MSK- lumbar (and hip) Flashcards
What is metastatic cord compression? What are the signs?
A medical emergency that occurs when cancer spreads to the spine and presses on the spinal cord.
Hx of cancer
Band-like back pain
Heavy legs
Sleep grossly disturbed
Lying flat increases back pain
What is multiple myeloma? And what are the signs?
Cancer that affects the bone marrow
Dull ache and pain on palpation- back, ribs or pelvis
Tiredness
May cause bone fragility- may then result in fracture, vertbral collapse and cord compression
Extreme thirst
What are the different types of spinal infection? What are the general signs?
Spinal tuberculosis, Vertebral Osteomyelitis, Discitis
Weight loss
Localised spine pain
Extreme night sweats
Malaise
Fever
What is spondyloarthropathy? And what are the signs?
A group of inflammatory diseases that affect the joints and spine. Including AS, Reactive arthritis and psoriatic arthritis
Alternating buttock pain
Younger that 45years
Spinal pain which reduces with activity
Waking the second half of the night
Dactylitis
Psoriasis
What is Cauda Equina Syndrome? And what are the signs
The result of significant compression of the nerve roots within the cauda equina region particularly L4/5
Bilateral (not always) radicular pain, reduced perineal sensation, altered bladder function, loss of anal tone and loss of sexual function
What is CESS (suspected)?
Bilateral (not always) radicular pain- less than 4/5 strength
What is CESI (incomplete)?
Urinary difficulties- loss of desire to void, poor flow, need to strain
What is CESR (Retention)?
Neurogenic retention of urine
Painless retention of urine
Overflow incontinence
What is CESC (Complete)?
Objective loss of CES, absent perineal sensation, paralysed bladder and bowel
What is radicular pain when associated with LBP?
A pain that can be associated with lower back pain when there is some involvement of a nerve root.
This nerve root could be inflamed or slightly damaged.
It would present with pain that radiates into the leg.
No neurological deficits
Worse when coughing/sneezing
What is lumbar radiculopathy?
The compression of a nerve root in the lumbar spine.
The conduction of the nerves become impaired which will cause neurological deficits:
Pain, numbness, loss of sensation in a dermatomal pattern
Weakness in a myotomal pattern
Reduced reflexes
What is lumbar stenosis with claudication?
Is the narrowing of the spinal canal, compressing nerves.
Spinal stenosis is the radiological diagnosis, intermittent spinal claudication is the resulting condition.
Symptoms commonly occur bilaterally:
Pain with walking or extension
Eases with flexion
Dermatomal amd myotomal deficits
What is nociceptive facet joint pain?
When the facet joints of the spin become a source of pain.
Causes LBP to be a bit more to one side.
Back pain worse than any radiating pain into your leg
Pain radiating into leg (often groin or thigh) and usually stops above the knee.
Pain is worse with rotation, hyperextension, lateral bending and walking up hill
Stiffness getting up from bed or after sitting for awhile
What is nociceptive discogenic/intervertebral disc pain?
Discogenic pain is attributed to degenerative changes in the intervertebral disc due to aging or trauma.
Symptoms:
Aspecific
Axial (localised to the spine)
Without radicular pain
Occurs in the absence of deformity or instability
What is sacroilliac joint pain, risk factors and signs and symptoms?
Pain at the sacroilliac joints
Risk factors: leg length discrepancies, obesity, sedentary lifstyle and abnormalities of sacral bone
Pain worsens in a sitting position and with postural changes
Pain localised over the buttock
Can feel like a sharp stabbing pain which extends down the back of your thigh to your knee
Difficulty sitting in one place due to pain
No damage to nerves
Hip OA risk factors and signs and symptoms
Age, Female, Obesity, Joint Dysplasia, manual work, sedentary lifestyle
- Groin, hip, buttock, anterior thigh pain
- Gradual onset
- Stiffness in the morning but lasts less than 30 mins
- Aggs: walking, putting shoes on, getting out on car
- Antalgic gait
- Crepitus (not always)
- Reduced ROM- specificaly flexion, abducation and internal rot
How would hip OA present on objective exam?
Antalgic gait
Restricted hip joint ROM in capsular pattern
Reduced strength (especially glute)
Positive FABERS and Log roll
Crepitus and trendelenberg
What is FAI and the different types?
Abnormal contact between the femoral head/neck and acetabular rim
CAM= femoral head is not round
Pincer= direct contact (deep socket)
Mixed
What are the risks and signs and symptoms of FAI?
Hip dysplasia
Genetics
Repetitive athletic activity
- ‘C sign’
- Pain deep anterior groin
- Descriptions of clicking, catching, locking, reduced ROM
- Pain particularly into flexion and adduction
How would FAI present objectively?
Positive FADIRS
Evidence of restricted hip ROM
What are the risk factors and signs and symptoms of GTPS
Female, Middle aged, overuse
Pain in side lying
Pain on palpation of greater trochanter
Pain with resisted abduction
Pain with weight-bearing e.g walking, running
How would GTPS objectively present?
Positive trendelenberg
What is the STarTBack screening tool? And who came up with it?
Used to screen patients with LBP and subgroup them based on prognosis or risk of poor clinical outcome
Hill et al (2008) as part of research conducted by Keele Uni
What are the scores of the STarTBack tool and what is the associated risk factor?
Total score
3 or less = low risk
4 or more would look at the sub score
3 or less = medium risk
4 or more = high risk
