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CHI302 - Diagnosis and Chiro skill > Mechanical spinal pain syndrome- 3 > Flashcards

Mechanical spinal pain syndrome- 3 Flashcards

1
Q

Lateral Entrapment Syndrome- 2 types

A
  1. Those seen as a result of instability

2. Those seen as a result of degeneration

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2
Q

Lateral Entrapment Syndrome- Characterised by

A
  • Characterised by pain and a variety of parenthetic symptoms without any claudication signs
  • Sitting or lying alleviates the symptoms
  • Negative straight leg raise
  • Not many abnormal neurological findings
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3
Q

What is spondylosis?

A
  • Degeneration of the spine characterised by:
  • osteophytes
  • symmetrical loss of disc height
  • sclerosis
  • vacuum phenomenon
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4
Q

What are the two types of entrapments that can occur in instability causing LATERAL ENTRAPMENT SYNDROME?

A
  1. Structural changes narrow the lateral canal

2. Recurrent dynamic narrowing occurs because the superior articular process moves back and forth

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5
Q

LATERAL ENTRAPMENT SYNDROME- symptoms

A
  • Patients may or may not complain of low back pain
  • commonly in buttocks, trochanteric region and posterior thigh to the knee
  • somtimes pain passes further distally down the back of the calf (S1) or down the lateral aspect of the calf (L5) to the ankle and occasionally to the foot and toes
  • normal neurology
  • nerve root tension test may be positive
  • patient may complain of altered sensation or hypoesthesia in L5, S1 dermatome
  • movements are usually restricted
  • patient may have minimal complaints of low back pain as their leg pain is the predominant feature
  • reduced straight leg raise
  • pain may be increased with extension and lateral flexion towards the side of symptoms
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6
Q

LATERAL ENTRAPMENT SYNDROME- management

A
  • Trial of manipulation
  • Avoidance of lumbar spine rotation
  • Flexion distraction
  • Physiological therapeutics for pain control
  • ice, heat, electro therapies
  • No claudication (this distinguishes from central canal stenosis, spondylosis and myelopathy
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7
Q

CENTRAL CANAL STENOSIS IN LUMBAR SPINE- clinical features

A
  • Patient may present as having spinal stenosis although they have neurogenic CLAUDICATION, which indicates central canal stenosis
  • Use to walk everyday, now can only walk 250m (fixed distance) without getting leg pain
  • Pain relief in forward flexion as it widens central canal
  • Bilateral symptoms
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8
Q

CENTRAL CANAL STENOSIS IN LUMBAR SPINE- Neurogenic Claudication symptoms

A
  • Lower back pain
  • Bilateral leg pain
  • Numbness and motor weakness of lower extremities that is worse with walking and improved with sitting and supine rest
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9
Q

CENTRAL CANAL STENOSIS DIAGRAM

A

LEARN IT (14 MARKS ) IN EXAM PAGE 6

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10
Q

SPONDYLOLISTHESIS- Definiton

A
  • Anterior slipping of one vertebrae relative to the adjacent vertebrae
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11
Q

SPONDYLOLISTHESIS- 5 types

A
  • Dysplastic
  • Isthmic
  • Degenerative
  • Traumatic
  • Pathological
    ( Dysplastic and Isthmic are congenital, the others are acquired)
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12
Q

CENTRAL CANAL STENOSIS - Definition

A
  • Refers to the narrowing of the vertebral canal in which the spinal cord runs through
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13
Q

CENTRAL CANAL STENOSIS IN CERVICAL SPINE- clinical features

A
  • neck pain syndromes, myelopathy, rediculopathy
  • pain and stiffness (may be chronic or episodic)
  • neck injury may cause an acute presentation
  • decreased mobility
  • muscle spasms
  • tenderness
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14
Q

MYELOPATHY- Definition

A
  • compression of the spinal cord
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15
Q

MYELOPATHY- clinical features

A

C3-C5
- Numb and/or clumsy hands
- Loss of manual dexterity
- Abnormal sensation
- arm weakness
C5-C8
- cause a syndrome of spasticity and proprioceptive loss in the legs
- Extensor plantar responses are elicited
- Difficulty walking, unsteady feeling, loss of balance
- Loss of bowel and bladder function (end stage)
- Urinary frequency and urgency

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16
Q

CERVICAL MYELOPATHY- neurologic symptoms

A
  • Motor weakness, sensory loss, spasticity with hyperreflexia in the extremities
17
Q

