MS pathologies Flashcards
1
Q
Types of ARTHRITIS ?
A
Osteoarthritis (OA)/Degenerative Joint Disease (DJD)
Rheumatoid Arthritis (RA)
Gouty Arthritis
Septic Arthritis
2
Q
Osteoarthritis (OA) aka Degenerative Joint Disease (DJD) patho ?
A
Progressive degeneration and loss of articular cartilage.
Underlying bone is damaged, with formation of new bone (osteophytes) at margins.
3
Q
What is the key in dx OA ?
A
key thing of OA is osteophytes - dx degenerative condition (different from the others)
4
Q
Is OA non inflammatory to inflammatory ?
A
NON - inflammatory
5
Q
OA/DJD sxs ?
A
Slow onset, brief stiffness in AM or after overuse or inactivity
No generalized sxs of fatigue or malaise - not systemic disease just in joints itself
Usually additive
Commonly affects knees, hips, spine, wrists, DIP> PIP, not MCP ( helps you distinguish if from RA cause RA does not have DIP)
**athletes and obese cause pounding on joints , RA is more symmetrical **
6
Q
OA / DJD PE, signs ?
A
↓ AROM and PROM, crepitus
Rarely warm or red (cause it is not inflammatory)
Bony enlargement (from osteophytes) - new simulated bone
Heberden’s nodes – nodules at DIP jt.
Bouchard’s nodes –nodules at PIP jt.
7
Q
OA: Heberden’s nodes – nodules at ___ jt.
A
DIP
**osteophyte formation but they are not red swollen tender and stuff they are just hard a painless and the MCP joints are spared **
8
Q
OA: Bouchard’s nodes –nodules at ___ jt.
A
PIP
9
Q
OA / DJD - Treatment ?
A
NSAID’s
Pain meds (Tramadol) - opoid
Joint injections
Arthroplasty
rooster cone into the mixer and they inject it into the joint (synvisk)
10
Q
RA patho ?
A
Autoimmune disorder, unknown trigger, slow onset
Chronic inflammation of synovial membrane
-secondary erosion of cartilage and bone - damage to ligaments and tendons
**more slow onset
and they feel really crappy cause it is systemic and inflammatory
erosion of cart. and bone and damage to ligaments and tendons **
11
Q
RA sxs. ?
A
Symmetrically additive - usually both knee
Insidious onset, becomes chronic with exacerbations and remissions
Stiffness, lasting 1+ hours in AM or after inactivity (take them a while to get p and going)
Generalized sxs of weakness, fatigue, weight loss, fever
Females > Males
12
Q
RA PE, signs ?
A
↓ AROM and PROM
Tender and warm joints, seldom red
+/- subcutaneous nodules on ulnar surface
PIP and MCP most, rarely DIP
Ulnar deviation of fingers
Swan neck deformity
Boutonniere deformity (less common)
13
Q
Rheumatoid arthritis – swan neck and boutonniere deformities ?
A
top right is the swan hyper extension
inter osseous muscle atrophy cause they are not using the muscles look at bottom pic
14
Q
Acute gouty arthritis what crystal in the joint cause what type of reaction ?
A
Monosodium urate crystals in joint cause an inflammatory reaction
15
Q
Acute pseudogouty arthritis what crystal in the joint cause what type of reaction ?
A
(Pseudogout – calcium pyrophosphate crystals)
16
Q
Acute gouty arthritis - symptoms ?
A
Sudden onset of severe pain, often 1st MTP joint
but also instep, ankles, knees, elbows ( classically big toe)
+/- hx of recent, excessive intake of food (purines - high protein - shrimp) or ETOH, fasting or injury
Usually one joint on first episode
Repeat episodes become more frequent and more severe
17
Q
Acute gouty arthritis PE, signs ?
A
Very tender, hot and red
No stiffness, ↓ ROM is due to pain
Can be mistaken for cellulitis, septic arthritis
**looks like septic arthritis **
18
Q
Acute gouty arthritis labs ?
