Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Clinical conditions of the back > Flashcards

Clinical conditions of the back Flashcards

1
Q

What is mechanical back pain characterised by?

A
  • Pain when the spine is loaded
  • Worsens with exercise and is relieved with rest
  • Intermittent
  • Often triggered by innocuous activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for mechanical back pain?

A
  • Obesity
  • Poor posture
  • Sedentary lifestyle
  • Deconditioning of paraspinal muscles
  • Poorly-designed seating
  • Incorrect manual handling techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe disc degeneration in the spinal cord?

A
  • Nucleus pulposus of the intervertebral discs dehydrates with age
  • Leads to a decrease in the height of the discs, bulging of the discs and alteration of the load stresses on the joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does degeneration of the discs lead to?

A
  • Osteophytes called syndesmophytes develop adjacent to the end plates of the discs
  • This is called marginal osteophytosis
  • Osteoarthritic changes can develop - this can be painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens as vertebral disc height decreases and arthritis develops?

A
  • Compression of the spinal nerves
  • Perceived as radicular or nerve pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens as vertebral disc height decreases and arthritis develops?

A
  • Compression of the spinal nerves
  • Perceived as radicular or nerve pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the four stages of disc herniation?

A
  1. Disc degeneration: chemical changes associated with ageing causes disc to dehydrate and bulge
  2. Prolapse: protrusion of nucleus pulposus occurs with slight impingement into the spinal canal
  3. Extrusion: the nucleus pulposus breaks through the annulus fibrosus but is still contained within the disc space
  4. Sequestration: nucleus pulposus separates from the main body of the main body of the disc and enters the spinal canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most common sites for slipped disc?

A
  • L4/5
  • L5/S1
  • Due to mechanical loading at these joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where are the nerve roots most vulnerable?

A
  • Where they cross the intervertebral disc
  • When they exit the spinal canal in the intervertebral foramen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a paracentral prolapse?

A
  • Nucleus pulposus herniates posterolaterally
  • Causes compression of a spinal nerve root within the intervertebral foramen
  • Traversing nerve root is at risk (i.e. if L4/L5 disc is affected, L5 nerve root is compressed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does a central herniation carry a risk of?

A
  • Cauda equina syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is sciatica?

A
  • Pain caused by irritation or compression of one or more of the nerve roots that contribute to the sciatic nerve
  • L4, L5, S1, S2 and S3
  • Causes include marginal osteophytosis, slipped disc etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pain experienced in sciatica like?

A
  • Pain experienced is typically experienced in the back and buttock
  • Radiates to dermatome supplied by the affected nerve root
  • Paraesthesia is only experienced in affected dermatome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the typical distribution of pain in sciatica?

A
  • L4 sciatica: anterior thigh, anterior knee, medial leg
  • L5 sciatica: lateral thigh, lateral leg, dorsum of foot
  • S1 sciatica: posterior thigh, posterior leg, heel, sole of foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some causes of cauda equina syndrome?

A
  • Tumours affecting vertebral column or meninges
  • Spinal infection
  • Abscesses
  • Vertebral fracture
  • Spinal haemorrhage
  • Ankylosing spondylitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the red flag symptoms of cauda equina syndrome?

A
  • Bilateral sciatica
  • Perianal numbness
  • Painless urinary retention
  • Urinary/faecal incontinence
  • Erectile dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we treat cauda equina syndrome?

A
  • Surgical decompression within 48 hours of the onset of sphincter symptoms, otherwise prognosis is poor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is spinal canal stenosis?

A
  • Abnormal narrowing of the spinal canal that compresses either the spinal cord or nerve roots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some causes of spinal canal stenosis?

A
  • Combination of disc bulging, facet joint osteoarthritis, ligamentum flavum hypertrophy
  • Compression fractures of the vertebral bodies
  • Spondylolisthesis
  • Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of spinal canal stenosis?

A
  • Discomfort whilst standing
  • Discomfort or pain in the shoulder, arm or hand (cervical stenosis) or in the lower limb (lumbar stenosis)
  • Bilateral symptoms
  • Numbness at or below the level of stenosis
  • Weakness at or below the level of stenosis
  • Neurogenic claudication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the most common forms of stenosis?

A
  • Lumbar stenosis
  • Cervical stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is neurogenic claudication?

A
  • It is a symptom rather than a diagnosis
  • Patient reports pins and needles/pain in the legs on prolonged standing and on walking, radiating in a sciatica distribution
  • Also feels a cramping pain or weakness in the legs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does neurogenic claudication result from?

A
  • Compression of the spinal nerves as they emerge from the lumbosacral spinal cord
  • Results in reduced arterial inflow to nerves and transient arterial ischaemia
  • Results in pain or paraesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What relieves neurogenic claudication?

A
  • Rest
  • A change in position
  • Flexion of the spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is spondylolisthesis?

A
  • Anterior displacement of the vertebra above relative to the vertebra below
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is spondylolisthesis associated with?

