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  • Sprain of facet joint, lumbar
  • Arthritic changes in facet joint

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  • 847.2 Lumbar sprain

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  • S33 Dislocation and sprain of joints and ligaments of lumbar spine and pelvis
  • S33.5 Sprain of ligaments of lumbar spine

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Description

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  • Low back pain (LBP) with primary involvement of lumbar facet joint
  • Lower limb symptoms might be present in a non-dermatomal pattern as a result of referred pain
  • Neurological findings, minimal
  • Unilateral symptoms

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Essentials of Diagnosis

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  • Diagnosis made by clinical examination
  • Use of treatment- (impairment) based classification system is useful to determine evidence-based practice (EBP) treatment plan
  • Reproduction of symptoms when putting joint in closed packed position (combination of extension, side-bending towards involved side, rotation away from involved site)

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General Considerations

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  • Presentation can vary significantly based on anatomical structures and psychosocial factors
  • Often difficult to diagnose cause of pain

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Demographics

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  • Variable, based on specific condition

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Signs and Symptoms

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  • Pain in lumbar or sacral area that can be mechanically reproduced
  • Possible unilateral or bilateral referred pain, or pain in lower extremities
  • ROM limited in a capsular pattern: rotation and side-bending limited in opposite direction
  • Lumbar segmental hypomobility may be present in capsular pattern
  • May be associated with poor core-muscle strength and postural deviations

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Functional Implications

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  • Leading cause of occupational disability
  • May cause decreased ability to perform ADLs/IADLs
  • May impact ability to participate in sports and other recreational activities

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Possible Contributing Causes

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  • Occupational factors
  • Congenital anomalies
  • Physical condition
  • Smoking
  • Obesity
  • Socio-economic factors
  • Psychosocial and behavioral factors
  • Postural changes
  • Weakness of core musculature
  • Tightness of hip flexors, external rotators, hamstrings

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Differential Diagnosis

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  • Vascular insufficiency
  • Peripheral nerve impairment
  • Hip pathology with radiating pain-pattern
  • Malignant spinal tumor or metastasis
  • Referred pain from visceral structures
  • Systematic auto-immune diseases (RA, Reiter's, etc.)
  • Ankylosing spondylitis
  • Abdominal aortic aneurism
  • Radiculopathy

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Imaging

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  • Not necessary in most cases; only with persistent symptoms that do not respond to conservative management or presence of red/yellow flags
  • MRI helps to visualize compressed or inflamed nerve root/disc pathology in diagnosis
  • X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)
  • CT scan to show herniation compressing the spinal canal/nerves, rule out abdominal pathology
  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function
  • Doppler ultrasound to examine vascular function

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