09 - Pain / 10 Back and neck pain Flashcards
Egs of alternative therapies for pain
Acupuncture Massage Aromatherapy Meditation Reiki and crystal healing
What happens in entrapment syndromes ?
Eg?
Loss of tone and sensation accompanied by paraesthesia and pain.
Carpal tunnel
What is polymyalgia ? Features?
Association?>
Mx?
Pain and stiffness in neck, shoulders, upper arms and hips.
Also fatigue, fever and anemia.
Inflammatory reactive syndrome attacking synovial tissue of affected joints.
Associated with temporal arteritis.
Treat with oral steroids (pred).
Where does the conus medullaris start
L1/2
Cervical nerve functions
C1 Purely motor. Neck and throat muscles. C2 Neck and throat muscles C3 Diaphragm C4 Diaphragm C5 Deltoids, biceps C6 Wrist extensors, biceps, rotator cuff C7 Triceps and forearm C8 Hands and fingers
Lumbar nerve functions
Nerve Function L1 Hip and spine flexion L2 Hip and spine flexion L3 Hip stability, knees L4 Hip stability, knees L5 Legs and feet (toes)
Which type of incontinence is to do with the internal sphincter?
Sympathetic and parasympathetic innervation?
Stress
Symp: L1-2: tonically keeps sphincter contracted
Para: S2-4 relaxes and allows urination
Which type of incontinence is to do with the detrussor?
Sympathetic and parasympathetic innervation?
urge (key in door) incontinence
Symp: T10-L2 relaxes bladder
Para: S2-4 contracts bladder
Egs of cause of cord compression?
Signs?
trauma, ischaemia, metastasis, abscesses,
Back Pain
Bilateral Radicular Pain,
LMN Signs at Level of Compression, UMN Signs and Sensory Loss Below,
Sphincter Disturbance
Acute: Tone and Reflexes Reduced
Difference between conus medullaris and cauda equina
Both - Back pain and double incontinence
CM = (back pain, double incontinence, rarely sensory loss, UMN and LMN clinical picture)
CE = (radicular pain, classic ‘saddle’ anaesthesia, double incontinence and lower limb weakness. LMN only as all affected nerves are PNS)
what is Syringomyelia?
Features?
Cyst/abscess/cavity formation within the spinal cord.
Wasting of hands and arms, loss of pain and temperature in cape distribution
What is brown sequard?
Features?
Incomplete hemisection injury. Distribution depends on location of lesion.
IPSILATERAL Motor loss and propriorception
CONTRALATERAL Pain and temperature.
Define osteoperosis
Decreased bone mineral density leading to increased # risk and pain.
Due to Imbalance between bone resorption and formation.
Rfs for osteoperosis
hyperthyroid, menopause, alcoholism, kidney disease, drugs
Clinical diagnosis of osteoporosis
Bone density 2.5 SDs out is –porosis.
If 1 SD out then is –penia
Mx of osteoperosis
Bisphosphonate therapy (alendronate, palmidronate) and modifiable risk factors.
What is ankylosing spondylitis
Inflammatory disease of axial skeleton (seronegative spondyloarthropathy)
Features of ank spond
Dull chronic lower back pain. Early morning wakening. Stiffness. Reduced lung capacity. May have B symptoms. Associated with uveitis.
Young male onset.
Mx of ank spond ? Seen on Xray \/
Manage symptoms with NSAIDs, opiods, DMARDs and PT.
Bamboo spine on X-ray
What is osteomalacia ? Rf?
Decreased bone calcium and vit D leading to softening.
Rickets in children.
Dark skinned people in hemispheric extremes due to vit D metabolism.
Features of osteomalacia
bone and join pain, weakness, abnormal gait, # risk and bone deformity.
Rf for osteomalacia
kidney disease, malnutrition, heavy metal poisoning,
Mx of osteomalacia
vit D injections and lifestyle factors.
What is Paget’s disease of bone? Key thing to remember
Excessive and disorganized bone breakdown and remodelling leading to weakened and deformed bones.
DOES NOT SPREAD!
Ix Pagets?
Features?
Mx?
Causes classic facies, cranial nerve entrapment, arthritis and bone pain.
‘Pepperpot skull’
Bisphonphonates control but do not cure
Red flags of back pain
Incontinence Hx of trauma or malignancy Sensory loss (particularly saddle anaesthesiae) Sudden onset Age <16 45< Weight loss Deformity Worse at night