A
  • Gross instability of the spinal column
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the symptoms of spondylolisthesis?

A
  • Some individuals may be asymptomatic
  • Most complain of some discomfort ranging from occasional lower backpain to incapacitating mechanical pain, sciatica from nerve root impression, and neurogenic claudication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do we treat spondylolisthesis?

A
  • Surgically using screws and rods to stabilise the spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the method for spotting spondylolysis?

A
  • Scottie dog seen in oblique views of the spine
  • If the dog’s head is detached from the body, indicating that spondylolisthesis has occurred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where is a lumbar puncture needle inserted?

A
  • In the midline between the spinous processes of the L3 and L4 (or L4 and L5) vertebrae
31
Q

What is cervical spondylosis?

A
  • Chronic degenerative osteoarthritis affecting the intervertebral joints in the cervical spine
32
Q

What is the primary pathology of cervical spondylosis?

A
  • Usually age-related disc degeneration
  • Followed by marginal osteophytosis
  • Facet joint osteoarthritis
33
Q

What causes radiculopathy during cervical spondylosis?

A
  • Narrowing of intervertebral foramina cab put pressure on spinal nerves
34
Q

What are the symptoms of radiculopathy?

A
  • Dermatomal sensory symptoms (e.g. paraesthesia and pain)
  • Myotomal motor weakness
35
Q

What causes myelopathy during cervical spondylosis?

A
  • If the degenerative process leads to narrowing of the spinal canal, this may put pressure on the spinal cord leading to myelopathy
36
Q

How does myelopathy present?

A
  • Global muscle weakness
  • Gait dysfunction
  • Loss of balance
  • Loss of bowel/bladder control
37
Q

Why do symptoms of myelopathy arise?

A
  • Due to compression and dysfunction of the ascending and descending tracts within the spinal cord
38
Q

What is a Jefferson’s fracture?

A
  • Fracture of the anterior and posterior arches of the atlas vertebra (C1)
  • Causes C1 vertebra to burst open like a polo mint
39
Q

What is the mechanism of injury of a Jefferson’s fracture?

A
  • Axial loading e.g. diving into shallow water
40
Q

What are the symptoms of a Jefferson’s fracture?

A
  • Pain but no neurological signs
  • Occasionally may be damage to the arteries at the base of the skull leading to secondary neurological sequelae e.g. ataxia, stroke or Horner’s syndrome
41
Q

What is a Hangman’s fracture?

A
  • The axis vertebra (C2) is fractured through the pars interarticularis
  • Unstable and requires treatment
42
Q

What is the mechanism of injury of a Hangman’s fracture?

A
  • Forcible hyperextension of the head on the neck
  • Road traffic collisions
43
Q

What can cause fractures of the odontoid process?

A
  • Can be caused by either flexion or extension injuries
  • Most commonly seen mechanism is an elderly patient with osteoporosis falling forwards and hitting their forehead (hyperextension)
  • Can also be caused by a blow to the back of the head resulting in a hyperflexion injury
44
Q

How do we detect an odontoid process fracture?

A
  • Detected on an open mouth AP X-ray or a CT of the cervical spine
45
Q

What is whiplash?

A
  • Forceful hyperextension-hyperflexion injury of the cervical spine
46
Q

What is the classical mechanism of a whiplash injury?

A
  • A patient’s car is struck from the rear leading to an acceleration-deceleration injury
  • Hyperextension and hyperflexion leads to tearing of cervical muscles and ligaments
  • Secondary oedema, haemorrhage and inflammation may occur
  • Spasm causes pain and stiffness
47
Q

What else may patients with whiplash injury present with?

A
  • Pain and paraesthesia as a result of injury to the spinal nerves during the whiplash movement of the cervical spine.
  • Patients may also develop shoulder injuries and lower back pain acutely
48
Q

How can some whiplash injuries result in injury to the cervical cord?

A
  • Cervical spine is highly mobile and the ligaments and capsule of the joints are weak and loose
  • There can be significant movement of the vertebrae at the time of impact
49
Q

What is a protective factor against cervical spinal cord injury?

A
  • Vertebral foramen is large relative to the diameter of the cord
50
Q

What makes a cervical intervertebral disc prolapse more likely to be painful?

A
  • There is little space available for the exiting nerves
  • So even a small cervical disc herniation may impinge on the nerve and cause significant pain
51
Q

What can cause cervical intervertebral disc prolapse?

A
  • May be spontaneous
  • May be related to trauma and neck injury
52
Q

What are the symptoms of cervical intervertebral disc prolapse?

A
  • Paracentral prolapse may impinge on a spinal nerve leading to radiculopathy
  • Canal filling prolapse may lead to acute spinal cord compression
  • Symptoms are dependent on the site of the prolapse
  • Exiting nerve root is compressed
53
Q

What is cervical myelopathy?

A
  • Spinal cord dysfunction due to compression of the cord
  • Caused by narrowing of the spinal canal
54
Q

What is common cause of cervical myelopathy?

