low back pain Increased pain with extension

41 DifferenBal Diagnosis Lumbar Facet Syndrome Mul%fidi myospasia Facet joint imbrica%on

42 Mechanical Low Back Pain Overuse Strain Myospasia DehydraBon Discopathy

43 Mechanical Low Back Pain Post- TraumaBc Pain Lumbar strain Lumbar sprain Lumbar fracture Lumbar strain/sprain

44 Lumbar Facet Joint ImbricaBon Zygapophyseal joint imbricabon with capsular degenerabon

45 Facet Joint InjecBon and Spinal ManipulaBon Reduces pain and edema prior to spinal manipulabon

46 Final Comments Perform a competent evaluabon Properly assess your pabent Educate your pabent Provide high quality care Be kind

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