A
↑ serum uric acid (but can be normal in 30% of patients) -
not diagnostic though - gives us a clue
19
Q
What is dx study for GOUT ?
A
Definitive Dx – aspirate joint fluid
20
Q
Acute gouty arthritis tx ?
A
NSAIDs - acute
Education re: prevention ( avoid triggers)
recurrent / chronic GOUT - allopurinol
21
Q
Septic arthritis is a MS ____________ .
A
emergency
Can leave a permanent functional disability
**needs to be dx really quickly with bone destruction cause it really does not grow back **
22
Q
Septic arthritis (SA): Bacteria in a joint causes ?
A
vascular congestion - taking up more space
increased synovial fluid - more space being taken up
destruction of articular cartilage
destruction of bone within one week of
onset - losing bone in one week
23
Q
SA: Bacteria comes from one of 3 routes, which are ?
A
Hematogenous - IV drug user, LUPUS, strep or UTI ( small infections that can cause it )
Direct inoculation - severe trauma, surgery
Contiguous - someting nearby like a soft tissue abcess that erodes into the joint
24
Q
SA sxs ?
A
rapid pain ( look like GOUT),
swelling
↓ROM
25
SA PE ?
fever
x-ray reveals effusion and narrowed articular cartilage ( as crowding takes place)
26
SA labs ?
joint aspirate – turbid, gray or creamy with ↓viscosity. Do a gram stain and C&S
27
SA tx ?
dependent on cause and culture
heme tx that
abscess - treat that
May need aspiration and ATB’s (not PO more parenteral)
May need surgical open debridement ( debride out dead bone)
28
SA prognosis ?
Dependent on virulent the bacteria and joint involved
Hip and ankle are more likely to have permanent damage
-finger heal better
**depend on how quick you are to figure it out and how much destruction has been done
from a replacement - then remove hardware and clean it out and then put it back in **
29
Other arthritides ?
Gonococcal (type of septic) type of septic joint
Psoriatic
Lyme
Etc.
30
Shoulder Rotator cuff made of the tendons of 4 muscles , which are ?
Supra spinatous
Infra spinatous
Teres minor
Subscapular
31
What muscle is most commonly involved in RC injuries etc ?
Supra spinatous
| most commonly involved cause of location
32
Rotator cuff muscle purpose ?
They reinforce the joint capsule
33
What RC muscle can you not palpate ?
subscapularis
34
Impingement syndrome patho ? and what results ?
When the acromion, coracoacromial ligament, AC joint or coracoid process impinge (pinch) on bursa, biceps tendon and rotator cuff
Inflammation results
**something soft tissue wise is getting pinched by hard tissue -bone **
35
Impingement syndrome sxs ?
Gradual onset of ant and lat shoulder pain
Can’t sleep on affected side ( so sleep on back or other side )
36
Impingement syndrome PE, signs ?
+ impingement sign
↓ abduction ( cause it recreated pinch
Pain with flexion (near to ear)
37
Impingement syndrome tx ?
NSAIDs x 10-14 days
Rest
Stretching exercises
Injection of 10 ml mix of cortisone (depomedrol) & 1%
lidocaine - works right away
**quick and long term relief **
38
Rotator cuff tendinitis is one type of ?
impingement
39
Rotator cuff tendinitis is ?
the cuff is pinched under the acromion
40
Rotator cuff tendinitis caused by ?
repetitive overhead motions that cause the rotator cuff to be pinched under the acromion (throwing, swimming, etc.) painters
**acute - edema and hemorrhage
chornic - fibrosis and scarring down **
41
Rotator cuff tendinitis sxs. ?
pain when arm is overhead
42
Rotator cuff tendinitis PE, sign ?
+ impingement sign
Neer (ear) and Hawkins
43
Rotator cuff tendinitis tx ?
activity modification
PT
NSAIDs
injection
44
Rotator cuff tear from ?
Can be from chronic or
acute injury
**not inflamed it is now teared **
45
Rotator cuff tear chronic ?
