Skeletal Pathologies Flashcards
Describe Scoliosis
Scoliosis describes a lateral S shape curve in the spine.
Generally the more pronounced the curve the more clinically relevant.
Do people live with Scoliosis
People live with Scoliosis and are often asymptomatic
How do we develop Scoliosis
We can be born with it, or it can develop throughout life (often adolescent onset)
It can develop from everyday imbalances i.e carrying a rucksack on one shoulder. It is also common in people with leg discrepancies.
What does severe Scoliosis cause
It can cause spinal nerve compression
Define Lordosis
Lordosis describes an increased concavity in the lumbar and cervical spine.
What causes individuals to become Hyper-Lordotic
It may be genetics/ethnic cause i.e (Afro-Caribbean women) it can be secondary to other musculoskeletal changes. More common in Obese individuals. It is a normal adaption for pregnant women.
What can a HyperLordotic posture cause
Muscular fatigue, it can also encourage the vertebral joints to move closer together causing inflammation
Describe Kophosis and what can happen to an individual
A healthy spine will include a kyphosis in the thoracic spine, which is important as it helps distribute forces through the spine.
An individual can become Hyper-Kyphotic which causes an excessive curvature of the spine hunching forwards.
What can cause a Hyper-kyphotic spine
Poor posture, occupation, stress. It can also be secondary to another disease such as Osteoporotic spinal fractures.
What are the symptoms of a Hyper Lordotic spine
It can cause pain around the Scapular (shoulder blade) It can also cause irritation to the ribs and may interfere with breathing.
Define Osteoporosis
Osteoporosis is described as chronic progressive thinning of the bones. (Porous bone)
How is Osteoporosis characterised and what does it lead to?
Decreased bone mineral density (BMD). It leads to bone fragility and an increased risk of bone fracture.
How do we diagnose Osteoporosis
By a Dual x-ray absorptiometry also known as a DXA Scan. A TScore of lower than -2.5 indicates Osteoporosis.
What are the 6 main risk factors for Osteoporosis
- Sedentary lifestyle
- Genetics - Family history
- Low Body weight
- High Alcohol consumption and smoking
- Toxins (heavy metals)
- Endocrine pathologies e.g cushings syndrome, hyperthyroidism, hyperparathyroidism and inability to produce Oestrogen.
Why is dairy not good for the body.
Although Dairy is an alkaline food when it enters the body it turns acidic and actually leaches calcium from our bones. It creates inflammation in the body and creates an acidic environment in the body.
What are the signs and symptoms of Osteoporosis?
Osteoporosis is asymptomatic until the bone has reached critical thinness, whereby fractures will occur spontaneously with minor trauma. Commonly affecting the spine and hips.
Focal pain, and kyphotic posture with loss of height
Pain is aggravated by prolonged sitting, standing or bending.
It is relieved by laying on the side with hips and knees flexed.
What is the Allopathic treatment for Osteoporosis?
Bisphosphonates (alendronic acid) and HRT
What are the complications of taking Bisphosphonates
They can cause muscle and joint pain, fractures,oesophagitis and gastritis
What are the natural treatments for Osteoporosis
To follow a healthy alkaline diet and no caffeine/alcohol. Increase calcium, magnesium, Vitamin D3 and K2. Encourage weight baring exercise, hormone balancing herbs and avoiding toxins
Define Osteomalacia and Rickets
Inadequate mineralisation of the bone matrix in spongy and compact bone. Characterised by decalcification and hence softening of the bone.
What is the Allopathic treatment for Osteoporosis?
Bisphosphonates (alendronic acid)
What is the difference between Osteomalacia and Rickets
Rickets is in children prior to the closure of the epiphyseal plate under 18 years of age.
Osteomalacia is found in adults
What are the causes of Osteomalacia or Rickets
Insufficient sunlight
Insufficient vitamin D
Secondary deficiency - Malabsorption disorders
Reduced receptor sites for vitamin D in tissues.
What are the signs of Osteomalacia and Rickets
Deformed bones (bowed legs) and possible fractures
Severe back pain and muscle weakness
In Rickets: Delayed closure of the frontanelles and skull softening
What does Myelo indicate
marrow
Define Osteomyelitis and how does it present?
A bacterial infection of the bone marrow resulting in necrosis and hence bone weakness.