DYSPLASTIC SPONDYLOLISTHESIS

A
  • Facet joint allows anterior translation of one vertebrae on another
18
Q

ISTHMIC SPONDYLOLISTHESIS

A
  • A lesion of the pars interarticularis
  • There are 3 subclasses:
  • stress fracture of the pars interarticularis
  • elongation of the pars interarticularis
  • acute fracture of the pars interarticularis
  • common at L5-S1
19
Q

DEGENERATIVE SPONDYLOLISTHESIS

A
  • Secondary to osteoarthritis leading to facet incompetence and disc degeneration
  • common at L4-L5
  • MAJOR CAUSE OF CENTRAL CANAL STENOSIS
  • pars is intact but facet joint degenerates
20
Q

TRAUMATIC SPONDYLOLISTHESIS

A
  • Due to a fracture of the posterior elements, other than the pars interarticularis leading to instability
21
Q

PATHOLOGIC SPONDYLOLISTHESIS

A
  • Due to a tumor or another primary disease of bone, affecting the pars interarticularis or the facet joints, leading to instability
22
Q

SPONDYLOLYSIS- Definition

A
  • Defect in the pars interarticularis

- Most common cause of back pain in a child

23
Q

SPONDYLOLYSIS - Clinical features

A
  • Pain in hyperextension of the lumbar spine, particularly with single limb stance
  • hamstring contracture
  • gait disturbances
  • child may have rediculopathy
  • scoliosis may be associated with spondylolysis
24
Q

SPONDYLOLISTHESIS- Treatment

A
  • activity modification and exercises
  • recurrent evaluation
  • hamstring stretching
  • steriod injections
  • WILLIAMS FLEXION EXERCISES
25
Q

CERVICAL SPINE ACCELERATION/ DECELERATION INJURY

A

TABLE PAGE 18 AND PAGE 19 EXAM (10MARKS) DO IT!

26
Q

CERVICAL SPINE ACCELERATION/ DECELERATION INJURY- treatment recommendations for acute WAD

A
  • Active exercise
  • Advice to act as usual, reassurance, education
  • within ongoing benefits
  • ice, heat, electro therapies, pharmacology, manipulation/ mobilisation
27
Q

CERVICAL SPINE ACCELERATION/ DECELERATION INJURY- Treatment that should not be undertaken for acute WAD

A
  • Collar immobilisation
  • surgery except in WAD 4
  • cervical pillows
  • intra articular injections
28
Q

THORACIC COSTOTRANSVERSE JOINT PAIN SYNDROME- clinical presentation

A
  • pain here is common in ankylosing spondylitis due to synovitis
  • dysfunction of costovertebral joint causes localised pain 3-4cm from midline
  • diagnosis is confirmed only when movement of the rib provokes pain at the costovertebral joint
29
Q

THORACIC COSTOTRANSVERSE JOINT PAIN SYNDROME- cancers can refer pain to the costo transverse area, cancers where?

A
  • cardiovascular
  • respiratory
  • G.I.T
  • musculoskeletal
30
Q

What three things influence ADOLESCENT IDIOPATHIC SCOLIOSIS

A
  1. Age
  2. Gender
  3. Magnitude of the curve
31
Q

ADOLESCENT IDIOPATHIC SCOLIOSIS - Prevalence

A
  • curve of 10 degress, ratio of boys to girls is equal
  • curve greater that 30 degrees, ration 10:1 (girls win)
  • prevalence of curve greater that 30 degrees in 0.2 percent
  • prevalence of curve greater that40 degrees is 0.1 percent
32
Q

ADOLESCENT IDIOPATHIC SCOLIOSIS- Definition

A
  • infant scoliosis has onset before age of 3
  • juvenile scoliosis detected between 3 and 10 yrs
  • adolescent idiopathic scoliosis found between 10 and skeletal maturity
  • THE YOUNGER THE AGE OF ONSET THE GREATER THE LIKELIHOOD OF PROGRESSION
33
Q

Lateral Entrapment Syndromes- definition

A
  • Progressive degenerative changes in both facets and the disc results in a loss of disc height
  • The approximation of the vertebrae creates a subluxation of facets joints whereby the superior facet moves upward and forward on the inferior facet impingement upon the pedicle above thereby narrowing of the intervertebral foramen
  • osteophytes that form on medial edge of superior facet may impinge on the nerve that exits one level lower and cause entrapment ( at L4-L5 the L4 nerve or the L5 nerve or both can be entraped

CHI302 - Diagnosis and Chiro skill (15 decks)

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