Repeated impingement ex: heavy lifting
46
Rotator cuff tear acute ?
FOOSH (fall on an outstretched hand)
47
Rotator cuff tear can be ?
Tears can be partial or complete and are graded by severity
48
Rotator cuff tear sxs. ?
weakness
pain
trouble with ROM
49
Rotator cuff tear PE, signs ?
+ Drop Arm test ( abduct arm and then we ask them to lower it down and it will eventually just fall - not smooth)
Impaired active abduction – end up shrugging instead
50
Rotator cuff tear tx ?
depends on severity, and how active they are,
Rest
PT
surgery
**dont have to treat these it just depends on the patient **
51
How long does it take to heal a Rotator cuff tear after arthroscopic debridement ?
Takes 6-12 months after arthroscopic debridement
of a partial tear for a throwing athlete to resume athletics
(devastating to athletic career)
52
Calcific tendinitis patho ?
Degenerative process of a tendon, with deposits of calcium salts
Usually involves the supraspinatus tendon
More common in females, + 30y.o.
**deposit of Ca in the tendon **
53
Calcific tendinitis sxs ?
may be acute or chronic episodes of pain
54
Calcific tendinitis PE, sign ?
arm held close to the side, all directions of movement increase the pain (any movement hurts cause Ca salt are being pinch and moved on)
**the sub acromiun bursa may get inflamed as well **
55
Calcific tendinitis Tx ?
Remove the calcifications (arthroscopy)
Reduce the inflammation
-through cortisone injection
56
Biceps tendinitis patho ?
Inflammation of the long head of the biceps tendon
May resemble a rotator cuff tendinitis, or the two may co-exist
**treatment are a lot the same
lateral rotation will expose areas a lot better **
57
Biceps tendinitis sxs. ?
anterior shoulder pain
58
Biceps tendinitis PE, signs ?
+ Yergason test (resisted supination) and it aggravated biceps tendon
**elbow at 90 against the body and resist supination **
59
Biceps tendinitis tx ?
Activity modification
rest
NSAIDs
Steroid injection into sheath of tendon (if into tendon, can degenerate or rupture the tendon – “Popeye sign”
have to be really careful with these
60
Biceps rupture what defect ?
“Popeye defect”
**still some function of biceps and maybe no surgery for olde rman but a young kid then yea surgery to reattach it
tx - surgical correction if there is a complete tear of a tendon head **
61
Adhesive Capsulitis
aka ?
“Frozen Shoulder”
62
Adhesive Capsulitis
patho ?
Fibrosis of glenohumeral joint capsule
Usually unilateral, females>males, 40-60 y.o., older athletes
Sometimes have a hx of antecedent event such as a painful disorder of the shoulder or a disabling illness
**adhesive - its getting all stuck together ,its the whole joint ( glenohumeral joint) not just one aspect of the joint it is the whole thing , bedridden for a long time and joint is just frozen down , fibrous aphrodesious **
63
Adhesive Capsulitis
sxs. ?
diffuse, dull ache, no point tenderness. Worse at night.
64
Adhesive Capsulitis
PE, signs ?
progressive loss of ROM
all directions (dont wanna move it at all or sleep on it )
65
Adhesive Capsulitis
tx ?
ROM exercises (only way to break fibrous capsule and get it going)
PT
injections
NSAIDs
nerve stimulation (by PT), U/S
**walk finger up a wall for slow progression and try and go higher and higher each day
it will be awhile before it starts to get better **
66
Adhesive Capsulitis
prognosis ?
chronic, lasting months to years, but may resolve spontaneously (fully or partially)
67
Acromioclavicular arthritis is it common ?
yes
68
Acromioclavicular arthritis patho ?
Degenerative changes to the A/C joint, usually as a result of prior trauma
**AC joint
pinpoint right to it
movement of the scapula it painful
**
69
Acromioclavicular arthritis sxs. ?
pain at AC joint
70
Acromioclavicular arthritis PE, signs ?
movement of scapula is painful
movement of glenohumeral joint is NOT
71
Acromioclavicular arthritis tx ?
cortisone injections
shave arthroscopy
shave back bone to provide more joint space
surgical excision of acromial head
72
Subacromial bursitis usually between ?
