Orthopaedics Unit 2 Flashcards
what is important to remember in the management of back ache
most back ache is self limiting
what is the group name for non-nervous tissue of the spine and what is the term for abnormalities in this area
spodylitides
spondylitis
what are the types of pain in spinal disorders
locally
- difficult to pin point back pain
- tends to be a general lumbar or dorsal pain
referred pain
- down buttock, thigh and leg
- rarely below mid-calf
- up shoulder and upper arm
along length of the nerve arising from affected nerve root
- disease of facet joints or discs may put pressure on nerve roots
what is the anatomy of nerve roots
nerve roots emerge from the vertebrae via the vertebral foramina
surrounded by facet joints behind and intervertebral disc in front
what is sciatica
compression of the sciatic nerve from the foramen in the lower lumbar region
Sx of sciatica
pain down the back of the leg into the foot
exacerbated by coughing
Sx of nerve root compression
loss of sensation
muscle weakness
tingling
what are the classification and causes of vertebral conditions
- Related to spondylitides
a) aches and sprains
b) mechanical back pain
c) spondylolisthesis - Related to nervous tissue
a) disc prolapse
b) bony root entrapment
what is back sprain associated with
awkward twisting
poor lifting
what is a good lifting technique
Reducing the distance between the back and the weight results in less leverage and reduced spinal loading
how can you distinguish sprain from other types of back pain
there is no signs of nerve compression
Mx of back sprain
period of rest
gradual return to normal activities
NSAIDs
parcetamol
what is mechanical backache and causes of it
recurrent back sprains
spondylosis
primary OA
what is spondylosis
degeneration of the intervertebral disc leading to increased loading of the facet joints
which then develop secondary OA
Mx of mechanical backache
rest, physio, pain killers
what is spondyloisthesis
slippage of one vertebra relative to the one below
commonly seen in the lumbar spine.
what causes spondyloisthesis
bony abnormality which interferes with the stability of the facet joints and ligaments
congenital or acquired
what is thought to lead to acquired spondyloisthesis in adults
acute or fatigue fracture of the pars inter- articularis [small segment of bone that joins the facet joints in the back of the spine]
Sx and Ix of spondyloisthesis
low back pain
[similar to mechanical back pain]
no neuro Sx
x-ray
Mx of spondyloisthesis
spinal corset
- may relieve pain
physio, pain relief
fusion of 2 vertebrae
- if pain is severe
what is spondylolysis
defect or stress fracture in the pars interarticularis
w/out forward slipping of the vertebrae
where does the majority of spondylolysis cases occur
L5
Sx of disc prolapse
M > F
under 40 y/o
acute back and leg ache
-may describe a single event leading up to pain
pain down the back of the thigh and leg to the foot
how can you differentiate disc prolapse from referred back ache
referred pain usually goes no further than the knee or upper calf
what happens in disc prolapse
prolapse (extrusion) of the nucleus pulposus material through the annulus fibrosis
extrudes backwards and laterally impinging on the nerve root
what can happen if a disc prolapses posteriorly
impinges on the spinal cord or the cauda equina
what discs are most commonly affected in disc prolapse
discs between sacrum and the fifth lumbar vertebra
Mx of disc prolapse
ensure nerves supplying the bladder and bowel are not damaged
- cauda equina syndrome
analgesics
NSAIDs
they recover SPONTANEOUSLY as disc material is absorbed by cells released from bloodstream
if Sx persist, then surgical intervention is required to remove the material
Ix of disc prolapse
myelography
- injecting a radio-opaque material into the spinal fluid then taking an X-ray.
- image called a myelogram
clinical presentation of bony root entrapment a.k.a spinal claudication
M = F
over 40
Hx of mechanical back pain
develop new Sx of leg pain radiating to the foot, MADE WORSE BY EXERCISE
episodes are acute and recurrent
Mx of bony root entrapment
physio unlike to help
if pain is severe surgery may be necessary
- removal of bone to free trapped nerve roots
- may cause disturbance in spinal stability
- may need to fuse vertebrae
aetiology of bony root entrapment
bony overgrowth around the vertebral foramina where the nerve roots emerge
bony overgrowth secondary to degenerative changes in the adjacent facet joints i.e. primary OA or disc degeneration
why is the cervical spine prone to disease and injury
very mobile
what is Cervical Spondylosis
disc degeneration and joint disease
clinical presentation of Cervical Spondylosis
F > M
over 40 y/o
dull neck ache
referred to shoulders and upper arm
tingling in the arms
can progress and cause bony root entrapment or disc prolapse
Mx of Cervical Spondylosis
Analgesics
NSAID
soft collar
physio to relieve muscle spasm
clinical presentation of Cervical Disc Disease
pain
referred pain similar to Spondylosis
however, tend to have no Hx of neck trouble
Mx of Cervical Disc Disease
resting
gentle traction
support collar
potential fusion of affected vertebrae is localising signs are marked Sx do not regress
