Ortho Med Unit 2 Flashcards
What is spondylitis?
Abnormalities of any non nervous tissue in the vertebral column
What is the difference between local pain, referred pain and nerve root pain?
Local pain: hard to pin point to a specific location, usually related to a whole region of the back (dorsal/lumbar)
Referred pain: usually referred from the bum though or leg (has localising signs - loss of sensation/muscle weakness)
Nerve root pain: pain along the length of a nerve - associated with loss of sensation or muscle weakness (localising signs)
How does nerve root pain occur?
Due to compression of the nerve roots (can be compressed by disease/abnormalities of the vertebrae, vertebral foramina, facet joint or intervertebral disc)
What are the symptoms of sciatica and how does it occur?
Pain down the back of the leg (the whole way to the foot)
Can be exacerbated by coughing
The sciatic nerve becomes compressed in the lumbar spine
What is the cause of back sprains and how are they managed?
Associated with awkward twisting or poor technique when lifting (causes muscle or ligament injuries)
Different from neurological causes as there are no neurological signs
Rest, NSAIDS, brief investigation (rule out more serious causes)
What is the difference between mechanical backache and back sprains?
Mechanical backache = recurrent back sprains
What are the causes of mechanical backache and how is it managed?
Spondylosis: degeneration of intervertebral disc causing increased loading do the facet joints and secondary OA
Primary arthritis of facet joints
Personal management to prevent recurrent episodes
Rest, physio, NSAIDs for episodes, osteopath/chiropractors can help via manipulation
What is spondylolisthesis? What is the difference from spondylolysis?
Spondylolisthesis: slipping of one vertebrae on the one below (in the lumbar spine) - due to a bony abnormality which interferes with the stability of the facet joints/bony/ligamentous elements
Spondylolysis: fracture of the pars interarticularis (without forward slipping)
What is the cause of spondylolisthesis? How does it present? How is it managed?
Either congenital or acquired
Acquired = following fracture of the pars interarticularis (of the facet joint)
Low back pain (similar to mechanical back pain). No neurological symptoms (diagnosis via X-rays)
Spinal corset
No surgery unless very severe pain (surgical fusion)
Rest, physio, NSAIDs
What is the correct term for slipped disc? Where does it most commonly occur?
Prolapsed intervertebral disc
Lumbar or cervical spine (lumbar much more common)
Between sacrum + L5 most common - sciatica)
What structures are most commonly affected by a prolapsed intervertebral disc?
Posterolateral: nerve root impingement
Posterior: spinal cord (cauda equina)
How is a prolapsed intervertebral disc managed?
- Ensure bladder and bowel not damaged (caudal equine syndrome)
- Rest + gentle mobilisation
- Usually recovers spontaneously (disc materials are absorbed by cells in the blood stream)
If persists/increases in severity
- myelography (to see the site of prolapse - injection of radiopaque fluid into spinal cord + an X-ray taken, can’t pass the prolapse)
How does a prolapsed intervertebral disc usually occur/present?
Men under 40
Often associated with a single event of lifting or sprain but can be spontaneous
Acute backache and legache (the whole way to the foot unlike mechanical backache)
Usually has localising signs as affects a peripheral nerve (sciatica)
What causes spinal claudication? How does it present?
Bony root entrapment; from bony overgrowth around the vertebral foramina (where nerve root emerge)
Either due to primary OA in the facet joints or disc degeneration
Person >40yo with history of mechanical backache
New symptoms of leg pain radiating to the foot which worsen on exercise
Often acute recurrent episodes on a history of chronic backache
Either remain mild episodes or increase in severity
How is bony root entrapment managed?
No role for physio
If severe = surgery (bony removal or fusion of affected vertebrae for stability)
Why is the cervical spine prone to disease and injury?
Very mobile
What is cervical spondylosis?
Degenerative disc and joint disease in the cervical spine (arthritis)
What is spondylosis?
Arthritis of vertebrae; can affect spinal movement or impinge on nerves
How does cervical spondylosis usually present?
Dull neckache which is referred to shoulders and upper arms
Tinging in the arms (from entrapment of nerve roots) - localising sign
Most common in women over 40
How is cervical spondylosis managed?
Analgesia, NSAIDs, soft collar, physio (to relieve muscle spasm)
Must be warned that recurrent attacks are common
If nerve root entrapment; surgical fusion of the vertebrae may be necessary
What is the difference between the presentation of cervical disc disease/prolapse and cervical spondylosis?
Disc prolapse: neck muscles in spasm and movement of the neck is restricted
Both: dull neck ache referred to upper arms and shoulders (tinging in arms from nerve root entrapment)
How is cervical disc prolapse managed?
Rest, gentle traction, supporting collar
If severe localising signs or symptoms to not reduce, may require surgical fusion of the vertebrae
