MSK PATHOLOGIES - Spinal Conditions and Red Flags Flashcards
Name 6 Spinal Conditions.
- ANKYLOSING SPONDYLITIS (AS)
- SPINAL STENOSIS
- SPONDYLOSIS
- SPONDYLOLISTHESIS
- SCOLIOSIS
- WHIPLASH ASSOCIATED DISORDER (WAD)
Name 9 Red Flag Pathologies ?
- MYELOPATHY (spinal cord compression)
- CERVICAL ARTERY DYSFUNCTION
- MALIGNANCY
- DVT
- INFLAMMATORY CONDITIONS ( Rheumatoid Arthritis )
- INFECTIONS
- FRACTURES
- RELATIVE ENERGY DEFICIENCY (RED-S)
- CAUDA EQUINA SYNDROME ( ces )
What is ANKYLOSING SPONDYLITIS ?
Systemic Inflammatory Arthritis ( its all over the body )
Its characterised as dysregulation of the immune system which can result into Tissue Damage.
ANKYLOSING SPONDYLITIS Risk Factor.
- GENETICS (HLA-B gene)
- MEN > WOMEN
- AGE ( late adolescent )
What are the typical presentation of ANKYLOSING SPONDYLITIS.
- Gradual onset of back pain & stiffness over weeks/months.
- Persistent for more than 3 months
- Feeling better after exercise and worst after rest.
- Weight loss
- Fatigue / Tiredness
- Feverish / Night sweats
Common Spinal Condition Managements
- Exercise
- MEDICATION ( to reduce underlying inflammation and pain )
- Biologic medication (therapy)
- Address individuals beliefs and goals
- REASSURANCE ( normal age related )
- Encouragement normal movement and functions/ normal activities
- (surgery)
What is Spinal Stenosis ?
Its the narrowing of the spinal canal.
What are the 2 different Spinal Stenosis ?
And how do they differ from each other.
1.) CENTRAL SPINAL STENOSIS
Its the narrowing in the Central Spinal Cord.
- It can cause MYELOPATHY / CES
2.) FORAMINAL SPINAL STENOSIS
Its the narrowing of where the nerve root exits.
- symptom is improved with FLEXION because the canal opens up
What are some possible cause of Spinal Stenosis ?
- Osteophytes
- Disc Herniation
- Thickening of the LGT
- Age
What are some common Spinal Physiotherapy Management ?
- ADVICE & EDUCATION
- PAIN MANAGEMENT STRATEGIES
- EXERCISE
- LIFESTYLE CHANGES
What is SPONDYLOSIS ?
Its a generic umbrella term for OSTEOARTHRITIC changes within the spine.
- It can affect vertebra / Intervertebral discs / Facet Joints / Joints of LUSHKA
How to reduce symptom of SPONDYLOSIS ?
You have to keep moving so that it remains strong rather than protecting and not doing anything.
What is SPONDYLOLISTHESIS ?
SLIPPED VERTEBRA
( anterior translation of the superior vertebra relative to the Inferior Vertebra )
There’s 5 grades depending on severity
What are some SPONDYLOLISTHESIS risk factors ?
- GENETICS
- TRAUMA
- DEGENERATION
- SPONDYLOLISIS PARS FRACTURE
What is SCOLIOSIS ?
Its an S-shaped curve in the spine that may/not cause pain
IDOPATHIC
What is WHIPLASH ASSOCIATED DISORDER (WAD) ?
Its a generic term for neck pain following sudden force acceleration / deceleration.
- Once all serious pathology have been ruled out (SCI/Fractures) it can be diagnosed as WAD.
What are some possible symptoms of WAD ?
- Neck Pain
- Hearing Loss
- Headaches
- Tinnitus
- Double Vision / Vision Loss / Eye Pain
- Weakness of Extremities
What is MYELOPATHY ?
Its a term used to describe any neurological deficit related to SC.
- This is usually due to compression of the Spinal Cord.
What are some common Myelopathy Symptoms ?
- Muscle weakness
- Impaired co-ordination
- Spinal Pain
- Altered Muscle Tone
- Sensory Loss / Spasticity
- GAIT & URINARY DISTURBANCE
What is CERVICAL ARTERY DYSFUNCTION (cad) ?
Its an umbrella term used into cover a range of VASCULAR PATHOLOGIES (arterial/venous disease) and ANATOMICAL SRUCTURES that may be compromised by movement/manual therapy.
- This can lead to CERVICO-CRANIAL ISCHAEMIA.
What are some symptoms of CERVICAL ARTERY DYSFUNCTION ?
- Pain
- Stroke
- Cranial Nerve Dysfunction
- Blindness
- Sympathetic Nerve Dysfunction
- DEATH
What are some Cervical Artery Dysfunction (cad) symptoms of compromised movement/manual Therapy ?
- DYSPHAGIA ( swallowing problems )
- DYSPHASIA ( cant generate speech )
- DYSARTHRIA ( unable to control their tongue / slur words )
- PARAESTHESIA ( numbness)
What are some Cervical Artery Dysfunction Risk Factors ?
- Previous trauma to CX Spine
- Long term use of STEROIDS
- Hypertension
- High Cholesterol
- Diabetes
- History of smoking
- Cardiac Vascular Disease
What is Malignancy ?
This is when cell divides in an uncontrolled way forming a tumor.
What are the 2 different tumours ?
1.) PRIMARY TUMOR
- Cancer starts to grow and spread, causing healthy body parts to be pushed away
causing damage.
2.) SECONDARY TUMOR (metastases)
- This forms when cancer cell spread to distant part of the body via
bloodstream/lymphatic system.
What are some General Signs and Symptoms of Malignancy ?
- Constant Pain
- General Fatigue
- Night Sweats
- Unexplained weight loss
- Unusual Lumps / Bumps / Swelling
- Previous HX of Cancer
What is DEEP VEIN THROMBOSIS ?
Its a type of venous thrombosis involving the formation of a blood clot in a deep vein.
What are some DVT Symptoms ?
- Pain
- Swelling
- Redness
- Enlarged Veins in affected areas
What Increases a person’s chance of getting DVT ?
- Age
- Past Surgery
- Long Distance Flight
- Pregnancy
- Drugs ( Oral Contraceptives )
- Medical co-morbidity ( its a condition where a person has more than one disease )
What causes DVT ?
VIACHOUS TRIAD
- ) Vessel Injury
- ) Venous Stasis
- ) Hypercoagulability
What are the different Phases of Thrombosis (DVT) ?
1.) EMBOLISM
- This is the most Life Threatening Phase whereby, THROMBISE becomes embolise
and it travels to the heart via circulatory system, Blocking the pulmonary artery.
( it can cause INFARCTION & complications )
- ) PROPAGATION
- ) ORGANIZATION
- ) RECANULIZATION
What is INFLAMMATION ? and give one common inflammatory condition.
Inflammation is a biological response to a stimuli interpreted by the body to have a potentially Harmful Effect.
- RHEUMATOID ARTHIRIRTIS (RA)
What is Rheumatoid Arthritis ?
RA is a systemic autoimmune disease characterised by Inflammatory arthritis with extra articular involvement.
What are some factors that Increases a person’s chance of getting RA ?
- Genetics
- Air pollution
- Low Vitamin D
- Smoking
- Obesity
What are some Clinical Presentation of RA ?
- Insidious onset over a period of months.
- Joint stiffness in the morning.
- Deformity and restricted mobility in affected joints
How does INFECTIONS occur ?
Infections occur when a foreign organism enters the body or multiplies in a harmful way. (BACTERIA / VIRUS / FUNGI / PARASITE > INFECTION)
What increases the chance of having an Infection ?
- Drugs ( steroids/ Anti-rejection drugs for a transplanted organ )
- HIV + AIDS
- Cancer ( other disorders that affect your immune system )
- Open Surgery
- Poor Nutrition / Stress / Lack of sleep
What are some signs and symptoms of an Infection ?
IT CAN AFFECT THE WHOLE BODY.
- Fatigue
- Weight loss
- Night Sweats
- Swelling
- Loss of Appetite
- Fever / Chills
- coughing / runny nose
- Aches and Pain
What are some different types of Fractures ?
- Transverse
- Linear
- Oblique non / displaced
- Spiral
- Greenstick
- Comminuted
What Increases a persons chance of having a Fracture ?
- TRAUMA
- Age + Gender
- Alcohol
- Smoking
- RA
- Diabetes
- other SYSTEMIC DISEASE
What kind of Management would be done if someone had a Fracture ?
- None ( rib fracture )
- Sling
- Cast
- Internal / External Fixation
Physiotherapy, help restore ROM / Strength and Function. ( depending on patients goal )
What is Relative Energy Deficiency (RED-S) ?
RED-S is a syndrome in which disorder eating ( low energy availability ) and decreased bone mineral density (osteoporosis) are present.
Name a RED-S Risk factor.
Eating too little food
to support the amount of energy being expended.
What are some Signs and Symptoms of RED-S ?
- Dull pain along the bone ( can increase w/ activity ).
- Potential Mild swelling around the affected area.
- Tenderness around the Affected area
How do you manage RED-S ?
- PHYSIOTHERAPY GUIDANCE
Advice and educate, teach them Techniques - MDT IS REQUIRED
GP, Dietician + PT, potentially Psychologist
What is CAUDA EQUINA SYNDROME (CES) ?
This is when the spinal cord terminates between the L1 - L2 vertebra forming the conus medullas.
Name some possible cause of CAUDA EQUINA SYNDROME.
- HERINATED LUMBAR INTERVERTEBRAL DISC
- Epidural Abscess ( infection in between the skull and brain lining )
- SPINAL EPIDURAL HAEMATOMA
( accumulation of blood in the epidural space that compresses the SC ) - DISKITIS ( infection in between the vertebra )
- Tumor
- Trauma
- SPINAL STENOSIS ( narrowing of spaces within the spine )
What are some common RED FLAG SIGN & SYMPTOMS.
- ) SADDLE ANAESTHESIA
- loss of feeling around the anus / genital area.
- ) BACK PAIN
- severe low back pain with uni / bilateral weakness.
- ) BLADDER DYSFUNCTION
- inability / difficulty in urinating / Urinary Retention / Loss of sensation.
- ) BOWEL DYSFUNCTION
- faecal Incontinence / Loss of anal tone or sensation.
- ) NUMBNESS AND LEG WEAKNESS
- ) ALTERED REFLEXES IN KNEES & ANKLES
What are some common Management for a RED FLAG PATHOLOGY.
- EARLY NEUROLOGICAL REVIEW
- SURGICAL DECOMPRESSION (acute ces patients)
- MALIGNACY / RADIOTHERAPY / CHEMOTHERAPY
( patients not suitable for surgery )
