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CONDITION/DISORDER SYNONYMS

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  • Lumbar hyperlordosis

  • Saddle back

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ICD-9-CM CODES

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  • 737.2 Lordosis (acquired)

  • 754.2 Congenital musculoskeletal deformities of spine

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ICD-10-CM CODES

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  • Q67.5 Congenital deformity of spine

  • Q76.3 Congenital scoliosis due to congenital bony malformation

  • Q76.425 Congenital lordosis, thoracolumbar region

  • Q76.426 Congenital lordosis, lumbar region

  • Q76.427 Congenital lordosis, lumbosacral region

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PREFERRED PRACTICE PATTERNS

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  • 4B: Impaired Posture1

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated With Localized Inflammation2

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders3

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PATIENT PRESENTATION

A 38-year-old female was referred to physical therapy by her primary care physician. She presents with low back pain (LBP) that began in her seventh month of pregnancy. She reports that her baby is 3 months old, but the pain is still present. She notes that the pain is worse after standing for long periods of time at work as a middle school teacher. She notes that the pain is worse when she rotates her back to write on the board. She mentions that it is becoming difficult to carry her baby due to the pain.

The PT examination revealed the following information. Posture showed an increase in lumbar lordosis with an anterior pelvic tilt. Pain was reproduced during the lower quarter screening during lumbar extension. MMT revealed hamstring strength bilaterally 4-/5, with all other bilateral lower extremity (LE) muscles 5/5. PIVM showed mobility in the spine to be 5 at L2 to L4 and 4 at L5 to S1. Patient had a positive quadrant test to the right side, a positive prone instability test, and a positive Thomas test.

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KEY FEATURES

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Description
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  • Excessive lumbar lordosis curvature

  • Increased extension of the lumbar spine compresses the facets

  • Anterior pelvic tilt

  • LBP with primary involvement of lumbar facet joint

  • Lower limb symptoms might be present in a nondermatomal pattern as a result of referred pain

  • Neurological findings, minimal

  • Bilateral symptoms

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FIGURE 142-1

Lordotic posture, exaggerated by standing on toes, associated with trunk and hip weakness. (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.)

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FIGURE 142-2

Curvatures of the spine affecting the thorax. (A) Kyphotic thorax. (B) Lordotic thorax. (C) Scoliotic thorax. Note the narrowing of the rib interspaces on the right and the accentuation of the interspaces, posterior humping of the chest, and elevation of the shoulder on the left. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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