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J MSK > Back conditions > Flashcards

Back conditions Flashcards

1
Q

which imaging technique is used to show spinal cord damage, intervertebral discs, nerves etc

GOLD standard for back pain

A

MRI

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2
Q

what do xrays show

A

bone only

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3
Q

scoliosis definition

A

lateral curvature of the spine

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4
Q

aetiology of scoliosis (6)

A

congenital
idiopathic
secondary to; neuromuscular disease, tumours, infection, spina bifida

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5
Q

is scoliosis painful

A

sometimes

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6
Q

investigations for scoliosis

why

A

MRI - for tumour

blood tests - for infection

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7
Q

scoliosis treatment if causing no pain and not deteriorating (3)

A

physio
casts/brace
wheelchair

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8
Q

scoliosis treatment if painful and deteriorating

A

anterior surgery

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9
Q

risk of surgery of any back surgery (eg for scoliosis)

A

spinal cord injury

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10
Q

presentation of scoliosis

A

resp distress

posture to one side (L or R)

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11
Q

where is your centre of gravity in kyphosis

A

anterior to spine

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12
Q

what does chance fractures increased your risk of

A

kyphosis

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13
Q

treatment of kyphosis (4)

A

same as scoliosis;
physio
brace
surgery

pain management

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14
Q

forward slippage of one vertebrae onto another

A

spondylolisthesis

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15
Q

aetiology of spondylolisthesis (3)

A

arthritis
trauma
stress fracture

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16
Q

where does spondylolisthesis occur (vertebral levels (2))

A

L4/5

L5/S1

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17
Q

where is the pain in spondylolisthesis

A

lower back

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18
Q

risk factors for spondylolisthesis (3)

A

often young
sport (bending over)
jobs with heavy weights

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19
Q

treatment for spondylolisthesis

A

rest
pain relief
physio

surgery (rarely - if >50% slip)

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20
Q

mechanical back pain treatment (4)

A

generally nothing
increase exercise (NOT bed rest)
pain relief
acupuncture, physio

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21
Q

back pain with no neuro symptoms, no red flags

A

mechanical back pain

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22
Q

what is the problem in mechanical back pain

A

muscles

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23
Q

aetiology of mechanical back pain

A

poor posture
obesity
facet joint OA

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24
Q

when is the pain worst in mechanical back pain

A

movement

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25
Q

when is pain relieved in mechanical back pain

A

rest

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26
Q

are slipped discs and spondylolisthesis different things

A

yes, different aetiology, there is no slipped disc in spondylolisthesis (just the vertebrae)

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27
Q

what is the most common cause of back pain in primary care

A

mechanical back pain

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28
Q

common name of prolapsed intervertebral disc

A

slipped disc

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29
Q

risk factors for slipped disc (2)

A

heavy lifting

old age

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30
Q

pathophysiology of slipped disc

A

outer fibrous ring allows central part of disc (annulus) to bulge out

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31
Q

what are the common conditions at L4/5 and L5/S1 (2)

A

slipped disc

spondylolisthesis

32
Q

where does slipped discs usually occur

A

L4/5 and L5/S1

33
Q

why is a slipped disc painful

A

annulus is highly innervated

34
Q

what feature of intervertebral discs makes them more likely to prolapse (slipped disc)

A

if they are dehydrated

35
Q

presentation of PAIN in slipped disc

when is the pain worse

A

episodic back pain then onset of leg pain

worse walking uphill

36
Q

what imagining technique shows disc dehydration for increased risk of slipped discs

A

MRI

37
Q

treatment of slipped disc (4)

A

self limiting
pain relief - NSAID, gabapentin if leg pain
increased activity (not bed rest)
physio

38
Q

slipped discs are self limiting, what % are fine after;

3 months
2 years

A

70%

90%

39
Q

what is usually the cause of sciatica

A

slipped disc at L4-S3 = compression of sciatic nerve

40
Q

buttock/leg pain not caused by hip, knee or ankle

A

sciatica

41
Q

is sciatica usually unilateral or bilateral

A

unilateral

42
Q

what pattern is the leg pain in sciatica in

A

dermatomal

43
Q

pain worse walking downhill

A

spinal stenosis

44
Q

what is spinal stenosis

A

narrowing of spaces in your spine = pressure on spinal cord = pain

45
Q

aetiology of spinal stenosis (2)

A

bulging discs

osteophytosis (bony spurs)

46
Q

spinal stenosis risk factors (4)

A

male
>50 years old
manual worker
obesity

47
Q

when is pain worst in spinal stenosis

A

walking downhill

48
Q

why does walking downhill cause pain in spinal stenosis

A

need to extend back to stay upright = compresses spinal cord

49
Q

when is pain relived in spinal stenosis

example

A

bending forward eg cycling

50
Q

apart from the back, where else might you get pain in spinal stenosis when walking downhill

A

legs

51
Q

investigation for spinal stenosis

A

MRI

52
Q

what causes discogenic pain (2)

A

acute disc tear

degenerative disc

53
Q

how is discogenic back pain different from other types of back pain (how does the pain present)

A

severe sudden exacerbations of pain
worse as day goes on, worse with activity
deep seated central back pain

54
Q

discogenic back pain treatment (2)

A

physio

analgesia

55
Q

spinal stenosis treatment (3 think of risk factor)

A

physio
weight loss
surgery (spinal decompression)

56
Q

degenerative disease of facet joints (cartilage between them)

A

facet joint arthritis (facet arthropathy)

57
Q

why is there pain in facet joint arthritis (facet arthropathy)

A

nerves travel close to facet joints

58
Q

when is pain worst in facet arthropathy

A

morning

rest (no movement)

59
Q

when is pain relieved in facet arthropathy

A

exercise

60
Q

which back problem presents with morning stiffness

A

facet arthropathy

61
Q

treatment of facet arthropathy (3)

A

exercise
pain relief
facet joint injections

62
Q

aetiology of cauda equina syndrome

A

disc prolapse at S3/4 level

63
Q

where is the cauda equina in relation to the spinal cord

A

below it, but still in the vertebrae

64
Q

presentation of cauda equina (3)

A

lower back pain
loss of bladder/bowel control
saddle anaesthesia - bilateral loss of sensation to buttocks/perineum/inner thigh

65
Q

investigations for cauda equina syndrome (2)

A

MRI

PR exam

66
Q

findings on PR exam in cauda equina syndrome

A

loss of anal tone

67
Q

treatment of cauda equina syndrome

A

emergency surgery within 24 hours

68
Q

complication of untreated cauda equina syndrome

A

paralysis

69
Q

complication of treated cauda equina syndrome

A

permanent bladder/bowel dysfunction

70
Q

spinal fracture with complete cord lesion results in…

A

complete paralysis

71
Q

spinal fracture with incomplete cord lesion results in…

A

some sensory/motor loss function below the point of injury

72
Q

what is the complete loss of sensation and motor function below the level of spinal cord injury that resolves in 24 hours called

A

spinal shock

73
Q

what conditions that affect the rest of the spine can also affect the cervical spine (4)

A

ankylosing spondylosis (degeneration)
disc prolapse
instability
fractures

74
Q

which 2 conditions are associated with cervical spine instability

A

downs syndrome

rheumatoid arthritis

75
Q

where does cervical instability typically happen (spinal level)

A

between C1 and C2 (atlanto-axial subluxation)

76
Q

acute pain and stiffness in cervical spine
bilateral foot pain
difficulty breathing
50 year old

A

ankylosing spondylitis

J MSK (30 decks)

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