orthopaedics: back + spinal pain Flashcards
what type of joints are intervertebral ones
secondary cartilaginous joints
what are facet joints
posterior between vertebra, synovial
what are red flags of back pain (8)
younger than 20, older than 50, thoracic pain, previous carcinoma, immunocompromised, feeling unwell, weight loss, neuro, spinal deformity
what is the most common cause of lumbar back pain
mechanical
what are risk factors contributing to mechanical lumbar back pain
obesity, age, OA, spondylosis, no red flags
how do you manage mechanical lumbar back pain
physio and analgesia
what is not advised in mechanical lumbar back pain
bed rest as it can lead to stiffness
what is spondylosis
degenerative process causing loss of fluid from intervertebral discs
what joints are commonly affected in spondylosis
L4/5, T12/S1
what can help manage spondylosis
facet joint injections
what is an acute disc tear
outer annulus fibrosis of a disc ruptures
what can cause acute disc tear
lifting heavy objects
what are the symptoms of acute disc tear
severe pain, worse on coughing
what can be used to manage acute disc tears
analgesia and physio
what is sciatica
disc tear –> gelatinous nucleus herniating through tear (prolapse) and compressing sciatic nerve
what is sciatica a type of
disc prolapse/ lumbar radiculopathy
what level of the spine is the sciatic nerve
L4,5, S1-3
what are symptoms of sciatica
pain radiating from buttocks. thighs, parasethesia, numbness, sensory/ motor changes (lower motor neurone symptoms)
how do you manage sciatica (mild –> severe)
normally self-limiting, analgesia and anti inflamm, neuropathic eg gabapentin, pregablin, decompression surgery
what is bony nerve root entrapment
OA of the facet joint resulting in osteophytes damaging nerve roots
what are the symptoms of bony nerve root entrapment
similar to sciatica - different levels
how do you treat bony nerve entrapment
surgical decompression, trimming of osteophytes
what is spinal stenosis
narrowing of spinal canal causing nerve compression
what can cause spinal stenosis
spondylosis, bulging discs, osteophytes
what are symptoms of spinal stenosis
60+, overweight, claudication and pain on walking
how do symptoms of spinal stenosis differ from vascular symptoms regarding pain on walking
pain is burning not cramping, LESS painful going uphill, pedal pulses are fine
how do you manage spinal stenosis
physio, analgesia and weight loss
what is cauda equina syndrome
damage to bundle of nerves at end of spinal cord (cauda eqiuna) which is a surgical emegency
what can cause cauda eqiona
L1 disc prolapse/ herniation (Common), spinal stenosis, ankolysing spondylitis
what nerve is compressed in cauda equina syndrome
sacral nerve
what are the symptoms of cauda equina syndrome
urinary/ faecal retention and or incontinence, bilateral leg pain, numbness or paraplegia, numbness in sitting saddle area
what investigations must always be done in cauda equina syndrome
MRI and PR
what causes an osteoporotic crush fracture
osteoporosis
what are the symptoms of an osteoporotic crush fracture
pain and kyphosis (hunchback)
how can an osteoporotic crush fracture be managed
balloon vertebroplasty, injecting cement
what happens in cervical disc spondylosis
disc degeneration + water loss –> faster OA
what are the symptoms of cervical disc spondylosis
insidious onset of stiffness and pain in neck, worse on extension, radiation to shoulder and occiput
what levels are normally affected in cervical disc spondylosis
C5-7
what are symptoms of cervical disc prolapse
shooting neurological pain in dermatomal distribution, weakness in affected area, upper motor neurone signs
what investigation is done for a cervical disc prolapse
MRI
what is cervical spine instability
atlanto-axial subluxation due to destruction of synovial joint (can be fatal )
who normally gets cervical spine instability
down syndrome and RA
what are symptoms of cervical spine instability
wide gait, weakness, increased tone
what management is done fro cervical spine instability
collar and surgery