Bursa between acromion and head of humerus inflames
73
Subacromial bursitis tender where ?
below tip of acromion (below top peak of the shoulder)
74
Subacromial bursitis pain w/ ?
Pain with abduction and rotation
75
Subacromial bursitis tx ?
NSAIDs
injections
76
Olecranon bursitis patho ?
Swelling and inflammation of olecranon bursa
Can be secondary to trauma, RA, gout, etc.
**tip of elbow
can get inflamed and it gets as big as a tennis ball (6cm in diameter)**
77
Olecranon bursitis sxs. ?
asymptomatic or painful, acute or chronic
78
Olecranon bursitis PE, signs ?
swelling, can become quite large
can reach 6 cms in diameter
79
Olecranon bursitis Tx. ?
Can aspirate (get culture) and inject but can recur
Apply compression wrap after aspiration - unless it will just fill back up
* *get a culture if you are worried about infection if it is warm and hot and red
* *
80
Rheumatoid Nodules what are they ?
Subcutaneous nodules can develop at pressure points on extensor surface of ulna in patients with RA or rheumatic fever - strep
Firm and nontender
**dont have to be treated but you ant to treat the arthritis **
81
Lateral Epicondylitis aka ?
tennis elbow
82
Lateral Epicondylitis patho ?
Secondary to repetitive extension of wrist against resistance or repetitive pronation/supination of forearm
**back hand swing
cashiers**
83
Lateral epicondylitis sxs. ?
pain and tenderness of lat. epicondyle, increased with movement against resistance
84
Lateral epicondylitis Tx. ?
– RICE
stop offending activity (rest), ice,
compression, elevation
- cortisone injection
- strengthen forearm - to help balance load
- elastic band around elbow
to change point of pull - take pressure off insertion point - same thing as taping a catheter
85
Medial Epicondylitis aka ?
Pitcher’s, Golfer’s, or
Little League elbow
86
Medial Epicondylitis patho ?
Secondary to repetitive flexion of wrist against resistance
87
Medial Epicondylitis sxs ?
pain and tenderness of lat. epicondyle, increased with movement against resistance
88
Medial Epicondylitis Tx ?
– RICE
stop offending activity (rest), ice,
compression, elevation
- cortisone injection
- strengthen forearm - to help balance load
- elastic band around elbow
to change point of pull - take pressure off insertion point - same thing as taping catheter
89
Ulnar nerve entrapment patho ?
Ulnar nerve (“funny bone”) is impinged at the elbow
90
Ulnar nerve entrapment caused by ?
- trauma
- prolonged bed rest - patient cant move and then in same position for a long time
- compression - cast or swelling of the elbow
91
Ulnar nerve entrapment sxs. ?
numbness of 4th and 5th finger, tender ulnar groove, decreased dexterity, 5th finger weakness
92
Ulnar nerve entrapment tx ?
avoid repetitive activity, take pressure off elbow so nerve can settle back down
rarely surgery to relive nerve compression
93
Most common soft tissue tumor of the hand and wrist its benign ?
Ganglion
94
Ganglion description ?
Round, cystic structure (soft ans squishy), often pedunculated (stalk), connecting the cyst to the joint capsule or tendon sheath
**Contains synovial fluid
usually on the dorsal surface of the wrist
make sure it is not pulsatile cause it could be an aneurysm **
95
Ganglion sxs. ?
usually painless unless large
96
Ganglion tx. ?
none, unless symptomatic
- aspirate and inject with steroid,but often recur will help scar it down
- excise ir recurrent
- may disappear spontaneously
**smash it with a book is the old tx**
97
Ganglion is most often on __________, over carpals or radial aspect of wrist
dorsum of wrist
98
Carpal Tunnel Syndrome patho ?
