Definitions

Question 0

Reactive arthritis

Answer 0

Classic Presentation:
• Young male
• Associated w/ venereal or dysenteric infection
• c/o LBP began after onset of urethritis, conjunctivitis, and skin lesions
–Diagnostic Tetrad:
1. Polyarthritis affecting the knees and ankles asymmetrically but SI is most common symptomatic joint (asymmetric sacroilitis)
2. Urethritis
3. Conjunctivitis (resolves w/n 1-2 d)
4. Lesion (tongue, palate, penis or foot)

Question 1

Degenerative spondyloisthesis

Answer 1

– Type III: Degenerative
• Secondary to long standing arthrosis
-Older patient with degenerative slippage, usually at L4
• 3 F’s: Female, Forty, Fourth Lumbar (L4)

Question 3

Coccydynia

Answer 3

• Irritation of the coccyx or sacrococcygeal junction with possible displacement of the coccyx
Etiology:
• Trauma: direct contusion or flexion sprain/anterior displacement or the rare extension injury from childbirth

Question 4

Infectious spondylitis

Answer 4

Classic Presentation:
No typical patient but some red flags include:
• Presentswithacomplaintofdeepbackpain
• Historyofarecentrespiratorytract,urinary
tract, or skin infection (or IV drug use or DM)
• Patientisantalgic
• Complainsoffeveranddifficultysleepingdueto pain
NOTE: pt is not always febrile

Question 5

Psoriatic arthritis

Answer 5

• Psoriasis usually precedes arthritis – Occasionally by as many as 5 - 20 y
– Can develops in the absence of detectable psoriasis
– 15-20% of patients, arthritis appears before the psoriasis
• Affects 5-8% of patients with psoriasis
• MC in caucasians, 35-55 yoa (but can occur at any age) • Men and women affected equally
• Labs: elevated ESR, (+) or (-) HLA-B27, (-) RF – Not diagnostic

Question 6

Ankylosing spondylitis

Answer 6

Classic Presentation:
• Young male (3months)
• Reliefwithmildtomoderateactivity
• Fatigueiscommon
“trolley track” sign

Question 7

Isthmic spondy

Answer 7

Type II: Isthmic
• Lytic or fatigue fracture of the pars interarticularis
• Elongated but intact pars • Acute fracture of the pars
– Isthmic: Patient with stress fracture of the pars interarticularis (spondylolysis) or an elongated pars 90% at L5
• Most Common type
• Pars is weakest part of neural arch
• Repetitive flexion and extension motion creating fracture
• Increased incidence in athletes
(eg. gymnastics, weight lifting, and football)
• 90% at L5
• Majority of slippage occurs in children under age of 10 • Lysthesis most likely to occur in patients with weakness
in iliolumbar ligament and TPs not well developed

Question 8

Isthmic spondy

Answer 8

– Isthmic: Patient with stress fracture of the pars interarticularis (spondylolysis) or an elongated pars 90% at L5
• Most Common type
• Pars is weakest part of neural arch
• Repetitive flexion and extension motion creating fracture
• Increased incidence in athletes
(eg. gymnastics, weight lifting, and football)
• 90% at L5
• Majority of slippage occurs in children under age of 10

Question 9

Metastatic carcinoma

Answer 9

Classic Presentation:
• Ptc/oinsidiousonsetofpain,persistent
• Worseatnightandnotmechanicallyaffected • OftenaHxofweightlossandfatigue
NOTE:
– Patient may be asymptomatic until late in course of disease
– May become symptomatic after trauma due to pathological weakness of the vertebrae