MSK Spinal Pathologies

Question 1

Define ankylosis spondylitis

Answer 1

Inflammatory condition affecting spine and sacroiliac joints occurring between vertebral bodies and discs, characterised by bony growths and results in fusion of vertebrae

Question 2

AS- indicator

Answer 2

HLA-B27 positive- an antigen present on white blood cells indicated immune response.

Affects males mainly. Average age onset 24

Question 3

AS symptoms

Answer 3

SI joint pain, early morning stiffness, loss of spinal curvatures

Question 4

Define spinal stenosis

Answer 4

Narrowing of vertebral foremen, irritating the spinal cord

Question 5

Spinal stenosis causes

Answer 5

Osteoarthritis bony growths
Tumours
Herniated discs
Thickened ligaments

Question 6

Spinal stenosis presentation- lumbar and cervical

Answer 6

Gradual onset
Cervical- sensation changes, weakness, balance changes in upper and lower limb
Lumbar- neurogenic Claudication: pain in legs standing for a long time or walking, eased by positional changes. Weakness and back pain

Question 7

Disc herniation definition

Answer 7

Where nucleus pulposa protrudes into annulus fibrosis and this can put pressure onto nerves within spinal cord

Question 8

Disc herniation symptoms

Answer 8

Leg, buttock pain if lumbar
Numbness and weakness
Rapidly worsening Shoulder pain. Worse in extension, pain to cough/ sneeze

Question 9

Herniated disc causes

Answer 9

30s - age, smoking
More common in lumbar

Lifting and twisting heavy objects
Overweight

Question 10

Radiculopathy definition

Answer 10

Nerve root entrapment, caused by irritation or inflammation.

Question 11

Nerve root entrapment causes

Answer 11

Disc herniation
Trauma
Muscle spasms

Question 12

Nerve root entrapment presentation

Answer 12

Myotomes and dermatomal changes
Muscle weakness
Altered sensation

Question 13

Spondylolithesis definition

Answer 13

Vertebrae shifting, usually anteriorly

Graded 1-5 depending on severity and percentage shift from the vertebrae below

Question 14

How to classify lower back pain

Answer 14

Specific or non specific
Maladaptive or adaptive
Movement impairment or control behaviour

Question 15

Spondylosis definition

Answer 15

Degenerative disc disorder affecting intervertebral joint.
Commonlower cervical c5-6, 6-7
Can lead to nerve root entrapment due to foraminal narrowing.

Question 16

Spondylisis symptoms

Answer 16

Loss of ROM - side flex and rotation
Painful PAIVM passive accessory movements
Pain in neck and refer to shoulder
Dermatome changes if nerve root entrapment
Degenerative changes on X-ray

Question 17

Spondylisis causes

Answer 17

Most common in 45 plus and lumbar spine

Due to disc degeneration with age

Question 18

Myelopathy

Answer 18

Compression of spinal cord centrally
Causes: severe degenerative changes, large central disc prolapse
Signs: chronic neck pain, clumsy, bladder dysfunction, gait disturbance
Medical emergency like cauda equina

Question 19

Whiplash MOI

Answer 19

Acceleration, deceleration injury. Often injury is anterior due to the hyper extension of neck.
Full resolution 3 months but depends on psychosocial factors

Question 20

Whiplash symptoms and signs

Answer 20

Neck pain, stiffness, headaches, nausea, dizziness and blurred vision

Question 21

How are whiplash injuries classified

Answer 21

Whiplash association disorder

Most common is 2A - neck pain, local hyperalgesia

Question 22

Cervicogenic headache cause

Answer 22

Irritation of cranial nerves or transgeminal nuclei in upper cervical spine. Symptoms radiate up into a tension headache

Or trigger point referral patterns often upper traps

Question 23

Cervicogenic headache special questions

5d 2n

Answer 23

5D- dysphasia, dysphagia, dizziness, Diplopia, drop attacks

2N- nausea, nyestagmus (pupils flicker)

Question 24

Cervicogenic headache symptoms

Answer 24

Unilateral neck pain that spreads up, treat with MWM

Question 25

Thoracic outlet syndrome

Answer 25

Compression of nerves and vascular structures of brachial plexus between clavicle and first rib.
Parasthesia, numbness, sensory changes
Common in people who have repetitive arm movements
Gets worse on exercise

Question 26

T4 syndrome

Answer 26

More common in women, rule out other conditions - hard to diagnose.
Symptoms: glove distribution of numbness/ sensation changes, localised Thoracic pain