MSK - GALS Screen + Spine Flashcards
What are the extra-articular features of ankylosing spondylitis?
- Anterior uveitis
- Aortitis
- Aortic regurgitation
- AV node block
- Apical pulmonary fibrosis
- Amyloidosis → glomerulonephritis
- Achilles tendon (and other tendon) enthesitis
You examine a patient with a positive sciatic nerve stretch test. What pathology does this indicate?
A positive sciatic nerve stretch test indicates sciatic nerve irritation, usually due to L4-S1 disc herniation/facet joint impingement
Which neurological features would you expect in L5 radiculopathy due to disc prolapse?
L5 radiculopathy may cause:
* Some ankle dorsiflexion weakness (L4>L5)
* Ankle inversion weakness (L4/5)
* Hip abduction weakness (L4/5)
* Big toe extension weakness (L5)
* Dermatomal pain/sensory loss in anterolateral lower leg and dorsum of foot
Which investigations may be used to help differentiate the causes of back pain?
Bloods: FBC, U&E, ESR, CRP, HLA-B27
X-rays
MRI spine
Bone scan
What are the definitions of spondylolysis and spondylolisthesis?
Spondylolysis = stress fracture through the pars interarticularis (part of vertebra connecting the upper and lower facet joints)
Spondylolisthesis = fractured pars interarticularis separates and the affected vertebra shifts forward relative to vertebra below it
3 GALS screening questions
Features/Causes of antalgic gait
Less time spent on painful limb (limp)
Pathology of hip/knee/ankle
Features/Causes of Trendelenburg gait
Waddling gait
Features/Causes of Parkinsonian gait
Features/Causes of cerebellar gait
Broad-based
High-stepping
Looking carefully ahead
Causes: cerebellar lesion (usually vermis)
Features/Causes of hemiplegic gait
Foot plantarflexes and knee extended
Leg must be abducted and swung in a lateral arc
Arm may also be held in UMN position
Features/Causes of foot-drop
High-stepping to allow toes to clear ground
Acute monoarthritis/oligoarthritis - investigations, ∆∆
Typical age/gender, joint involvement, other information + specific investigations for: Gout
Typical age/gender, joint involvement, other information + specific investigations for: Reactive arthritis
Typical age/gender, joint involvement, other information + specific investigations for: Septic arthritis
Typical age/gender, joint involvement, other information + specific investigations for: Pseudogout
Which spine movements to test?
Describe ankylosing spondylitis
∆∆ lumbar back pain
Neurogenic claudication
Describe Schober’s test
Describe the straight leg raise
Describe the femoral stretch test