Carpal tunnel lies along the palmar aspect of wrist, covered by the transverse carpal ligament
Median nerve runs through
this tunnel innervating thumb,
2nd, 3rd and half of 4th digits
**this ligament is not stretchy **
99
Carpal tunnel syndrome epidemiology ?
trauma to wrist, acute or chronic inflammation, overuse, pregnancy, amyloidosis, CHF
100
Carpal tunnel syndrome sxs. ?
numbness, burning, tingling in thumb, 2, 3 and ½ 4 digits.
Awakens pt. at night, worse with driving, typing, phone (flexion)
**wake up at night and shake wrists **
101
Carpal tunnel syndrome PE, signs ?
Phalen’s – sxs recreated with sustained wrist flexion
Tinel’s – sxs recreated with tap over median nerve - more reliable
Thenar atrophy - if more long term
102
Carpal tunnel syndrome tests ?
Electromyelogram (EMG) - nerve conduction study
**delay in nerve conduction with this , this exam is mainly for insurance purposes **
103
Carpal tunnel syndrome tx ?
splint, especially at night,
decrease repetitive movements
change keyboard height,
steroid injection,
surgery (92% effective) - Carpal Tunnel Release
Takes several months for sxs to resolve
**numbness in the hand can also come from damage to the cervical region and mostly likely carpal tunnel **
104
Acute Flexor Tenosynovitis patho ?
Infection of flexor tendon sheath
105
Acute Flexor Tenosynovitis follows a ?
May follow local injury - from infection
**can spread infection to fossa of the palm so treat aggressively and quickly **
106
Acute Flexor Tenosynovitis may be tender where?
Tender along tendon sheath - cause it is tenosynovitis
107
Acute Flexor Tenosynovitis what is painful ?
Finger extension is painful - cause it is stretching tendon
108
Felon patho ?
Fingertip injury, infection of finger pad fascial space
**penetrating problems or cat bites
can spread to fossal spaces quickly **
109
Felon sxs, signs ?
Pain, swelling, dusky redness
110
Felon tx ?
I/D
111
Dupuytren’s contracture patho ?
Thickened fibrotic plaque of a flexor tendon
Progressive, nodular thickening develops on distal palmar surface, often of the ring or middle finger
**permanent contracture ,sometimes both finger and maybe both hands and it happens overtime not just over night **
112
Dupuytren’s contracture etiology ?
Etiology unknown, but ↑ association with epilepsy meds, alcohol abuse, DM, family history
Usually 40-60 y.o.
Males>females
Northern European ancestry
113
Dupuytren’s contracture sxs. ?
flexion contracture at MCP joint (or PIP, DIP)
Cannot extend digit – even with force
114
Dupuytren’s contracture tx ?
Xiaflex injection
- Fasciectomy, with post op
stretching exercises
**post op a lot of ROM exercises **
115
DeQuervain’s tenosynovitis patho ?
Inflammation of tendon sheaths of
- abductor pollicis longus (abductor of thumb)
- extensor pollicis brevis
116
DeQuervain’s tenosynovitis sxs. ?
pain at base of the thumb in “anatomical snuff box”
when thumb is adducted and wrist is ulnarly deviated it will stretch these tendons and it is a positive sign
(e.g. lifting frying pan)
117
DeQuervain’s tenosynovitis PE, signs ?
Finkelstein test
Enclose thumb
Sharply deviate wrist ulnarward
Elicits pain = + sign
118
DeQuervain’s tenosynovitis Tx ?
– rest
- thumb spica splint to prevent wrist deviation
- steroid injection
- surgical release
**put it in a spica splint **
119
Trigger Finger (Stenosing Tenosynovitis) patho ?
Painless nodule on flexor tendon, causes “catching” or “triggering” after forceful flexion. Nodule is trapped by annular pulley
120
Trigger Finger (Stenosing Tenosynovitis) more common in ?
DM
121
Trigger Finger (Stenosing Tenosynovitis) tx ?
steroid injection or rarely, surgery
**this one you can extend but you need force : Dupuytren’s contracture you cant extend at all!**
122
Low Back Pain (LBP) prevalence ?
