Orthopedics/rheumatology 8% Flashcards
Injury occurs as a result of a rear impact, with rapid extension followed by flexion of the cervical spine (usually after MVA or fall).
Stiffness and pain in the neck.
Will present with paraspinal muscle tenderness and spasm and a + Spurling test.
Cervical strain
Dx: clinical
Tx: soft collar
ICE/heat
gentle active ROM
Most common cause of back pain - commonly due to lifting or strenuous activity.
Characterized by stiffness and difficulty bending.
Back pain + NO RADICULAR SYMPTOMS
Back strain
Patients who have NOT improved in 4-weeks should be re-evaluated.
In the absence of ‘red-flag’ symptoms, treat conservatively with NSAIDs, heat or ice, PT, and home-based exercises (avoid bed-rest). May include a muscle relaxant such as cyclobenzaprine or short-term use of a benzodiazepine.
What to do when?
Mid-gluteal sciatica; posterior thigh; posterolateral leg; lateral foot, heel, or toes
Mild to aching discomfort to a severe knife-like stabbing, radiating down the leg, superimposed on intense ache
Pain referral (sciatica)
narrowing of the central or lateral lumbar spinal canal caused by degenerative joint disease, which puts pressure on the cord or sciatic nerve roots before their exit from the foramina
lumbar stenosis and cervical stenosis being the most frequent
positional back pain and referred buttock pain, symptoms of nerve root compression, and lower-extremity pain during walking or weight-bearing
Pain in elderly that increases with extension (walking downhill and standing upright) and is relieved with flexion at the hips and by leaning forward (sitting, leaning over a shopping cart)
Straight leg raise (nerve root tension sign) is usually negative
Neurogenic claudication -
DX: MRI
Unilateral radicular pain from foraminal stenosis made worse by extension of the back
Kemp sign
Treatment of
STENOSIS
Lumbar/cervical
(abdominal muscle strengthening), weight loss and bracing Steroid injections (epidural and transforaminal) for advanced symptoms
Surgical decompression laminectomy and/or fusion when neural compression and poor quality of life.
Vertebral compression fracture
Most common in the elderly (>60) with osteoporosis
Dx
TX
DX: X-ray, CT scan, DEXA (dual-energy X-ray absorptiometry)
TX:
Prevention of osteoporosis
HRT if there no history of breast cancer, VTE, or endometrial disease
Calcitonin therapy if HRT contraindicated
Bisphosphonates (alendronate) prevent osteoclastic resorption of bone
Surgery (anterior decompression and fusion) for neurologic deficits or significant compression
Pain is worse with extension, twisting, and improved with flexion
Spondylosis is degenerative osteoarthritis of the joints between the center of the spinal vertebrae or neural foramina
If severe, it may cause pressure on nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, and muscle weakness in the limbs
Dx
Tx
Spondylosis
DX: X-ray: formation of osteophytes and disc narrowing → facet joints, MRI
TX: NSAIDS, PT, lumbar epidural injections, facet injections (selective nerve blocks), ACDF in advanced disease
