3 - Spine Flashcards
What is mechanical back pain
Recurrent, relapsing and remitting back pain
No neurological symptoms
Pain is worse on movement and relieved by rest
What can cause mechanical back pain
Obesity Poor posture Poor lifting technique Lack of exercise Depression Disc prolapse Facet joint OA Spondylosis
What is spondylosis
Intervertebral discs lose water content with age
Results in less cushioning and increased pressure on facet joints
Leads to secondary OA
How do you treat mechanical back pain
Analgesia
Physio - need to keep back moving
When might a patient with mechanical back pain benefit from spinal stabilisation surgery
If a single level is affected by OA or instability
If they haven’t improved with physio and conservative treatment
No other issues that affect surgery outcome
Surgery is effective in multi-level mechanical back pain - true or false
FALSE
there is no role for surgery
Describe the pain of an acute disc tear
Can be severe due to rich innervation
Pain is often worse on coughing
What is the classic cause of an acute disc tear
Lifting a heavy object
How do you treat an acute disc tear
analgesia
physio
symptoms usually resolve but can take 2-3 months
What can happen if a disc prolapses
disc material can press on an exiting nerve root
This can cause pain and altered sensation in a dermatomal distribution
Describe the pain of sciatica
Neuralgic burning or severe tingling pain down the back of the thigh towards the knee
How do you treat disc prolapse/ nerve pain
First line: analgesia, maintain mobility and physio
Then neuropathic pain drugs such as Gabapentin if severe pain
How can OA lead to nerve pain
OA of the facet joints can result in osteophytes forming and impinging on exiting nerve roots
How can nerve symptoms caused by OA be treated
Surgical decompression with trimming of osteophytes
Only done in suitable patients
What is spinal stenosis
When various back pathologies such as bulging discs, spondylosis and osteophytes mean there is less space for the spinal cord and so multiple
Spinal stenosis causes claudication in the legs - true or false
TRUE
Describe the presentation of claudication caused by spinal stenosis
The claudication distance is inconsistent
The pain is burning
Pain is less walking uphill
Pedal pulses are preserved
How do you treat spinal stenosis
Conservatively - physio and weight loss
Surgery - decompression
What causes cauda equina syndrome
Very large central disc prolapse that compresses all the nerve roots in the cauda equina
It is an emergency
What are the symptoms of cauda equina
Bilateral leg pain
Saddle anaesthesia
Altered urinary and bowel function
How do you manage cauda equina syndrome
Mandatory PR exam
Urgent MRI to determine level of prolapse
Surgery
List some red flags of back pain
Back pain in young patient
New back pain in older patient
Pain that is constant, severe or worse at night
Systemic upset
Usually suggests wither tumour or infection
What is an osteoporotic crush fracture
Occurs in severe osteoporosis
Vertebral body will have a spontaneous crush fracture
What are the symptoms of a osteoporotic crush fracture
Acute pain
Kyphosis
How do you treat a osteoporotic crush fracture
Conservatively
Some perform surgery in those with chronic pain
What are the symptoms of cervical spondylosis
slow onset of stiffness in the neck
Pain that can radiate to shoulders
How do you treat cervical spondylosis
Physio
Analgesia
What are the symptoms of a cervical disc prolapse
Neck pain
Shooting neuralgic pain in dermatomal pattern
Weakness and loss of reflexes (dependant on nerve affected)
Large prolapses may lead to myelopathy and upper motor neurone signs
What conditions are related to cervical spine instability
Down’s syndrome e
Rheumatoid arthritis
How can you manage cervical instability
Minor cases - avoid high impact/contact sport
More severe cases will need surgical stabilisation
What is carpal tunnel syndrome
Compression of median nerve caused by swelling or inflammation of the carpal tunnel
What can cause carpal tunnel syndrome
Idiopathic
RA
Conditions causing fluid retention - pregnancy, diabetes etc
Consequence of fractures
How does carpal tunnel present
Parathesia in the digits innervated by the median nerve
Usually worse at night
Loss of sensation/weakness in the thumb
How do you treat carpal tunnel syndrome
Wrist splints at night
Steroid injection
Surgery
What is cubital tunnel syndrome
Compression of ulnar nerve at elbow (behind medial epicondyle)
Can be due to a tight band of fascia forming over the roof of the tunnel
How does cubital tunnel syndrome present
Parathesia over the 1.5 fingers supplied by the ulnar nerve
Weakness of innervated muscles
How do you confirm diagnosis of cubital and carpal tunnel syndromes
Nerve conduction studies
