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Clin Med II MHM - FINAL > Back and Neck Disorders Stowell > Flashcards

Back and Neck Disorders Stowell Flashcards

1
Q

What is the MC cause of work disability?

A

Low back pain

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2
Q

Cause of low back pain

A

Unable to determine in most cases

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3
Q

70-90% of low back pain cases are:

A

Nonspecific (aka mechanical)

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4
Q

Majority of low back pain cases resolve within:

A

4-12 wks

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5
Q

Various causes of low back pain

A
  • Non specific (70%)

- Ortho pathology (25%)

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6
Q

Inflammatory arthritis causing low back pain is often a/w:

A

HLA-B27

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7
Q

What are examples of orthopedic pathology that can cause low back pain?

A
  • Degenerative changes (OA)
  • Disc herniation
  • Compression fracture
  • Spinal stenosis
  • Trauma (fracture)
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8
Q

What clinical factors increase probability of neoplasm causing low back pain?

A
  1. Previous history of non-skin cancer
  2. Age over 50
  3. Unexplained wt loss
  4. Failure of conservative tx for LBP
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9
Q

Etiologies of infection causing low back pain?

A
  • Post-traumatic
  • Vascular insufficiency (DM)
  • Hematogenous seeding (S aureus)
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10
Q

What clinical features suggest ankylosing spondylitis?

A
  • Age less than 40
  • Morning stiffness
  • Duration more than 3 months
  • Symptoms improve w/easy exercise
  • Not relieved w/rest
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11
Q

What PE findings can be found with ankylosing spondylitis?

A
  • Sacroiliac tenderness
  • Limited chest expansion
  • Limited lumbar ROM
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12
Q

Imaging findings of ankylosing spondylitis

A
  • Grading of sacroilitis

- Bamboo sign (fusing of vertebral bodies)

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13
Q

Describe the HLA-B27 gene and its relation to AS

A
  • Normal finding in 8% of Caucasians
  • Only 2% of people w/the gene will develop AS
  • So it is NOT diagnostic for AS
  • Can be a finding though
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14
Q

What abnormal lab is found in 70% of patients with AS?

A

Elevated ESR

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15
Q

What is cauda equina syndrome (CES)?

A
  • Compression of lower spinal nerve roots
  • Impairs motor and sensory function to lower extremities and bladder
  • MEDICAL EMERGENCY
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16
Q

What is the MC finding a/w CES?

A

Urinary retention

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17
Q

What is saddle anesthesia and what is it a/w?

A
  • Unable to feel anything in body areas that sit on a saddle

- A/w CES

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18
Q

Define degenerative joint disease (DJD)

A

Term used interchangeably with osteoarthritis (OA)

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19
Q

Define degenerative disc disease

A
  • Degenerative changes of disc
  • Fissures develop
  • Reduced ability to maintain fluid flow (loss of disc height)
  • Can be a source of chronic LBP
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20
Q

Define ankylosis

A
  • Joint stiffness d/t disease or surgery

- Union of proximal/distal bones of joint

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21
Q

Describe osteoarthritis

A

Gradual progression of disc degeneration and articular cartilage mechanical breakdown

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22
Q

What dynamic is altered in OA?

A

Cartilage/disc fluid (decreased ability to absorb/distribute mechanical stress)

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23
Q

What joint alterations occur with OA?

A
  • Osteophytes (bone spurs)
  • Spondylosis
  • Spondylolisthesis
  • Stenosis
  • Decreased disc height
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24
Q

Why/how do osteophytes (bone spurs) form in OA?

A
  • Secondary to facet joint dysfunction
  • Body’s way of trying to splint or limit use of joint
  • Joints above and below will suffer additional/abnormal mechanical forces
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25
Q

Clinical features of OA

A
  • Age over 50
  • Gradual onset
  • Worse in AM or after prolonged rest
  • Relieved w/light activity
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26
Q

MOI for OA

A
  • Prolonged postural activity (painting, gardening)
  • Weekend warrior
  • Grandparenting syndrome
  • Usually not acute trauma
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27
Q

What is the common ROM pattern with OA?

A
  • Extension (side bending) feels worse

- Flexion feels better

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28
Q

What imaging confirms OA?

A

Plain film x-ray (AP and lat)

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29
Q

How do labs present in OA?

A

Normal

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30
Q

What is a disc bulge?

A
  • Herniated nucleus pulposa (HNP)

- May or may not compress/stretch a nerve root (asymp or symptomatic)

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31
Q

Define discogenic pain

A

Nociceptors in disc generate pain to back/LE

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32
Q

If a disc bulge compresses the nerve root, what is produced?

A

LE radiculopathy

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33
Q

Define radiculopathy

A

Spinal nerve root impingement d/t space occupying lesion in vertebral canal or IVF

34
Q

MC lumbar radiculopathy

A

L5 and S1 followed by L4

35
Q

Possible causes of radiculopathy

A
  • Herniated nucleus pulposa
  • OA
  • Spondylolisthesis (severe)
  • Lumbar spinal stenosis
36
Q

Disc herniation w/radiculopathy ROM pattern

A

Flexion makes it worse (provokes radicular symptoms)

37
Q

OA vs. disc herniation w/radiculopathy ROM patterns

A
  • Flexion feels better in OA

- Flexion feels worse in radiculopathy

38
Q

Motor and reflex findings of disc herniation w/radiculopathy

A
  • Motor: weakness of myotome of involved nerve root

- Reflex: diminished DTR of involved nerve root

39
Q

2 common neural tension tests to assess radicular symptoms

A
  • Straight leg raise (supine)

- Slump test (sitting)

