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Msk > Session 5 Clinical Conditions > Flashcards

Session 5 Clinical Conditions Flashcards

1
Q

What is mechanical back pain characterised by

A

Pain when spine is loaded, that worsens with exercise and is relieved by rest . Intermittent.

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2
Q

Risk factors for mechanical back pain

A

Obesity, poor posture, Sedentary lifestyle, deconditioning of core muscles, poor seating and incorrect manual handling

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3
Q

2 main degenerative changes in vertebral column

A

Disc degeneration and marginal osteophytosis

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4
Q

Disc degeneration key points

A
  • Nucleus pulposus of intervertebral discs dehydrates with age
  • Decrease in height of discs, bulging and alteration of load stresses
  • Osteophytes (bone spurs) called Syndesmophytes develop adjacent to end plate
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5
Q

What is marginal osteophytosis

A

Syndesmophytes developing adjacent to end plates of discs. Increased stress can cause osteoarthritis changes.

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6
Q

What are facet joints innervated by

A

Meningeal branch of spinal nerve, so arthritis in these joints is painful

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7
Q

As disc height decreases and arthritis develops in facet joints and vertebral bodies (due to disc generation and marginal osteophytosis), what happens

A

Intervertebral foramina decrease in size lading to compression of spinal nerves and radicular/nerve pain

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8
Q

Why does pain occur in herniated disc

A

Herniated disc material presses on spinal nerve

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9
Q

4 stages of disc herniation

A
  1. Disc degeneration
  2. Prolapse
  3. Extrusion
  4. Sequestration
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10
Q

What is disc degeneration

A

chemical changes associated with ageing cause discs to dehydrate and bulge

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11
Q

What is prolapse

A

Protrusion of nucleus pulposus occurs with slight impingement into the spinal canal

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12
Q

What is extrusion

A

Nucleus pulposus breaks through annulus fibrosis but is still contained within disc space

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13
Q

What is sequestration

A

Nucleus pulposus separates from main body of disc and enters spinal canal

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14
Q

Most common sites for slipped disc

A

L4/5 and L5/S1 due to mechanical loading

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15
Q

Nerve roots are most vulnerable at 2 sites:

A
  1. Where they cross the intervertebral disc

2. Where the exit the spinal canal in the intervertebral foramen

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16
Q

Nucleus pulposus most commonly herniates…

A

Posterolaterally (causing compression of a spinal nerve root within intertertebral foramen). Paracentral prolapse.

2% are far lateral and 2% are central

17
Q

Nerve roots at risk in far lateral, paracentral and central herniation

A

Far lateral- exiting nerve root
Paracentral- transversing nerve root
Central- cauda equina syndrome

18
Q

What is most frequently compressed in paracentral herniation of L4/5

A

L5 root (transversing root)

19
Q

What is sciatica

A

Radicular leg pain caused by irritation or compression of the nerve roots contributing to sciatic nerve (L4, L5, S1, S2 and S3)

20
Q

Sciatica pain

A

Back and buttock and radiates to dermatome supplied by affected nerve root.

21
Q

Distribution of pain in sciatica L4 L5 and S1

A

L4- anterior thigh, anterior knee, medial leg
L5- lateral thigh, lateral leg, dorsum of foot
S1- posterior thigh, posterior leg, sole of foot

22
Q

What is cauda equina syndrome

A

Can be Prolapsed intervertebral disc when there is a canal filling disc- compresses lumbar and sacral nerve roots within the spinal canal

Other causes- tumours, spinal infection, stenosis secondary to arthritis, fracture, haemorrhage and ankylosis spondylitis

23
Q

Red flag symptoms of cauda equina syndrome

A
  • Bilateral sciatica
  • Parianal numbness
  • Painless retention of urine
  • Urinary/faecal incontinence
  • Erectile dysfunction
24
Q

Treatment of cauda equina syndrome

A

Surgical decompression within 48 hrs of onset for good prognosis

25
Q

Outcome of untreated cauda equina syndrome

A

Chronic neuropathic pain, impotence, catheters, faecal incontinence, loss of sensation or weakness requiring a wheelchair

26
Q

What is spinal canal stenosis

A

Abnormal narrowing of the spinal canal that compresses either the spinal cord or nerve roots - tends to affect elderly

27
Q

Spinal canal stenosis can occur due to

A

Disc bulging, facet joint osteoarthritis, ligamentum flavum hypertrophy

(Or compression fractures, spondyolisthesis, trauma)

28
Q

Symptoms of spinal canal stenosis

A
  • Discomfort whilst standing
  • Discomfort or pain in shoulder, arm or hand (cervical stenosis) or lower limb (lumbar stenosis)
  • Bilateral symptoms
  • Numbness/weakness at or below level
  • Neurogenic claudcation
29
Q

Most common forms of spinal stenosis

A

Lumbar then cervical

30
Q

What is neurogenic claudication

A

Symptom- patient reports pain or pins and needles in legs on prolonged standing and walking. Radiates in sciatica distribution.

31
Q

What does neurogenic claudication result from

A

Compression of spinal nerves as they emerge from the lumbosacral spinal cord

Leads to venous engorgement of nerve roots during exercise, reduced arterial inflow and transient arterial ischeamia

Present in one or both legs

32
Q

What relieves neurogenic claudication

A

Rest, change in position, flexion of spine.

33
Q

What is spondylolisthesis

A

Anterior displacement of vertebra above relative to vertebra below. Can be congenital, isthmic, degenerative, traumatic, pathological or iatrogenic.

34
Q

What happens in isthmic spondylolisthesis

A

Defect (such as stress fracture) develops in pars interarticularis. Complete fracture here is spondylolysis and then anterior displacement of upper vertebra is spondylolisthesis.

35
Q

Symptoms and treatment for spondylolisthesis

A

Some asymptomatic

Discomfort- occasional lower back pain to incapacitating mechanical pain, sciatica from nerve root compression, and neurogenic claudication.

Treatment- surgical using screws and rods to stabilise spine

36
Q

What technique spots spondylolysis on fractures

A

Scottie dog collar, or draw lines along edges.

37
Q

What is Lumbar puncture

A

Withdrawal of fluid from subarachnoid space of lumbar cistern. Diagnostic test for CNS disorders including meningitis, MS etc…

38
Q

How do you perform lumbar puncture

A
  • Patient lie on side with back and hips flexed
  • Insert between L3 and L4 or L4 and L5 vertebrae
  • Find plane transecting iliac crests (usually passes through L4 spinous processes)
  • No danger of damaging spinal cord
  • 4-6cm in adults, needle pops through ligamentum flavum
  • Punctures dura and arachnoid, enters lumbar cistern
  • CSF escapes when stylet removed
39
Q

Herpes zoster (shingles) key points

A

Viral infection, skin of single dermatome

Reactivation of varicella zoster virus (chickenpox)

Virus travels through a cutaneous nerve and remains dormant in dorsal root ganglion

When host is immunosupressed, VZV reactivates and travels through peripheral nerve to skin of a single dermatome

Msk (38 decks)

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