09 - Pain / 10 Back and neck pain

Question 1

Egs of alternative therapies for pain

Answer 1

Acupuncture
Massage
Aromatherapy
Meditation
Reiki and crystal healing

Question 2

What happens in entrapment syndromes ?

Eg?

Answer 2

Loss of tone and sensation accompanied by paraesthesia and pain.

Carpal tunnel

Question 3

What is polymyalgia ? Features?
Association?>
Mx?

Answer 3

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).

Question 4

Where does the conus medullaris start

Answer 4

L1/2

Question 5

Cervical nerve functions

Answer 5

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

Question 6

Lumbar nerve functions

Answer 6

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)

Question 7

Which type of incontinence is to do with the internal sphincter?
Sympathetic and parasympathetic innervation?

Answer 7

Stress

Symp: L1-2: tonically keeps sphincter contracted

Para: S2-4 relaxes and allows urination

Question 8

Which type of incontinence is to do with the detrussor?

Sympathetic and parasympathetic innervation?

Answer 8

urge (key in door) incontinence

Symp: T10-L2 relaxes bladder

Para: S2-4 contracts bladder

Question 9

Egs of cause of cord compression?

Signs?

Answer 9

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

Question 10

Difference between conus medullaris and cauda equina

Answer 10

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)

Question 11

what is Syringomyelia?

Features?

Answer 11

Cyst/abscess/cavity formation within the spinal cord.

Wasting of hands and arms, loss of pain and temperature in cape distribution

Question 12

What is brown sequard?

Features?

Answer 12

Incomplete hemisection injury. Distribution depends on location of lesion.

IPSILATERAL Motor loss and propriorception

CONTRALATERAL Pain and temperature.

Question 13

Define osteoperosis

Answer 13

Decreased bone mineral density leading to increased # risk and pain.

Due to Imbalance between bone resorption and formation.

Question 14

Rfs for osteoperosis

Answer 14

hyperthyroid, menopause, alcoholism, kidney disease, drugs

Question 15

Clinical diagnosis of osteoporosis

Answer 15

Bone density 2.5 SDs out is –porosis.

If 1 SD out then is –penia

Question 16

Mx of osteoperosis

Answer 16

Bisphosphonate therapy (alendronate, palmidronate) and modifiable risk factors.

Question 17

What is ankylosing spondylitis

Answer 17

Inflammatory disease of axial skeleton (seronegative spondyloarthropathy)

Question 18

Features of ank spond

Answer 18

Dull chronic lower back pain. 
Early morning wakening. 
Stiffness. 
Reduced lung capacity. 
May have B symptoms. 
Associated with uveitis.

Young male onset.

Question 19

Mx of ank spond ? Seen on Xray \/

Answer 19

Manage symptoms with NSAIDs, opiods, DMARDs and PT.

Bamboo spine on X-ray

Question 20

What is osteomalacia ? Rf?

Answer 20

Decreased bone calcium and vit D leading to softening.
Rickets in children.

Dark skinned people in hemispheric extremes due to vit D metabolism.

Question 21

Features of osteomalacia

Answer 21

bone and join pain, weakness, abnormal gait, # risk and bone deformity.

Question 22

Rf for osteomalacia

Answer 22

kidney disease, malnutrition, heavy metal poisoning,

Question 23

Mx of osteomalacia

Answer 23

vit D injections and lifestyle factors.

Question 24

What is Paget’s disease of bone? Key thing to remember

Answer 24

Excessive and disorganized bone breakdown and remodelling leading to weakened and deformed bones.

DOES NOT SPREAD!

Question 25

Ix Pagets?
Features?
Mx?

Answer 25

Causes classic facies, cranial nerve entrapment, arthritis and bone pain.
‘Pepperpot skull’

Bisphonphonates control but do not cure

Question 26

Red flags of back pain

Answer 26

Incontinence
Hx of trauma or malignancy
Sensory loss (particularly saddle anaesthesiae)
Sudden onset
Age <16 45<
Weight loss
Deformity
Worse at night