MSK Back Pain + CES Teaching Flashcards
what are common symptoms of cervical myelopathy
neck pain and stiffness
occipital headache
diffuse bilateral, non dermatomal paraesthesia of the extremities
bilateral weakness and decreased manual dexterity
gait instabiltiy
what can you expect to see on examination of a patient with cervical myelopathy
decreased pain sensation
proprioception dysfunction (advanced disease)
UMN signs: hyperreflexia, babinski +
Romberg’s sign
difficulty performing heel-toe walk
what is lhermitte’s sign
‘electric shock’ sensation down the spine on neck flexion
sign of cervical myelopathy
what are some causes of cervical myelopathy
degerative cervical spondylosis
- most common
- compression may be from:
osteophytes,
spondylisthesis,
ligament flavum hypertrophy
trauma,
epidural abscess,
cervical hyperkyphois
what is cervical myelopathy
a condition which describes the compression of the spinal cord at the cervical level
what imaging is suitable for cervical myelopathy
MRI
visualises the soft tissue
evaluate the degree of compression
what conservative management options are there for cervical myelopathy
NSAID, gabapentin if symptoms not improving
Physio
Immobilisation - hard collar in slight flexion
who is conservative management appropriate for with cervical myelopathy
mild disease with no functional impairment
pts who are poor candidates for surgery
what surgical options are there for cervical myelopathy
surgical decompression
for those with significant functional impairment and level 1-2 disease
what are red flag symptoms of back pain
thoracic pain
fever and unexplained weight loss
bladder/ bowel incontinence
painless urinary retention
Hx of malignancy
progressive neurological deficit
disturbed gait
saddle anaesthesia
<20yrs, >55yrs
what are some general differentials for back pain
muscular strain
vertebral fracture
prolapsed intervertebral disc
discitis
ankylosing spondylitis
spinal stenosis
maliganancy
what are risk factors for muscular lower back pain
heavy lifting
prolonged seating
obesity
smoking
gender
what is the management for muscular back pain
analgesia - NSAIDs, paracetamol, codeine
avoid heavy lifting
physiotherapy
saftey net
follow up in 2/52 to assess progress
imaging can be done if no improvement over 1 month or red flag symptoms preseny
symptoms of CES
lower back pain, can be the only symptom in early disease
unilateral/bilateral sciatica, motor or sensory symptoms
saddle anaesthesia
incontinence
painless urinary retention
erectile dysfunction
what should you examine for in suspected CES
reduced anal tone
uni/billateral lower limb weakness
reduced/absence sensation of the perineum, perianal reigon and posterior thigh
palpate bladder to check for retention