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syposium control and movement > Back > Flashcards

Back Flashcards

1
Q

how is the spine a shock absorber along with the legs?

A

This occurs because the spine is flexible, and is supported by strong muscles and tendons

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2
Q

What happens if the spine is no longer able to absorb shocks?

A

we lose the ability to protect ourselves from abnormal shocks and vibrations (ankylosing spondylitis)

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3
Q

what are the 3 main curves in the spin?

A

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis

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4
Q

what does kyphosis mean?

A

excessive outward curvature

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5
Q

what does lordosis mean?

A

excessive inward curvature

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6
Q

what part of the spine is most flexible and why?

A

Cervical spine is the most mobile part of the spine, due to having relatively thick discs in comparison to the size of the adjacent vertebrae

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7
Q

what part of the spine is least flexible and why?

A

Thoracic spine is the least mobile, partly due to the ribs inhibiting movement

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8
Q

what part of the spine is mainly shock absorbers?

A

the interverebral discs

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9
Q

at what time of day is the discs most stiff?

A

They are most stiff in the morning. They are swollen with water so the annulus and intervertebral ligaments resist bending strongly and are more vulnerable to injury

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10
Q

How does the disc become more flexible but what potential problem can this cause?

A

As the day progresses, discs lose up to 20% of their water and height so the spine is more supple but low back pain can increase during the day and with standing

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11
Q

what happens to the spine especially the intervetebral discs with increae age?

A

Discs lose water and lose strength and become thinner
Vertebral endplates and underlying bone structure loses strength
Repetitive loading/trauma can result in annular tears in the discs
Dryer, weaker discs result in slacker ligaments
Spine is less stable
New bone grows (osteophytes) to try to stabilise the spine
Increased load over the facet joints

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12
Q

what is the problem with osteophytes?

A

they usually grow in areas they should not

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13
Q

what are osteophytes?

A

they are new bone for compensation to the spine. To help with the added pressure in certain parts of the vertebral column

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14
Q

what is clinical importane does this have on the vertebral column for elderly people?

A

Loss of movement
Muscle weakness and wasting
Both due to ‘fear avoidance

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15
Q

what should people with LBP do?

A

Keep flexible

Keep strong

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16
Q

what determines back pain?

A

Genetics
Environment
Body weight
Muscle strength need them to support spine
Mechanical loading strengthens vertebral bodies and increases the water content within discs
OVERloading should be avoided

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17
Q

what occupation risk factors are there for lower back pain?

A 
Heavy physical jobs
Lifting 
Driving to work
Previous episodes of LBP
Mental health
Posture- laptops, seating, desk set-up
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18
Q

what are the classifications of LBP?

A

Simple backache
Nerve root involvement
Possible serious spinal pathology

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19
Q

describe the the first episode of Mechanical (simple) back pain?

A

First episode often sudden onset while lifting/twisting/turning

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20
Q

With mechanical back pain what occurs with reccurent episdoes?

A

Recurrent episodes with decreasing inter-episode frequency

Variable pain related to position/posture

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21
Q

how do patients elevate mechanical back pain?

A

Better lying flat

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22
Q

where else can pain radiate to with mechanical back pain and when during the day is it worse?

A

May radiate to buttock and leg

Often worse at the end of the day and better with lying down/resting

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23
Q

what is a characteristic of sciatic pain?

A

pain below the knees

24
Q

what was the old thinking with treatment to mechanical back pain?

A

How to lift
Imaging
Bed rest
Don’t return to work until 100% better

25
Q

what is the current thinking with treatment to mechanical back pain?

A 
Exercise
No imaging
Activity
Light duty option
Work to contact re welfare
26
Q

with LBP how long should you rest for?

A

no longer than 1-3 days

27
Q

when do you refer a patient with LBP to secondary care?

A

after 6 weeks of pain

28
Q

what is LBP early management guidlelines?

A 
Simple analgesics
Physiotherapy if symptoms > few days
Rest for no longer than 1-3 days
Practice psychosocial management
Work absence only if unavoidable
Early return to work, possibly graded
Consider secondary care referral if on going at 6 weeks
29
Q

what is the drug treatment for LBP?

A 
Paracetamol 
NSAIDs 
Opioids
Tricyclic anti-depressants (amitriptyline)
Nerve modulators
30
Q

what is sciatica?

A

name given to any sort of pain that is caused by irritation or compression of the sciatic nerve.

31
Q

what is the sciatic nerves?

A

– L4 to S3

32
Q

where is the pain radiating in sciatica?

A

Pain radiating from the back to the leg below the knee

33
Q

what might be assoicated with sciatica?

A

May be associated with pins and needles in leg

May be associated with numbness and weakness

34
Q

what is the commonest neurological sign for sciatica?

A

loss of ankle jerk

35
Q

what is the most common weakeness for people with sciatica?

A

foot drop?

36
Q

what is red flag symptoms for possible serious spinal pathology?

A 
Age (young or old) at first onset
History of carcinoma
Weight loss
Constant (24h) pain > 1 month
No response to treatment
Pain worse at rest
History of IV drug abuse or HIV positivity
UTI or other infection
37
Q

what is the difference between inflammatory back pain and mechanical back pain?

A

with inflammatory the pain gets better with movement and worse with rest but is the opposite for mechanical

38
Q

what occurs with Ankylosing spondylitis?

A 
pain and stiffness in the spine
 large joint oligoarthritis
 enthesitis
 iritis
 FH of associated diseases (IBD, psoriasis)
39
Q

who are most likely affected by Ankylosing spondylitis?

A

young men

40
Q

what does oligoarthritis mean?

A

is the most common type of juvenile idiopathic arthritis

41
Q

what does enthesitis?

A

it is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.

42
Q

what is iritis?

A

inflammation of the iris

43
Q

what are the risk factors of Osteoporosis?

A 
Age
Female (oestrogen)
Smoking
Steroids
Alcohol
Family history
44
Q

what is Osteomalacia ?

A

softening of the bones, typically through a deficiency of vitamin D or calcium.

45
Q

what is paget disease?

A

chronic disorder that can result in enlarged and misshapen bones.

46
Q

when does paget disease usually occur?

A

Prevalence increases with age

47
Q

is paget disease symptomatic or asymptomatic?

A

asymptomatic

48
Q

what is raised with paget disease?

A

alkaline phosphatase

49
Q

what is common site for paget disease and what can it cause?

A

Commonest site is pelvis

Can cause spinal stenosis

50
Q

what is the history of a infection/neoplastic damage to the spin?

A 
Insidious onset, sometimes subacute
Slow deterioration
24 hr pain
Weight loss
Associated symptoms
Sometimes fever
51
Q

what occurs with spinal stenosis?

A

Usually a history of chronic back pain
Bilateral leg symptoms
Weakness, tingling, sometimes described as ‘cold water running down the legs’

52
Q

when does symptoms of spinal stenosis usually come about?

A

Leg symptoms come on while standing or walking

53
Q

how is symptoms of spinal stenosis relieved?

A

Relieved by rest (sitting) or leaning forward

54
Q

how is spinal stenosis distinguised to intermittent claudication ?

A

by normal peripheral pulses and worse walking downhill

55
Q

what is Cauda equina syndrome?

A

Difficulty with micturition
Loss of anal sphincter tone or faecal incontinence
Saddle anaesthesia
Low back and/or leg pain

syposium control and movement (11 decks)

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