Common – 60-90% of population will experience LBP at some point
Expensive to the economy due to missed work, medical care, etc. +$100 billion/year
123
Low Back Pain, what is important to get ?
Hx is important! - may be able to diagnose by history
Leg and buttock pain that does NOT go below the knees is most likely mechanical (sprain, strain, arthritis), not neurological
**not below the knees then most likely Muscouskeletal **
124
Low Back Pain, pain questions ?
Location
Duration
Severity
Quality ( neurologic is more burning and MS is more sharp and achy)
Timing
radiation
Similar sxs. before
response to previous tx and did it help
125
Risk factors for acute and chronic low back pain ?
Smoking
Obesity, poor conditioning
Age 30-50 years
Female gender
Work that is sedentary or perceived as stressful
Lower educational level
Workers’ compensation cases
Certain psychological characteristics
-people who like illness behavior
126
Low Back Pain – RED FLAGS Potentially indicate ?
Infection
Malignancy
Serious and/or emergent condition
127
Low Back Pain – RED FLAGS ?
Age <20 or +70 years (think more urgent things like fracture or malignancy )
Hx of cancer or recent wt loss
indicator of ongoing malignancy
Hx of fever, immunosuppression, immunocompromise, IVDU
New or progressive neurologic defect (incontinence, saddle anesthesia, b/l sciatica) - things involving spinal cord
Major trauma
Sxs +6 weeks - chronic - not usually MS by this point, something else is going on
128
Low Back Pain - Physical ?
Check skin
rash (shingles-zoster), bruising or edema
Check posture
leaning to one side, walking funny, guarding things?
Abdominal exam
aorta dilation in a aneurysm
Neuro exam – sensation, strength and DTR’s
deep tendon reflexes
Rectal exam – tone (no everyone with back pain)
spinal cord conditions can cause loss of rectal tone
MuscSkel – SLR and Contralat SLR
straight leg raise - put stretch on nerve and retreat pain down the back down the leg ( radicular pain, not quad pain)
**undress patient - look at skin, asking the patient to point to where it hurts is very helpful , if it is more midline then concern for spine but side then not as worrisome **
129
LBP is divided into 3 groups ?
1. Nonspecific LBP – 85%
2. LBP potentially associated with spinal condition
3. LBP associated with another cause
130
LBP: nonspecific LBP ?
No additional work up needed
GENERALLY DO FINE W.O TX.
131
LBP: ass. w/ spinal condition ?
Stenosis (pressure on cord), sciatica (inflammation), fracture, etc.
132
LBP: ass. w/ another cause ?
CA, infection, etc.
| secondary to CA or infection
133
Low Back Pain - Nonspecific: most common is ? for example ?
mechanical
- Lumbosacral strain/sprain (pull a muscle or tendon)
going to get better no matter what you do
134
Low Back Pain - Nonspecific sxs ?
No radiation of pain - it stays in lower back
No red flags
Pain better with recumbency - laying down
Normal neuro exam -DTR intact
135
Nonspecific Low Back Pain
Lumbosacral strain/sprain PE, signs ?
Paraspinal muscle spasms (of to the side maybe tender and tight)
Pain reproduced by direct (hurts cause right on the surface)
compression over the area
Pain with forward flexion, or walking uphill
Negative SLR - does not recreate any pain
136
Low Back Pain - Tests: Who to XR/CT/MRI ?
– If sxs don’t resolve quickly or worsen
- If + 70 y.o.
look for fracture or sign of metastasis
- If hx of trauma, CA, wt. loss, pain at rest, infxn (red FLAGS)
- Radiculopathy, IF results will impact tx
not for sciatica
137
Low Back Pain - Tests: Who to XR/CT/MRI notes ?
MRI – assesses neural compromise better than CT
choose MRI over CT cause more information about nerve supply
138
Nonspecific Low Back Pain - Treatment
?
