Orthopaedics Unit 2

Question 1

what is important to remember in the management of back ache

Answer 1

most back ache is self limiting

Question 2

what is the group name for non-nervous tissue of the spine and what is the term for abnormalities in this area

Answer 2

spodylitides

spondylitis

Question 3

what are the types of pain in spinal disorders

Answer 3

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

Question 4

what is the anatomy of nerve roots

Answer 4

nerve roots emerge from the vertebrae via the vertebral foramina

surrounded by facet joints behind and intervertebral disc in front

Question 5

what is sciatica

Answer 5

compression of the sciatic nerve from the foramen in the lower lumbar region

Question 6

Sx of sciatica

Answer 6

pain down the back of the leg into the foot

exacerbated by coughing

Question 7

Sx of nerve root compression

Answer 7

loss of sensation
muscle weakness
tingling

Question 8

what are the classification and causes of vertebral conditions

Answer 8

1. Related to spondylitides
   a) aches and sprains
   b) mechanical back pain
   c) spondylolisthesis
2. Related to nervous tissue
   a) disc prolapse
   b) bony root entrapment

Question 9

what is back sprain associated with

Answer 9

awkward twisting

poor lifting

Question 10

what is a good lifting technique

Answer 10

Reducing the distance between the back and the weight results in less leverage and reduced spinal loading

Question 11

how can you distinguish sprain from other types of back pain

Answer 11

there is no signs of nerve compression

Question 12

Mx of back sprain

Answer 12

period of rest
gradual return to normal activities

NSAIDs
parcetamol

Question 13

what is mechanical backache and causes of it

Answer 13

recurrent back sprains

spondylosis
primary OA

Question 14

what is spondylosis

Answer 14

degeneration of the intervertebral disc leading to increased loading of the facet joints

which then develop secondary OA

Question 15

Mx of mechanical backache

Answer 15

rest, physio, pain killers

Question 16

what is spondyloisthesis

Answer 16

slippage of one vertebra relative to the one below

commonly seen in the lumbar spine.

Question 17

what causes spondyloisthesis

Answer 17

bony abnormality which interferes with the stability of the facet joints and ligaments

congenital or acquired

Question 18

what is thought to lead to acquired spondyloisthesis in adults

Answer 18

acute or fatigue fracture of the pars inter- articularis [small segment of bone that joins the facet joints in the back of the spine]

Question 19

Sx and Ix of spondyloisthesis

Answer 19

low back pain
[similar to mechanical back pain]
no neuro Sx

x-ray

Question 20

Mx of spondyloisthesis

Answer 20

spinal corset
- may relieve pain

physio, pain relief

fusion of 2 vertebrae
- if pain is severe

Question 21

what is spondylolysis

Answer 21

defect or stress fracture in the pars interarticularis

w/out forward slipping of the vertebrae

Question 22

where does the majority of spondylolysis cases occur

Answer 22

L5

Question 23

Sx of disc prolapse

Answer 23

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

Question 24

how can you differentiate disc prolapse from referred back ache

Answer 24

referred pain usually goes no further than the knee or upper calf

Question 25

what happens in disc prolapse

Answer 25

prolapse (extrusion) of the nucleus pulposus material through the annulus fibrosis

extrudes backwards and laterally impinging on the nerve root

Question 26

what can happen if a disc prolapses posteriorly

Answer 26

impinges on the spinal cord or the cauda equina

Question 27

what discs are most commonly affected in disc prolapse

Answer 27

discs between sacrum and the fifth lumbar vertebra

Question 28

Mx of disc prolapse

Answer 28

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

Question 29

Ix of disc prolapse

Answer 29

myelography

• injecting a radio-opaque material into the spinal fluid then taking an X-ray.
• image called a myelogram

Question 30

clinical presentation of bony root entrapment a.k.a spinal claudication

Answer 30

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

Question 31

Mx of bony root entrapment

Answer 31

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

Question 32

aetiology of bony root entrapment

Answer 32

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

Question 33

why is the cervical spine prone to disease and injury

Answer 33

very mobile

Question 34

what is Cervical Spondylosis

Answer 34

disc degeneration and joint disease

Question 35

clinical presentation of Cervical Spondylosis

Answer 35

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

Question 36

Mx of Cervical Spondylosis

Answer 36

Analgesics
NSAID
soft collar
physio to relieve muscle spasm

Question 37

clinical presentation of Cervical Disc Disease

Answer 37

pain
referred pain similar to Spondylosis

however, tend to have no Hx of neck trouble

Question 38

Mx of Cervical Disc Disease

Answer 38

resting
gentle traction
support collar

potential fusion of affected vertebrae is localising signs are marked Sx do not regress