40
Q

Imaging for diagnosis of disc herniation w/radiculopathy

A

Not indicated! Unless red flags or need to rule in or out other

41
Q

Non-surgical management of disc herniation w/radiculopathy

A
  • OTC pain meds (often not good enough)
  • Steroid taper
  • Epidural steroid injections
  • McKenzie Method (centralization technique by PTs and chiropractors)
  • Patient education for coping
42
Q

Surgical management of disc herniation w/radiculopathy

A
  • Micro-discectomy

- Discectomy

43
Q

Pros of surgical management of disc herniation w/radiculopathy

A
  • Pts w/dominant leg pain can have excellent results

- 85-90% return to full function

44
Q

Cons of surgical management of disc herniation w/radiculopathy

A

Up to 15% of patients have continued back pain that may limit their return to full function

45
Q

Define spinal stenosis

A

Narrowing of vertebral canal and/or IVF

46
Q

Causes of spinal stenosis

A
  • Disc, tumor, cyst
  • Congenital narrowing
  • OA
47
Q

How does spinal stenosis present?

A
  • Age over 55-60 yrs
  • Radiating leg pain that gets worse with downhill walking (extension worsens it)
  • LE symptoms consistent w/neurogenic claudication (relieved forward flexion)
  • May or may not have back pain
48
Q

Surgical treatment of spinal stenosis

A
  • X stop implant
  • Laminectomy (decompress the nerves)
  • Fusion (if unstable segments)
49
Q

Describe X stop implant

A
  • Spinal stenosis surgery
  • Titanium wedge inserted b/w spinous processes
  • Outpatient procedure
  • Permanent but does not attach to bone or ligaments
50
Q

Define spondylolysis

A

Defect in pars interarticularis of a vertebra

51
Q

Define spondylolisthesis

A
  • Defect in pars interarticularis of a vertebra

- WITH anterior displacement of the vertebra

52
Q

Define spondylosis

A

Stiffening or fusing of joint (often from degenerative changes)

53
Q

Classifications of spondylolisthesis

A 
Type 1: congenital
Type 2: isthmic (classic presentation of adolescent patient)
Type 3: degenerative
Type 4: traumatic
Type 5: pathologic
54
Q

Who are those affected by spondylolisthesis?

A
  • Adolescents

- Athletes in extension type sport (football, gymnastics, figure skating)

55
Q

When do symptoms usually develop in spondylolisthesis?

A

Usually around a growth spurt

56
Q

How does spondylolisthesis present clincially?

A
  • Extension is worse

- Straight leg raise positive

57
Q

Diagnosis of spondylolisthesis

A
  • Need to order plain film oblique view!

- Scotty dog defect

58
Q

Treatment of spondylolisthesis

A
  • Rest and remove provoking activity
  • Pain management
  • Bracing only if severe
  • Protocols for return to sport
59
Q

Grading of spondylolisthesis

A 
1 = 0-25%
2 = 25-50%
3 = 50-75%
4 = 75-100%
5 = 100+%
60
Q

Define scoliosis

A

Lateral curve of the spine (at least 10 degrees) with a rotational deformity

61
Q

What is the MC spinal deformity?

62
Q

Define structural scoliosis

A
  • Bony deformity

- Curve NOT reducible w/flexion or lateral flexion

63
Q

Define non-strucutral scoliosis

A
  • Fixed (curve NOT reducible)

- Non-fixed (curve reducible w/flexion or lat flexion)

64
Q

Define functional scoliosis

A
  • Flexible

- Curve able to be reduced partially or completely w/flexion or lateral flexion

65
Q

Types of scoliosis

A
  • Structural
  • Non-structural
  • Functional
66
Q

Causes of scoliosis

A
  • Idiopathic
  • Congenital
  • Neurouscular
  • Misc (tumor, abscess)
67
Q

Types of idiopathic scoliosis

A
  • Infantile (under 3 yo, majority resolve spontaneously)
  • Juvenile (3-9 yo, high rate of progression and lead to severe deformity)
  • Adolescent (80-90% of idiopathic cases, onset at puberty)
68
Q

Describe adolescent idiopathic scoliosis

A
  • Puberty (10-13 yo)

- Female 3.6 to male 1

69
Q

Diagnosis of scoliosis

A
  • Postural screen (look from posterior and lateral)

- Forward flexion test (look for rib hump)

70
Q

Treatment of scoliosis curves greater than 20-25 degrees

A

May need bracing and exercise

71
Q

Treatment of scoliosis curves greater than 45 degrees

A

Cannot be effectively braced

72
Q

Treatment of scoliosis curves greater than 45-50 degrees

A

May need surgery

73
Q

How often do we monitor younger patients w/scoliosis?

A

Every 4-6 months

74
Q

Describe bracing in scoliosis

A
  • Goal is to stop worsening curve
  • Wear 23 hours a day (some just at night)
  • May have to wear months to years
75
Q

How does cervical myelopathy present?

A

Hyperreflexia of DTRs

Hoffman’s sign (finger flexor reflex)

76
Q

Most cervical spine fractures occur where?

A

C2 or C6-7

77
Q

Most fatal cervical spine injuries occur where?

78
Q

Jefferson fracture and types

A

C1 fracture

  • Posterior arch (MC)
  • Burst
79
Q

Hangman’s fracture

A

Pedicle of C2 resulting from hyperextension injury

80
Q

Cervical compression fracture types

A

I: simple wedge fx
II: teardrop
III: comminuted burst body fx
IV and V: complex involving posterior elements

81
Q

MC locations of cervical disc herniation w/radiculopathy

A
  • C7 (60%)

- C6 (25%)

Clin Med II MHM - FINAL (16 decks)

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