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spondylosis tx
cervical collar, traction, PT, analgesics
advanced: fusion, diskectomy
what is cauda equina syndrome
large midline disk herniation that compresses several nerve roots(usally L4-L5). bowel and bladder function impaired. leg pain, paralysis, saddle anesthesea noted
what is spondylosis
deg changes occuring in disk, frequently C5-6 with osteophytes and disk narrowing. later facet joints and luschka are affected.
sx of spondylosis
paresthesias and numbness in fingers. pain increases with extension and decreases with flexion of the neck
maybe long tract signs-babinski and gait disturbance (from compression by central disk protrusion or osteophyte)
Kienbock’s disease
osteonecrosis of lunate (OA of wrist)
OA features
heberdens(DIP) and Bouchards
RA features
PIP, soft tissue swelling, MCP joints
organism of a human bite
eikenella corrodens
xray shows a ground glass appearance of proximal pole
scaphoid fx
unilateral low back and buttock pain that gets worse with standing in one position
sacroiliac joint involvement
spinal stenosis symptom
worse with walking and relieved by leaning forward
what are mckenzie exercises for
for disk derangement
possible underlying causes of scoliosis
upper or lower motor neuron disease, myopathies
what is the most common spinal deformity
idiopathic adolescent scoliosis
most common types of scoliosis
right thoracic(T7-T8) then double major(right thoracic and left lumbar)
PE findings for scoliosis
asymmetry of shoulder/iliac height/scapulars, flank crease with bending…showing right thoracic and left lumbar prominence
what kinds of scoliosis curves are less likely to progress to other curves
curves less then 20 degrees, diagnosed less then 2 years post menarche, and risser stage 2-4
what is cobb’s method
measurement is perpendicular to the end plate of the most tilted vertebra for scoliosis, worry if it is over 15%
scoliosis treatment
10-15 degree curves: 6-12 mnth follow up. 15-20 degree curves need serial xrays every 4 mnths for large curves and 6-8 months for smaller curves
over 20 degrees: see specialist
kyphosis
increased CONVEX curvature of thoracic spine; 1/3 present with scoliosis. (robins back)
scheuermann’s disease
juvenile kyphosis, idiopathic osteochondrosis of the thoracic spine
pott’s disease
TB of spine d/t extrapulmonary lesion(kyphosis)
kyphosis dx and tx
standing lateral film definitive
45-60 degree curves should be observed every 3-4mnths and do exercises. curves 60 degrees needs a milwaukee brace.
what is central spinal stenosis
compression of the thecal sac, can be idiopathic or developmental
what is lateral spinal stenosis
impingement of nerve root lateral to thecal sac.
spinal stenosis more common in who
men. symptomatic in late middle age
spinal stenosis dx
xray, plain CT, postmyelographic CT, MRI
hip contractures, fixed cervical, thoracic, lumbar hyperkyphosis
ankylosing spondylitis
extra-articular manisfestations of ankylosing spondylitis
uveitis, hrt abnormalities, and interstitial lung disease
Labs in ankylosis spondylitis
elevated CRP and ESR; 90% whites and 50% blacks will have positive HLA-B27
best tx for ankylosing spondylitis
swimming
whiplash
mechanism
duration of pain
tx
rapid extension then flexion
pain can last 18 months or longer
soft, cervical collar 2-3 days, ice/heat, analgesics, gentle ROM
if a spinal curve is a result of faulty posture…
it will disappear with spinal flexion
kyphosis with
multiple vertebra
single vertebra
round back if multiple
angular curve if 1
excessive lumbar lordosis common when
in kyphosis
