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SUMMED2 > ORTHO- SPINE > Flashcards

ORTHO- SPINE Flashcards

1
Q

What is the MC reason Pt visit HCP? BE PREPARED! CAncer infection

A

1.SKin-CA, infx 2. Jt pain-SLE, CA, OA 3. BACK PAIN- Nerve, CA. 80% LBP, 28% disabled from LBP-largest cause of disability WW

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2
Q

What are the DDX for Mechanical LBP?

A
  • Lumbar strain (70%)-compression, TP 2/2 glutes
  • Degenerative disk disease
  • Spinal stenosis
  • Disk herniation
  • Spondylolisthesis
  • Compression fracture
  • Severe deformity (scoliosis, kyphosis)
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3
Q

What are the visceral MC of LBP?

A

Neoplasm, Infecion, Dissecting Aortic Aneurysm, Pancreatitis, Cholecystitis, Ankylosing spondylitis, Paget, Prostatitis, Gastric ulcer, Nephrolithiasis, PID, Intermittent claudication-vascular

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4
Q

What MC LBP etiology is self limiting, assoc. w/ heavy lifting, twisting, or sudden deceleration injuries; usually non-radiating

A

Muscle strain-Assess dehydration, TP, Hip jt assess, Leg length, Glute strength, Breath, Anxiety

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5
Q

What MC LBP etiology develops slowly but acute event triggers disk rupture, tear, or herniation resulting discogenic back pain, may also have sciatica

A

Degenerative Disk Disease

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6
Q

What MC etiology result from compression or flexion injuries and consist of anterior wedging; severe injury “burst” fracture with involvement of vertebral body and posterior elements; vertebral chip fracture caused by fall from a height- L5 most common**

A

Fracture spine

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7
Q

What are some important Q/A to ask with LBP?

A

a. Sudden or gradual
b. Location, pattern, intensity, and duration
c. What makes it worse? Does it feel better with activity or with rest?
d. Leg/arm pain, weakness, or numbness? Problems walking?
e. Bowel/bladder problems?
f. Hx of back pain: congenital spine problems, previous episodes of low back pain, previous back injuries
g. Is this a work-related injury? Any legal action related to your back pain?
h. Smoking, drinking, drug use, arthritis, cancer, malabsorption, arthritis, weight loss, fever

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8
Q

What is PE work with LBP?

A
  1. Asses body type and habit- lean to one side, Leg length, Breath 2. Gait 3. AROM 4. AP of SP tender 5. Above and below level 6. Organs, Wt loss, Fatigue 7. SLR 8 Strength- Hip and Core, UE, Neck 9. Sensation- Head to toe 10. Reflex Head to toe- patella, Achilles- Clonus?
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9
Q

What is test when Pt relaxe their hand and lift their hand from their middle finger and you flick their middle finger – Positive all the other fingers will move like a jellyfish, Flexion of Index finger and ADD of thumb

A

Hoffman’s Reflex/Test- check integrity of UMN (corticospinal) cervical radiculopathy

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10
Q

What is Grade of strength if pt cannot overcome gravity?

A

2/5. 0- flaccid, 1/ flicker, 3/ can’t overcaome resistance 4/ weaker than normal

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11
Q

What condition is often found in school or family notice should asymmetry?

A

Scoliosis- Rib hump when Pt flexes spine, Waist and Shoulder Asymmetric

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12
Q

What is work up for Scoliosis?

A

DX- 36in(3ft) AP XR - Lateral curver >10deg Cobb angle. Lateral for Kyphosis. Annual until skeletally mature. TX-PT refer Spine surgeon or neuro. Bracing >25 deg curve

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13
Q

What is the MCC of chronic lumbar disk pain and leg pain?

A

Disk degeneration L4-L5, L5-S1. Post op alway check Toe EXt strength L5 integrity

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14
Q

Who are are risk?

A

Obese, sedentary, lifters, smoking, alcohol (dries out faster), Drivers-sit bulge, posture, compression

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15
Q

What is the pathology of degeneration of disk?

A

Inne nucleus pulposus surround y annulus fibrosus- disk protrude posteriorly 1. L/2 central stenosis- narrowing of spinal cord canal, radiates down leg. Push through DAP layers of spinal cord compressing nerves. 2. Also posterolateral-easy space to fill. Intervertebral space decrease dehydrates, which cause foraminal stenosis compressing on spinal nerve roots exiting

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16
Q

What are the benefits of the disk?

