Red flags Flashcards
name some red flag pathologies
myelopathy
cervical artery dysfunction (CAD)
malignancy
systemic inflammatory disorders e.g. RA
DVT
infections
Fractures
Cauda equina syndrome
What is myelopathy?
a term used to describe any neurologic deficit related to the spinal cord
What is myelopathy usually due to?
compression of the spinal cord
Where does myelopathy occur?
It is most commonly localised in the cervical spine but it can also occur in the thoracic and lumbar spine
Name some common symptoms of myelopathy
muscle weakness
altered muscle tones
sensory loss (in trunks and legs) and spasticity
impaired coordination
gait disturbances
spinal pain
urinary disturbances
What is cervical artery dysfunction?
an umbrella term used to cover a range of vascular pathologies which may lead to cervico-cranial ischaemia
How does CAD present?
presentations range from pain, through to cranial nerve dysfunctions, blindness, stroke or at worst death
Name some risk factors of CAD
previous trauma to Cx spine
migraine type headaches
HTN
High cholesterol
cardiac disease/vascular disease
diabetes
blood clotting disorders
anti-coagulant therapy
long term use of steroids
history of smoking
recent infection
immediately post-partum
absence of plausible mechanical explanation of symptoms
When does cancer occur?
when normal cells change such that they divide and grow in an uncontrolled way, forming malignant tumours
What is local spread?
When cancer cells spread to nearby area by pushing their way into healthy parts of the body and potentially damaging them
what are secondary tumours also known as?
metastases
What happens if metastatic spinal cord compression is not caught early?
It can lead to permanent paralysis from the level of the compression
What patients does MSCC most commonly occur in?
Patients with lung, breast or prostate cancer, lymphoma and multiple myeloma
Where is the most common site of MSCC?
thoracic spine followed by lumbosacral spine
What are the general signs and symptoms of MSCC?
Non mechanical pain
constant night pain
unexplained weight loss
general fatigue or feeling unwell
previous history of cancer
night sweats
unusual lumps/bumps/swelling
What does DVT stand for?
deep vein thrombosis
What is DVT?
a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis
Name some symptoms of DVT
pain
swelling
redness
enlarged veins in the affected area
What is inflammation?
a biological response to stimuli interpreted by the body to have a potentially harmful affect
What is an inflammatory disorder?
where the immune system mistakenly attacks your bodys own cells or tissues
What can inflammatory disorders result in?
chronic pain
redness
swelling
stiffness
damage to otherwise healthy body tissues
What is rheumatoid arthritis?
Systemic autoimmune disease characterised by inflammatory arthritis with extra-articular involvement
What happens with RA?
synovium is infiltrated by immune cells
fibroblasts and inflammatory cells lead to osteoclast generation resulting in bone erosion and loss of joint integrity
Name some risk factors of RA
genetic factors
smoking
air pollution
obesity
low vitamin D
Name some commonly affected joints for RA
elbow
shoulder
hip
knee
ankle
MTP
How can RA be managed?
Goal of treatment is symptom management
pharmacological management - disease modifying anti-rheumatic drugs
Nutrition
physiotherpay
When does an infection occur?
an infection occurs when a foreign organism enters the body or multiplies in a harmful way
What are some risk factors for infections?
taking steroids or other medications that supress your immune system, such as anti-rejection drugs for a transplanted organ
HIV or AIDS
having a certain type of cancer or other disorders that affect your immune system
open surgery
poor nutrition
stress
lack of sleep
What do the signs and symptoms of an infection depend on?
the type of disease
Name some signs of infection
fatigue
loss of appetite
weight loss
fevers
night sweats
chills
aches and pains
swelling
pus formation
increased temperature
Name some risk factors for fractures
age and gender
smoking
diabetes
alcohol
RA
Trauma
steroid use
other systemic diseases
What is RED-S?
Relative energy deficiency in sport is a syndrome in which disordered eating (or low energy availability) and decreased bone mineral density (osteoporosis and osteopenia) are present
What is RED-S caused by?
eating too little food to support the amount of energy being expended by an athlete, often at the urging of a coach or other authority figure who believes that athletes are more likely to win competition when they have an extremely lean body type
Name some signs and symptoms of RED-S
dull pain along the bone which can increase with activity
potential mild swelling around the affected area
tenderness around the affected area
How can RED-S be managed?
treatment is often multidisciplinary requiring a general practitioner, a dietician and a physiotherapist for stress fracture
in addition there is a potential for a sports psychologist to be required if RED-S syndrome is the primary factor for the stress fracture
What is the cauda equina?
the spinal cord usually terminates terminates between the L1 and L2 vertebra forming the conus medullas, emerging from this bundle of lumbar and sacral roots called the cauda equina
What does the nerves of the cauda equina serve?
sphincter muscle
sexual function
perineal sensation
sensation
motor functions throughout the lower limbs
What are some red flag signs and symptoms for cauda equina?
saddle anaesthesia
back pain
bladder dysfunctions
bowel dysfunction
What are the causes of cauda equina syndrome?
herniated lumbar intervertebral disc
epidural abscess
spinal epidural hematoma
diskitis
tumor
trauma