Tailor it the patient
Goal is early return to functioning
Bed rest has negative impact (not the best thing)
– ↓ muscle bulk and demineralization of bone
- prolongs disability
Avoid prolonged sitting, heavy lifting
Mild analgesics – Tylenol, NSAID’s
Short course of prednisone?
depend on pt. and provider but usually not necessary
Muscle relaxers?
cause drowsiness so no driving
Education, heat or ice , back exercises ( especially abd. exercises so back muscle get a rest), prevention
**3% of muscle bulk every day with bed rest and 6% of bone minerals every 6 weeks **
139
Low Back Pain
Lumbosacral strain/sprain - prognosis ?
Usually self-limited - good news!
50% recover by 2 weeks
90% by 6 weeks - if not then worry about sometime more
25% will have recurrence within a year
**tell them that they are going to get better but it is going to take time for inflammation to go away
if your nice to it it will happen sooner so dont be mean to it **
140
CHRONIC Low Back Pain (>3 months)
Treatment ?
Acetaminophen – first-line
Spinal manipulation may help mechanical pain
Anticonvulsants (neurontin) if radiculopathy
-Gabapentin
Muscle relaxers - controversial
Opioids–weigh risk/benefit
only severe pain for a short period of time (constipation)
NSAIDs - worry about GI effects and bad for kidneys , take OTC stuff and take it with food
PT/OT - teach strengthening exercise
Exercises, acupuncture, massage - not well studied
Antidepressants -
Benzos - good for spasms
TENS unit? - not proven to be effective even though they still use it quite a bit
**careful in liver disease or on other meds with acetomenophin **
141
CHRONIC low back pain prognosis ?
Longer recovery is associated with illness behavior, depression:
1. Cognitive Behavioral Therapy (CBT) - learn coping mechanisms if longer than 6 weeks
2. Benzodiazepines -
If pain lasts longer than 6 wks -refer
142
Herniated Nucleus Pulposus
(HNP) facts ?
total of 24 vertebrae
90% at L4-L5 or L5-S1 - were herniated disc mostly occur - cause sharp angle
143
Herniated disc: 90 % of herniations are at ?
L4-L5 (dorsiflexors)
L5-S1 (plantar flexors, Achilles)
Causes nerve root
compression
144
HNP ?
annulus rupture and it herniates the jelly out of the donut
it is a FB reaction plus the mechanism pressure on the nerve root is causing symptoms and will follow the nerve root or derotomal distribution
145
Herniated Nucleus Pulposus (HNP) pain description ?
- from direct pressure on nerve root
- from breakdown of nucleus pulposus
- in a dermatomal distribution
146
HNP -PE ?
Straight Leg Raise
Recreates radicular pain (in first 30-70° of raise)
Dorsiflex foot or raise
head for additional
stretch on nerve
- asymmetric DTR’s
- motor weakness - push foot out against hand and one might be stronger than the other so look for symmetry
- sensory deficit
147
HNP dx?
MRI
148
HNP tx ?
Bedrest x 2 days (no longer), then PT
NO CHIROPRACTIC
ADJUSTMENTS
Muscle relaxers
NSAID’s
Epidural steroids - if recurrent
Surgery - if recurrent
**back to functional as fast as possible **
149
HNP tx surgery ?
- discectomy with fusion or replacement
- laminectomy
**laminectomy- allows nerve to have enough room
take the herniated disc out and fused vertebraa together maybe a fake disc to keep the space**
150
Sciatica patho ?
Inflammation of sciatic nerve – often due to HNP ( forgiven body substance creating the inflammatory reaction)
**in the butt, radiative even down to the feet and toes, just below the SI joint with patient on their side flexing their leg and hip - for palpation**
151
Sciatica sxs ?
Radicular pain – usually below knee(s)
↑ pain with bending, sneezing, coughing
152
Sciatica PE ?
+SLR ( straight leg riase- stretch nerve - it is inflammed), pain on palpation over SI joint, sensory changes, ↓Achilles reflex
153
Sciatica tx ?
NSAIDs
