Ortho unit 2 Flashcards

1
Q

Spondylitides

A

non nervous tissue of spine

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2
Q

spondylitis

A

abnormalities in the spondylitides

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3
Q

pain in the spine

A

locally, referred, along the length of a nerve arising from an affected nerve root

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4
Q

local back pain

A

tends to be related to a whole region

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5
Q

referred pain

A

back pain may be referred to the buttock, thigh and leg, descending as far as mid calf but rarely below this

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6
Q

Nerve root pain

A

diseases affecting the facet joints and the discs may cause direct pressure on, or inflammatory reactions and swelling of, the nerve roots

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7
Q

common nerve root pain

A

foramina of lower lumbar region- sciatica-

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8
Q

what is sciatica characterised by

A

pain in the leg, mainly down the back of the leg but almost always into the foot- may be exacerbated by coughing

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9
Q

localising signs

A

tingling, loss of sensation and muscle weakness

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10
Q

back sprains

A

good loading- reduce distance between back and the weight- less leverage and reduced spinal loading

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11
Q

how can back sprains be distinguished from back pain of neurological cause

A

absence of signs of nerve compression

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12
Q

management of back sprain

A

brief period of rest followed by gradual return to normal activities. Anti inflammatory drugs can relieve symptoms but analgesia is usually sufficient

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13
Q

mechanical backache

A

recurrent back sprains

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14
Q

possible causes of mechanical backache

A

spondylosis- degeneration of IV disc leading to increased loading of the facet joints, which then develop secondary arthritis
primary OA- facet joints are likely to be as prone to primary OA as any other synovial joint

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15
Q

clinical presentation of mechanical backache

A

tends to recur, no known cure, rest, physic and medication will help sufferer through a bad episode. Osteopaths and chiropractors can provide some easing of the condition by manipulation

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16
Q

spondylolisthesis

A

slippage of one vertebra relative to the one below- commonly seen in the lumbar spine- caused by bony abnormality which interferes with the stability of the facet joins and their associated bony and ligamentous elements

17
Q

aetiology of spondylolisthesis

A

may be congenital or acquired so can occur at any age- adult forms are thought to be acquired. Appears to be acquired after an acute or fatigue fracture of the pars inter articularis

18
Q

clinical presentation of spondylolisthesis

A

low back pain- almost identical to mechanical

19
Q

diagnosis of spondylolisthesis

A

x ray, in severe slippage a step may be felt at the affected area. Condition v rarely causes near problems, even when the slippage is major- except in congenital cases- movement may be sufficient to damage nerves

20
Q

management of spondylolisthesis

A

spinal corset may help relieve pain, otherwise management similar to mechanical back pain. Most sufferers don’t require surgery unless experiencing severe pain- surgical fusion of the 2 vertebrae may be required

21
Q

spondylolysis

A

pars interarticularis defect such as a fracture seen on radiograph without forward slipping of the vertebra- can exist without causing pain. Pain experienced- conservative measures, pain severe- spinal fusion may be required

22
Q

disc prolapse

A

can occur in lumbar or cervical spine

23
Q

clinical presentation of disc prolapse

A

classical symptoms occur in people under 40, more common in men. Acute backache, leg ache, sometimes leg ache alone with back ache developing later. Sufferers may describe a single event of strain/lifting, it also may arise spontaneously

24
Q

characteristic symptom of disc prolapse

A

legate passing down the back of the thigh and leg into the foot

25
Q

aetiology of disc prolapse

A

abnormality of IV disc- leads to prolapse of the nucleus pulposus through the annulus fibrosis. If it protrudes backwards and laterally- impinges on the nerve root. Extrudes posteriorly- impinges on the spinal cord or caudal equina

26
Q

discs most affected by disc prolapse

A

between sacrum and 5th lumbar vertebra- explains why disc prolapses are often called sciatica- peripheral nerve arising from nerve roots emerging beneath 4th and 5th lumbar vertebrae

27
Q

management of disc prolapse

A

ensure nerves supplying bladder and bowel aren’t damaged. Rest, gentle and progressive mobilisation, analgesics, anti inflammatory drugs

28
Q

management of disc prolapse

A

most recover spontaneously- disc material absorbed by cells released from the blood stream- if pain persists surgical intervention to remove material is required- site of disc prolapse must be confirmed by injecting radio opaque material into the spinal fluid- won’t be able to flow where prolapsed disc presses on nerve- technique- myelography, image produced- myelogram

29
Q

bony root entrapment

A

person of either sex, usually over 40, pre history of mechanical back pain. Develop new symptoms of pain radiating to the foot, usually made worse by exercise- spinal claudication

30
Q

bony root entrapment clinical presentation

A

episodes usually acute and recurrent against a chronic history of back pain. Episodes may remain mild or progress to affect the patients lifestyle. Physio is unlikely to help, should pain be severe then surgery may be necessary

31
Q

cause of bony root entrapment

A

bony overgrowth around the vertebral foramina where the roots emerge. Cause would appear to be secondary to degenerative changes in the adjacent facet joints- may degenerate from primary OA or as a result of disc degeneration

32
Q

management of bony root entrapment

A

Removal of bone needed to free trapped nerve roots- may result in disturbance in spinal stability and lead to a need for fusion of the affected vertebrae

33
Q

cervical spondylosis

A

over 40s, more common in females, dull neck ache often referred to the shoulders and upper arms. Tingling of arms- assumed to be entrapment of nerve roots

34
Q

spondylosis

A

a painful condition of the spine resulting from the degeneration of the intervertebral discs.

35
Q

management of cervical spondylosis

A

if there are no localising near signs- analgesics and NSAI agents, use of soft collar and physic. Usual for recurrent attacks to occur. If nerve root entrapment is confirmed- surgical fusion of the vertebrae and decompression of the nerve root may be necessary

36
Q

cervical disc disease- clinical presentation

A

lower discs more likely to cause the problem. Symptoms of pain, referred pain sufferers tend to have no pre history of neck trouble. Following disc prolapse- neck muscles may be in spasm and the movement of the neck is severely restricted

37
Q

management of cervical disc disease

A

most recover with resting, gentle traction and wearing a supporting collar. Surgery and fusion of affected vertebrae may be necessary if localising signs are marked or symptoms don’t regress