It presents as severe bone pain which is often worse at night, with swelling, redness and warmth.
What are the causes of Osteomyelitis
Bacterial infection Staphylococcus aureus through the blood supply or post fracture.
Immunosuppression, Diabetes, HIV and drug users
Define Ankylosing Spondylitis
Systemic autoimmune disease that is associated with the spine and sacroilliac joints. Often leading to spinal fusion (ankylosis) and stiffness
What is gene is normally present in Ankylosing Spondylitis patients and what percentage
HBA - B27 gene is found in 95% of AS patients.
What is the age of onset for AS and is there a particular gender it is more common in.
Generally between 15- 30 years of age and more common in men.
What other diseases are linked with AS
Inflammatory bowel diseases (leaky gut) as well as urogenital or intestinal infections such as salmonella and shigella which cross reacts with HLA - B27
What are the signs and symptoms of Ankylosing Spondylitis
typically begins with sacroiliac and lower lumber spine pain, before progressing up the spine. Worsening morning stiffness
Lower back symptoms that often improve with activity.
The lumber lordosis flattens and patients often become kyphotic
Hip and heel (achilles) pain are common
20% suffer acute iritis - (HLA -B27 diseases)
Systemic symptoms: Fever fatigue and malaise
How do we diagnose Ankylosing Spondylitis
Blood tests - elevated inflammation markers CRP/ESR HLA - B27 positive
Xrays and MRI - identifies classic bamboo spine.
What is the Allopathic treatment for Ankylosing Spondylitis
Surgery, anti inflammatories including steroids and non steroidal
Define Gout
Gout is a type of monoarthritis (mono = one . Artho = joint) characterised by uric acid crystal deposition in the synovial joints
Indicate what happens pathologically in the joint of a patient suffering with gout
Uric acid crystal deposition
compare the distribution of joint symptoms seen in Rheumatoid Arthritis and Osteoarthritis
Osteoarthritis: unilateral or weight baring joints
RA: bilateral or widespread/smaller joints
What is Uric Acid
. Breakdown of purines produces Uric acid. By product from metabolism of proteins
Explain Hyperuricaemia
Elevated blood uric acid levels due to overproduction or underexcretion
What happens in Gout
Excess uric acid forms in solid crystals (monosodium urate) on cartilage surfaces. This causes white blood cells to infiltrate activating an acute inflammatory response.
What are the causes of Gout
Increase intake of purine rich food.
Alcohol especially red wine which accelerates the breakdown of purines.
Red meat, organ meat shellfish
Dehydration, kidney disease medications, obesity excessive alcohol consumption hypertension and diabetes
How is Gout diagnosed
Blood serum for uric acid (not definitive as can fluctuate) can be useful to monitor treatment.
Analysis of synovial fluid (needle aspiration)
What are the signs and symptoms of Gout
Most often affects the big toe can affect the mid feet, ankles, knees elbows or hands.
Usually monoarticular (one joint)
Sudden onset of intensely painful, red, hot and swollen joints often lasting 12-24 hours shiny skin over the joing
Urate crystals can deposit under the skin and produce Tophi.
What is the allopathic treatment of Gout
Allopurinol - to prevent episodes
Corticosteroid injections
What are the adverse effects of corticosteroid injections
indigestion, rapid heartbeat, nausea insomnia, mood changes diabetes glucoma and osteoporosis
What happens in a disc herniation
the Nucleus polposus of the intervertebral disc leaks out through the annulus fibrosus.
What discs are affected in disc herniation
The discs with the highest fluid content most commonly lumbar spine L5/S1 then cervical spine. Usually between the ages of 30-40
What are the complications of a disc herniation
It can compress spinal nerves
What is the classic injury mechanism for a disc herniation
Combined lumbar spine flexion (bending) and rotation.
What is the treatment for Disc Herniation
Manual therapy and exercise anti inflammatory nutrients and herbs
Name and explain the 3 types of fractures
Complete - bone broken into 2 or more fragments. Can either be open (perforated skin) or closed (soft tissues not compromised)
Incomplete - bone fractured but not into fragments
Avulsion - tendon or ligament pulls off a piece of bone
What are the following type of fractures
a. linear
b. transverse
a. along the bone length
b. dissect across the bone