A
  • Degenerative stenosis of the spinal canal caused by cervical spondylosis
  • Most commonly affects 50-80 years old
55
Q

What is the cause of cervical spondylotic myelopathy?

A
  • Degenerative changes that develop with age, including:
  • Ligamentum flavum hypertrophy or buckling
  • Facet joint hypertrophy
  • Disc protrusion
  • Osteophyte formation
  • These changes cause a reduction in canal diameter, compressing the spinal cord
56
Q

What are some other causes of cervical myelopathy?

A
  • Congenital stenosis stenosis of the spinal canal
  • Cervical disc herniation
  • Spondylolisthesis
  • Trauma
  • Tumour
  • Rheumatoid arthritis
57
Q

What causes the symptoms of cervical myelopathy?

A
  • Compression of the long tracts of the spinal cord
58
Q

What is the classical presentation of cervical myelopathy?

A
  • Loss of balance with poor coordination
  • Decreased dexterity
  • Weakness
  • Numbness
  • Severe cases can lead to paralysis
  • Pain may or may not be present
59
Q

How does cervical myelopathy affect elderly patients?

A
  • Cervical myelopathy often manifests with a rapid deterioration of gait and hand function
60
Q

What do upper cervical lesions cause?

A
  • Loss of manual dexterity
  • Difficulties writing
  • Non-specific alteration in arm weakness and sensation
  • May demonstrate dysdiadochokinesia
61
Q

What do lower cervical lesions cause?

A
  • Spasticity
  • Loss of proprioception in the legs
  • ‘Legs feel heavy’
  • Reduced exercise tolerance
  • Gait disturbance
  • May suffer multiple falls
62
Q

What is the usual function of the long tracts?

A
  • Dampen spinal reflexes so a person does not overreact to stimuli
63
Q

What happens when the long tracts are damaged?

A
  • Protective capabilities are less effective
  • Patient may demonstrate an exaggerated response to stimulation
  • Positive Hoffman’s or Babinski sign
64
Q

What is Hoffman’s test?

A
  • Doctor holds patient’s middle finger at middle phalanx and flicks the finger nail
  • If index finger and thumb move, the patient has a positive Hoffman’s sign
65
Q

What is the Babinski sign?

A
  • Stroke lateral side of sole of foot with a blunt instrument from the heels to the toes
  • Normal response is plantarflexion of toes
  • Abnormal/positive Babinski sign = hallux dorsiflexion and toes fan out
  • This suggests damage to the long tracts of the spinal cord
66
Q

What happens when spinal cord compression is severe in late cervical myelopathy?

A
  • If surgical decompression is not performed
  • Symptoms may progress to sphincter dysfunction and quadriplegia (paralysis of all four limbs)
67
Q

What happens if a patient develops myelopathy of the cervical spine at the level of C5?

A
  • Neck pain
  • Weakness of shoulder abduction and external rotation (C5 myotome)
  • Weakness of all myotomes distally, including the trunk and the lower limbs
  • Paraesthesia from the shoulder distally, trunk and lower limbs
68
Q

What are the commonest causes of thoracic cord compression?

A
  • Vertebral fractures
  • Tumours in the spinal canal - metastases are very common
69
Q

What are the symptoms of thoracic cord compression?

A
  • Pain at the site of the lesion
  • Spastic paralysis of the leg muscles
  • Weakness of intercostal muscles below the level of the lesion
  • Paraesthesia in the dermatomes distal to the site of cord compression
  • Loss of sphincter control
70
Q

How can pathogens reach the bones and tissues of the spine?

A
  • Haematogenous (most common route)
  • Direct inoculation during invasive spinal procedures
  • Spread from adjacent soft tissue infection
71
Q

Who is most commonly affected by spondylodiscitis?

A
  • Immunocompromised patients e.g. those with diabetes, HIV and patients on steroids
72
Q

How does infection spread to the intervertebral discs via the blood?

A
  • Discs are avascular
  • Organisms are initially deposited in vertebral body via its segmental artery
  • Leads to bony ischaemia and infarction
  • Necrosis of the bone then allows direct spread of organisms into the adjacent disc space, epidural space and adjacent vertebra bodies
73
Q

How does spread of infection into the spinal canal lead to neurological damage?

A
  • Septic thrombosis leading to ischaemia
  • Compression of neural elements by abscess/inflammatory tissue
  • Direct invasion of neural elements by inflammatory tissue
  • Mechanical collapse of bone leading to instability, particularly in chronic infections
74
Q

What are the common organisms that cause vertebral osteomyelitis/spondylodiscitis?

A
  • Staphylococcus aureus
  • Gram negative bacilli such as E. coli
  • Coagulase negative Staphylococci (Staph epidermis) common following invasive spinal procedures
  • Infection with more unusual organisms (e.g. Pseudomonas, Candida) may be seen in IV drug users

MSK (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions