MSK Precision & Pearls #3 Flashcards
What is lumbar spinal stenosis and what is the MCC?
symptoms of this condition?
Best Diagnostic?
Treatment is conservative or laminectomy if severe pain
Narrowing of the spinal canal with impingement of the nerve roots
-Back pain, numbness, paresthesias, radiates to the butt and thighs
-Worse with extension (standing)
-better with flexion (shopping cart sign)
MRI best diagnostic
What are some health maintenance tips you can give a patient with spinal stenosis?
Avoid stretching in standing position and extension stretches and Free weights, high impact exercises
Stretch while laying down, low impact exercises, physical therapy, weight loss
What is spondylolysis? This MC occurs at what location?
Name some symptoms of this condition and what population it is likely going to occur in on the exam!
Pars interarticularis defect due to stress fracture
MC at L5-S1
Low back pain with activity, tight hamstrings, most are asymptomatic though
Think of a gymnast or football player (adolescent)
What diagnostics are obtained for spondylolysis and what is shown on there (there is a specific finding).
Lateral, Oblique XR
-scotty dog neck broken on oblique
What is spondylolisthesis and it is usually a complication of what?
Forward slipping of a vertebrae on another usually a complication of spondylolysis (the pars fracture allows it to slip)
Symptoms of spondylolithesis
Lower back pain, decreased flexion/extension
Tight hamstrings, waddling gait
Sciatica, bowel/bladder dysfunction due to nerve compression
What is considered the gold standard diagnostic for spondylolisthesis?
Flexion-extension functional radiographs
What is the usual suspect for a patient with Ankylosing Spondylitis (who is it usually in?)
Young males, HLA-B27 positivity, Seronegativity (negative RF), Systemic Symptoms
Symptoms of ALS
-back pain, stiffness, decreased ROM worse in the morning and decreases with exercise/activity
kyphosis, sacroilitis, uveitis, dactylitis, carditis, low chest expansion
What is seen on radiographs of a patient with ALS?
However, what is the most accurate test?
Sacroilitis (narrowing of the SI joint)
Bamboo Spine: straight and loss of lumbar curve, squaring and fusion of vertebrae
MRI is most accurate
Treatment for ALS
NSAIDs are first-line
TNF inhibitors (Etanercept, -umab drugs)
What exam tests can you do for an effusion in the knee
Bulge sign
Ballottment
Patellar Tap Tests