A

Shock absorbers for axial forces (opp of sitting) 2. Pivot point for movement

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17
Q

What are significant history question regarding disk injury?

A
  1. Pain 2. sudden or gradual with event ie. lifting 3. **Acute disk cause MORE LEG PAIN 4. Degeneration MORE BACK PAIN 4. Leg pain numb or paraesthesia, weak
18
Q

What is prognosis of herniated nucleus propulsus?

A

**Herniation often self limiting 90% w/in 6wk. Denervation will worse over months to years

19
Q

What are some significant PE finding on disk exam?

A
  1. Pain w/ ROM -AROM first 2. Blunted Patellar L3-4, Achilles Reflex L5-S1 Grade 1+, DM poor 3. +SLR Radiculopathy of disk 4. Myotomes - weak DF L4-5, (Common Fib L4-S2), Weak PF L5-S1, weak Great toe FLX L5-S1
20
Q

What is concern IF pt c/o saddle anesthesia, reduced rectal tone reflex, bowel bladder incontinence?

A

Cauda equina-surgical evaluation ASAP- Spontaneous or Trauma

21
Q

What is work up for Disk pathology?

A

1 MRI** MC L4-L5, L5-S1- Central, lateral, bulge, extruded disk fragment. Deneration-modic vertebbral endplates, inflammtin of arthiris. IF UNABLE to get MRI- CT Myelogram

22
Q

What is the ideal TX for Disk pathology?

A
  1. 6-8wk recovery, RICE, no lifting or repetitive behind 2. NSAIDs, prednison, narcotics, CNS depressants-for sleep 3. PT INC ROM prevention, core MSK 4. Nerve pain stabilizers-gabapentin, pregabalin 5. CS inj for neurogenic pain-sciatica
23
Q

What do you do if Pt has new onset or progressive weakness or incapacitating pain beyond 6 weeks?

A

Refer to spine surgeon- MRI microdiscectomy for disk herniations or lumbar fusion for degenerative disk disease.

24
Q

What are indicators of cervical disk problem?

A

Neck pain, +/- HA 2. Radicular pain and paresthesia 3. Weakness

25
Q

What should be evaluated with cervical pain due to spinal stenosis?

A

Balance walking, spasms may occur. Myelopathic gait, ankle clonus, hyperreflexia

26
Q

What is important to check in PE for cervical neck pain?

A

Dermatomes** C6. TEST- Tinel sign

27
Q

What is ideal special test for spurling’s?

A

Cervical radiculopathy

28
Q

What is first line of Treatment for Cervical?

A

NSAIDs, PT, Soft cervical collar PRN- gabapentin or pregabalin

29
Q

When do you refer to surgeon for cervical spine?

A

incapacitating pain, declining motor fx, severe central stenosis

30
Q

What is the shopping cart sign?

A

Pain that goes away with flexion/leaning on cart.

31
Q

What are common findings with lumbar spinal stenosis?

A

Mayb normal, focal or global. 2. Pain DOES not INC w/ sitting 3. Flexion DEc pain 4. Pain B/L legs 5. Neurogenic claudication- similar to PVD, walking leg pain

32
Q

what is seen in young men w/ insidious onset of low back, buttock pain, AM stiffness improved with exercise?

A

Ankylosing spondylitis

33
Q

What are some lab that a Rheumatologist will order in ankylosing spondy?

A

ESR, HLA B27

34
Q

What is pathophysiology of AK?

A

erosion of annulus fibrosis at contact w/ vertebral body, followed by bony growth forming cross bridges at vertebral body edges forming DEC in spinal mobility- Bamboo spine

35
Q

What is inflammation of the spine?

A

Spondylitis

36
Q

What is general degenerative process of spine?

A

Spondylosis- bony spurts, disk degeneration

37
Q

What is MC location of spondylosis?

A

L4-L5, weakend pars articularis

38
Q

What is fracture through the pars articularis W/O DISPLACEMENT?

A

Spondylolisthesis- slippage on inferior vertebral-STEP off palpated

39
Q

What is DDX if focal tenderness on spine?

A
  1. Trauma FX 2. Chronic degenerative osteopenia and osteoporosis
40
Q

How to treat traumatic fractures WO listhesis?

A

External Bracing TLSO or internal bracing

41
Q

What type of fraction can indicate malignancy?

A

Compression on thoracic spine

SUMMED2 (38 decks)

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