O: Adult Spine & Hip Disorders

Question 1

what is an acute disc tear

Answer 1

tear in the outer annulus fibrosis of intervertebral disc

Question 2

aetiology of acute disc tear?

Answer 2

heavy lifting

Question 3

s/s of acute disc tear?

Answer 3

pain worse on coughing

Question 4

mx of acute disc tear

Answer 4

resolves within 2-3months + analgesia and physio

Question 5

what is a disc prolapse?

Answer 5

if an intervertebral disc tears, nucleus pulpous can prolapse through tear

Question 6

main risk of disc prolapse?

Answer 6

material can impinge on an exiting nerve root

Question 7

common sites for disc prolapse?

Answer 7

L4-S1, cervical spine

Question 8

which nerve is commonly affected by an L4-S1 disc prolapse?

Answer 8

sciatic nerve and often causes sciatica

Question 9

s/s of disc prolapse?

Answer 9

burning/tingling in dermatomal distribution, reduced power in myotomal (muscles) distribution

Question 10

ix for disc prolapse

Answer 10

clinical findings and MRI

Question 11

tx for disc prolapse?

Answer 11

analgesia and physio, discectomy

Question 12

what happens as a result of spinal stenosis and claudication

Answer 12

nerve root is compressed

Question 13

s/s of spinal stenosis claudication (as opposed to PVD claudication)?

Answer 13

distance is inconsistent, burning pain, pain is less when walking uphill, pedal pulses preserved

Question 14

mx for spinal stenosis & claudication

Answer 14

physio, wt loss, surgery (decompression)

Question 15

what is femeroacetbular impingement syndrome (FAI)

Answer 15

extra bone of femoral neck and acetabulum causes abatement of femoral neck on edge of acetabulum during movement

Question 16

what are the 3 types of FAI?

Answer 16

1. CAM: femoral head defamed so cannot rotate smoothly in acetabulum
2. Pincer: extra bone extends over normal rim of acetabulum
3. mixed

Question 17

epi of CAM FAI?

Answer 17

young athletic males

Question 18

epi of pincer FAI?

Answer 18

F>M

Question 19

s/s of FAI?

Answer 19

activity related pain in groin, difficulty sitting, C-sign +ve, stiffness, limping

Question 20

with which particular movement is FAI exacerbated?

Answer 20

flexion and rotation

Question 21

ix for FAI?

Answer 21

FADIR provocative test +ve, MR arthrogram, x-rays

Question 22

what is a FADIR +ve result?

Answer 22

pain on internal rotation of knee at 90º

Question 23

mx of FAI?

Answer 23

asymptomatic: observe, activity changes, physio
symptomatic: surgery to deride CAM + arthroplasty later in life

Question 24

what is avascular necrosis of hip?

Answer 24

failure of blood supply to femoral head

Question 25

epi of AVN of hip?

Answer 25

M>F, 30-50yo, bilateral in 80%

Question 26

aetiology of AVN of hip?

Answer 26

trauma, long term steroids, alcohol excess, blood cancers, haematological disease

Question 27

pathophysiology of idiopathic AVN of hip?

Answer 27

coagulation of interosseous circulation causing interosseous stasis

Question 28

s/s of AVN of hip?

Answer 28

low energy hip, insidious onset of severe groin/buttock/ hip pain

Question 29

ix for AVN of hip?

Answer 29

x-ray (after a few weeks), MRI

Question 30

what would be seen on MRI of AVN of hip?

Answer 30

patchy sclerosis, subchondral fracturing, incongruent femoral head, bone marrow oedema

Question 31

mx for reversible AVN of hip?

Answer 31

core decompression & bone grafting

Question 32

T/F: irreversible AVN of hip requires amputation of whole leg

Answer 32

F: requires total hip replacement

Question 33

idiopathic transient osteonecrosis of hip (ITOH) is…

Answer 33

transient loss of blood supply to femoral head resulting in inc pressure on femoral neck

Question 34

epi of ITOH

Answer 34

middle aged men, women in 3rd trimester of pregnancy

Question 35

s/s of ITOH?

Answer 35

progressive groin pain over several weeks, no weight bare

Question 36

MRI is gold standard ix for ITOH, what would be the findings?

Answer 36

osteopenia of head and neck, thinning cortices, preserved jt space, bone marrow oedema*

Question 37

mx for ITOH?

Answer 37

self limiting (6-9months), analgesia, crutches

Question 38

epi of trochanteric bursitis

Answer 38

young fit females

Question 39

aetiology of trochanteric bursitis?

Answer 39

repeated trauma to iliotibial band, unaccustomed exercise, inflammatory arthritis

Question 40

s/s of trochanteric bursitis?

Answer 40

pain at greater trochanter, worse going up stairs/ lying on affected side, pain on rested abduction

Question 41

T/F: mx for trochanteric bursitis is surgery

Answer 41

F: self limiting so conservative mx

Question 42

how to differentiate between trochanteric bursitis and gluteus medium tendinopathy?

Answer 42

gluteus medius tendiinopathy doesn’t get better with injections