Orthopaedics (Unit 2 - Backache & Neckache) Flashcards
What are the the non-nervous tissues in the back collectively called?
Spondylitides
Where can back pain be referred?
Buttock, thigh & leg
Where do nerve roots emerge?
Vertebral foramina (surrounded by facet joints behind & IV disc in front)
What can cause direct compression on te nerve roots?
Diseases affecting facet joints and discs
How does sciatica present?
Pain down the back of the leg but almost always into the foot (may be exacerbated by coughing)
How are back sprains managed?
Brief period of res then gradual return to activities
Anti-inflammatory drugs
Analgesia
What are causes of mechanical back pain?
Spondylosis
Primary OA
What is spondylosis?
Degeneration of the IV disc leading to increased loading of facet joints which then develop secondary OA
What is spondylolisthesis?
Slippage of one vertebra relative to the one below
Where is spondylolisthesis commonly seen?
Lumbar spine
What is the most likely cause of an adult developing spondylolisthesis?
Fracture of pars interarticularis
How is spondylolisthesis diagnosed?
X-ray techniques
When is spondylolisthesis most likely to cause nerve tissue damage?
If it is congenital
What management may help to relieve pain in spondylolisthesis?
Spinal corset
What is spondylolysis?
Par interarticularis defect without a forward slipping of the vertebra
What is the last line management for severe pain in spondylolysis?
Spinal fusion
Clinical presentation of prolapsed intervertebral disc
Men under 40
Acute backache & legache (sometimes backache develops later)
May describe single event
Legache passes down the back of the thigh and leg TO THE FOOT
What is a prolapsed intervertebral disc?
Extrusion of the nucleus pulposus material through the annulus fibrosis
What might the prolapsed disc impinge if it extrudes backwards & laterally?
Nerve root
What might the prolapsed disc impinge if it extrudes posteriorly?
Spinal cord, or more commonly cauda equina
What is the management of disc prolapse?
Rest & progressive mobilisation
Analgesia/anti-inflammatory for sympomatic relief
What is the management of a disc prolapse if pain persists or localising signs get more severe?
Surgical removal of disc material
What investigation is used to confirm a disc prolapse?
Myelography (radio-opaque material will not be able to flow where disc presses on the nerve)
What is the typical patient demographic to present with bony root entrapment?
Either sex
Over 40
History of mechanical backache
Clinical presentation of bony root entrapment
Back sufferer who develops new symptoms of leg pain radiating to the foot, made worse by exercise
What causes bony root entrapment?
Bony overgrowth around the vertebral foramina where nerve roots emerge (secondary to degenerative changes in adjacent facet joints)
What is the management of bony root entrapment?
Do not remove the disc as it will make the condition worse.
Removal of bone required to free trapped nerve roots
What is the downside of the surgery for bony root entrapment?
Discturbance in spinal stability may lead to a need for fusion of the affected vertebrae
What patient demographic is most likely to present with cervical spondylosis?
Over 40
Females > males
How does cervical spondylosis present?
Dull neckache referred to shoulders and upper arms
Tingling in arms
(can be progressive and bony nerve entrapment may occur with neuro signs)
What is the treatment of cervical spondylosis if there are no localising neuro signs?
Analgesics
NSAIDs
Use of a soft collar
Physio (to relieve muscle spasm)
What is the management if nerve entrapment is confirmed in cervical spondylosis?
Surgical fusion of the vertebrae and decompression of the nerve root
How do you differentiate between the presentations of cervical disc disease & cervical spondylosis?
Sufferers from disc disease tend to have no previous history of neck trouble
