21: Approach To Thoracolumbar Complaint Flashcards
Risk factors for spina bifida
FHx neural tube defects, folate deficiency, DM, increased body temp, obesity, meds
Three types of spina bifida and what they mean
- Spina bifida occulta: mildest, no sx besides possible patch of hair
- Meningocele: sac of fluid comes through baby’s back, nervous tissue intact and normal
- Myelomeningocele: most severe, spinal canal open with membranes and spinal nerves pushed through sac, can cause paralysis/bladder and bowel dysfunction
What does meningo mean?
Lining of vertebral canal
What does myelo mean?
Spinal cord proper
What does cele mean?
Something bulging out
Most common form of scoliosis
Adolescent idiopathic scoliosis (AIS)
Females with scoliosis
5-10x more likely to progress to severe disease
If both parents have AIS…
Offspring 50x more likely to require treatment for scoliosis
Why can scoliosis screenings be harmful?
May have referrals and radiographs that lead to significant expense and harm to patient when treatment isn’t even necessary
Risser Sign-progression prediction
Shows amount of calcification present in iliac apophysis (grade 1 = low ossification, grade 4 = 1–% ossification, grade 5 = fusion has occurred)
How to interpret Risser sign-progression prediction
The lower grade Risser sign means the child has a lot more growth to do, meaning scoliosis is likely to progress more
Five red flags for scoliosis
- Onset before age 8
- Severe pain
- Rapid curvature progression (>1 degree per month)
- Unusual left thoracic curve)
- Neurological deficits/findings
When does the first episode of LBP occur?
Between 20-40 years of age
Acute low back pain: definition
6-12 weeks of pain between the costal angles and gluteal folds that may radiate to 1 or both legs
Acute low back pain specificity
Acute LBP is often non-specific without a definite cause
Most susceptible population for compression fractures
Elderly white females
Some historical findings that may lead to believe pt has a compression fracture
- Significant age-related trauma (strongest)
- Prolonged steroid use
- Age 70+, osteoporosis
Most common “cause” of compression fractures
Osteoporosis
Some causes of herniated nucleus pulposus
Obesity, occupation, genetics, smoking
Where do the following injuries refer pain to: spine, sacroiliac joint, lumbar roots
Spine -> refers to thigh
Sacroiliac joint -> refers to thigh, sometimes knee
Lumbar root -> refers to leg
L1-L3 nerve root injury vs L4-S1 nerve root injury: where the pain radiations
L1-3: radiates to hip/thigh
L4-S1: radiates below knee
Where are 98% of disc herniations?
Between L4/L5, L5/S1
Where to test sensation for L4, L5, and S1?
L4: patella
L5: great toe
S1: Achilles, lateral foot
Some red flags that may point to cancer in the back
Metastatic cancer, unexplained weight loss, pain increased with rest, vertebral tenderness
Red Flags for back pain (with mnemonic)
TUNAFISH T: trauma U: unexplained weight loss N: neurologic sx A: age >50 F: fever I: IVDU S: steroid use H: Hx cancer
Is psoas syndrome common?
No, other conditions such as herniation, arthritis, and sacroiliac pain are much more common
What can cause psoas syndrome?
Shortening/injury of iliopsoas, most common in athletes, after sitting for a prolonged time and standing up
Anatomical short leg syndrome vs functional short leg
Anatomical: one leg longer, can be corrected with a heel lift
Functional: apparent short leg, but structurally both are the same length when measured
Two major causes of piriformis syndrome
Anatomical variation, Hx direct trauma to butt
How is piriformis Syndrome different from disc herniation?
Piriformis syndrome exacerbated by active external hip rotation
Neurogenic claudication
A combo of LBP, leg pain, numbness, and motor weakness that starts/intensifies after walking, eased by lying down
Population where spondylosis is most common
Children and adolescents, most common in children/teeens in sports with lots of low back stress
What is the most common cause of back pain in teens?
Spondylolisthesis
Two examples of CT diseases
RA, SLE
General presentation of CT disease
Multiple joint arthralgia, fever, weight loss, fatigue, other joint tenderness
Spondyloarthropathies
Forms of arthritis that affects bones and nearby joints
General presentation of spondyloarthropathies
Intermittent pain at night, morning pain, inability to reverse from lumbar lordosis to lumbar flexion
Three examples of spondyloarthropathies
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
Most common form of spondyloarthropathy
Ankylosing spondylitis
Most susceptible population to Ankylosing spondylitis
White males between 15-40 years of age
What happens in Ankylosing spondylitis
Ossification of annulus fibrosus in lumbar spine from formation of syndesmophytes
Scottie Dog is related to what condition?
Spondylolysis
Step-off is related to what condition?
Spondylolisthesis
Bamboo spine is associated with what condition
Ankylosing spondylitis
Most susceptible population for reactive arthritis
Males in late teens/early adulthood
Reiter’s syndrome
Spondyloarthropathy with eye, urethra, and joint inflammation
