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MSK SM > Prolapsed Intervertebral Disc > Flashcards

Prolapsed Intervertebral Disc Flashcards

1
Q

What are the 3 components of back pain

A

Biological
Psychological
Social

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2
Q

What neurological symptoms are important to ask about

A

Numbness
Paraesthesia
Weakness
Temperature disturbance

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3
Q

What are 4 red flag features of back pain in the history

A

Non-mechanical pain (does not vary with activity - also troublesome at night)
Systemic upset
Major, new, neurological deficit (suspicious of cord compression)
Saddle anaesthesia +/- bladder or bowel upset (surgical emergency)

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4
Q

What happens in saddle anaesthesia

A

Painless retention of urine with overflow and a lack of awareness of the bowels opening

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5
Q

What do we look for on examination from the back and side

A 
Deformity 
Asymmetry
Hairy patches
Neurofibromata 
Masses
Bulges
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6
Q

What does forward bending do

A

Accentuate any structural deformity - exentuate saddle deformity
Scolliosis

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7
Q

What does the normal movement go to during forward bending in Schober’s Method

A

21cm

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8
Q

What is a movement of less than 18cm suggest

A

Pathologically stiff

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9
Q

What is a movement range of more than 21cm indicate

A

Hypermobile

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10
Q

What should you see on lateral movements

A

Smooth curve eitherway

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11
Q

What are the 4 tests in the neurological examination

A

Myotomes
Dermatomes
Reflexes
Nerve irritation (straight leg raise)

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12
Q

What are the myotomes for

1) hip flexion
2) knee extension
3) foot dorsiflexion and Extensor halls longus
4) ankle plantarflexion

A

1) L1,2
2) L3,4
3) L5
4) S1,2

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13
Q

How do we test L1,2

A

Hip flexion

With a bent knee as the patient to push up against your hand

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14
Q

How do we test for L3,4

A

Knee extension

Ask the patient to straighten their knee against your hand with knee at 45 degrees

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15
Q

How do we test L5

A

Extension or dorsiflexion of the foot

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16
Q

How do we test S1,S2

A

Plantar flex the foot against your hand
Powerful movement and deficit needs to be gross to pick it up

Ask the patient to stand on tip toes for more subtle deficits

17
Q

What is different about the way we test plantar reflexes?

A

We use the opposite end of the tendon hammer and scratch the sole of the foot

18
Q

How do we perform the femoral stretch test

A

Patient on their side, flex the knee to 90 degrees and extend their hip

19
Q

How do we test distraction SLR

A

Ask the patient to sit at 90degrees with the legs straight

20
Q

What is the gold standard investigation for back pain

A

MRI / CT

21
Q

What is a patients definition of Sciatica

A

Any sort of vague buttock or leg pain

22
Q

What is a GPs definition of sciatica

A

Any sort of buttock or leg pain not obviously coming from the hip, knee or ankle

23
Q

What is a spinal surgeon’s definition of sciatica

A

Buttock and / or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

24
Q

What is an important feature of a prolapsed disc

A

Leg pain (sciatica) often accompanied by neurological disturbance

25
Q

Disc prolapse are always symptomatic. True or false

A

False

26
Q

What is the purpose of surgery for a prolapsed disc

A

To treat leg pain or sciatica - not normally back pain

27
Q

What are 4 common presentations of disc prolapse

A

Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dominant
Myotomes and dermatomes will tell you where the prolapsed disc is

28
Q

What generally do we do for disc prolapses

A 
Leave them (conservative)
Only surgery for cauda equina symptoms
29
Q

What are some of the second line treatments for a prolapsed disc

A 
Education/ instruction and reassurance 
physio
Osteopathy / chiropractic 
TENS/ psychology / pain clinic
Complementary therapies 
Surgery
30
Q

What is the difference between stress and distress

A

Stres is a normal emotion in response to life

Distress is excessive or abnormal stress response

31
Q

What are some symptoms of stress

A 
Feeling under pressure 
Feeling overwhelmed 
Chronic fatigue 
Anxiety 
Muscle tension
Aches and pain 
Sweaty hands

MSK SM (42 decks)

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