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Musculoskeletal System > Spinal disorders > Flashcards

Spinal disorders Flashcards

1
Q

Epidemiology of mechanical backpain

A
  • more common in women
  • 80% of people experience mechanical back pain
  • Onset = 20-55yrs
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2
Q

What are the clinical features of back pain

A
  • systemically well
  • pain worse towards end of day
  • pain in lumbosacral area, buttocks and thighs
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3
Q

Prognosis of mechanical back pain

A
  • good
  • 90% get better within 6 weeks
  • 50% get better within one week
  • 60% tend to get a recurrence within 1 year
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4
Q

What are the features of nerve root pain?

A
  • unilateral leg pain more than back pain
  • radiates below the knee
  • nerve irritation signs
    e.g ightheadedness.
    Dry eyes and mouth.
    Constipation.
    Bladder dysfunction.
    Sexual dysfunction
  • Motor, sensory or reflex change (limited to one nerve root)
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5
Q

Which nerve root tends to have prolapsed intervertebral discs?

A
  • L5 (51%)

- S1 (22%)

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6
Q

What are the motor signs of L5

A

Weak dorsiflexion of big toe
Weak dorsiflexion of lateral 4 toes
weak eversion

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7
Q

Motor signs of S1

A 
absent ankle jerk 
weak gluteal contraction 
weak knee flexion 
weakness toe plantar flexion 
(do not occur without absent ankle jerk)
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8
Q

Epidemiology of sciatica

A
  • annual prevelance 1-5%
  • rarely seen before the age 20
  • incidence peaks in 5th decade then declines
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9
Q

Modifiable risk factors of sciatica

A
  • Smoking
  • Obesity
  • Occupational factors
  • General health status
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10
Q

What is sciatica?

A

Leg pain secondary to lumbosacral nerve root pathology

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11
Q

What are the nice recommendations for patients with back pain?

A

Imaging in a specialist setting

Examine patient

Consider group exercise programme

Educate to self- manage their low back pain & encourage to continue normal activities

Consider manual therapy e.g spinal manipulation, mobilisation or soft tissue techniques such as massage

Weak opiods

Consider NSAIDS

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12
Q

What are against nice guidelines regarding managing back pain

A
  • belts or corsets
  • foot orthotics or rocker sole shoe
  • acupuncture
  • traction
  • only paracetamol, antidepressants or anticonvulsants
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13
Q

Interventions for backpain (surgical)

A
  • Radiofrequency denervation: focused electrical energy heats and denatures the nerve
    > provides relief for at least 6-12months

Epidurals/nerve root injections

Spinal fusion: can improve QoL

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14
Q

Chronic pain risk factors

A

Previous history of back pain

Unfit

Poor general health

Smoking

Depression/anxiety

Disproportionate pain behaviour

Personal problems

Previous time off work

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15
Q

Red Flags in Back Pain

A
  • Malignancy
  • Corticosteroids use
  • Pt systemically unwell
  • Weight loss
  • Widespread neurology
  • Age < 20 yrs or >55yrs
  • Violent trauma
  • Thoracic pain
  • IV drug abuse/ HIV infection
  • Structural deformity

etc.

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16
Q

How does physical activity help with back pain?

A
  • rest perpetuates disability
  • could relieve venous congestion and oedema
  • muscular afferent activity might interfere with pain signal processing
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17
Q

Clinical features of Cauda Equina Syndrome

A
  • lower back pain
  • sciatica
  • numbness in legs
  • bilateral leg pain
  • loss of bowel control
  • loss of urinary retention and haematuria
  • saddle area numbness
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18
Q

Causes of Cauda Equina Syndrome

A
  • bleeding
  • trauma
  • IV disc prolapse
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19
Q

Investigations and management of Cauda Equina Syndrome

A

Investigation:
Emergency MRI

Treatment

  • Discectomy
  • Stabilisation and fusion of vertebrae
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20
Q

What is the cauda equina syndrome?

A
  • Nerve roots compression from L1/L2 down to sacral roots
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21
Q

What is spinal stenosis

A

Narrowing of spinal canal and can cause compression of nerve roots

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22
Q

How do you do a bio psychological assessment?

A
  1. Look for red flags
  2. Take a thorough history
  3. PMD and procedures/treatment etc
  4. Medical Regime - benefits? Side effects?
  5. Look for yellow flags
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23
Q

What do plain radiographs of spinal conditions show?

A
  • information is readily available
  • provides structural information: vertebral collapse, spondyloisthesis, scoliosis
  • it is INSENSITIVE to EARLY DISEASE
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24
Q

What is the DEXA scan and name some features of it

A
  • Dual energy X-rays
  • Shows different absorption by bone
  • compares it with a population data set
  • it is dependent on bone density
  • DOENST GIVE ANY INFORMATION ABOUT OTHER DISEASE PROCESSES
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25
Q

What are the features of a Nuclear Medicine Bone scan (PET SCAN)

A
  • It is a functional scan
  • it is sensitive but not specific
  • emits radiation
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26
Q

What are the advantages of CT scans for spinal imaging?

A
  • widely available

- access for people who cannot have an MRI scan

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27
Q

What are the disadvantages of CT scan?

A
  • radiation

- falsely reassuring

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28
Q

When is imaging required for people with lower back pain?

A
  • if LBP is persistent

- used to exclude sinister pathology e.g malignancy, infection and vertebral collapse

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29
Q

Who should not have MRI scans?

A
  • patients that have internal metal sutures, shrapnel internally, plates, screws etc.
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30
Q

When is low back pain considered persistent?

A

> 6 weeks

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31
Q

What are limitations of plain film radiographs when imaging back pain?

A
  • insensitive to early stages of disease
  • to be able to visualise destructive lesions, at least 80% of medullary bone has to be gone
  • it is unable to distinguish between chronic and acute vertebral compression fractures
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32
Q

Limitations of plain film radiographs

A
  • might miss acute pars fractures particularly in the pre-fracture state
  • high radiation dose
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33
Q

What imaging method is preferred to investigate spinal diseases?

A
  • MRI scans
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34
Q

What are some things that would be detected by a MRI scan of the spine, that would not by a plain film

A
  • acute pars stress oedema
  • early spondylo-arthropathy
  • neurogenic tumours
35
Q

When should special investigations of spinal conditions start?

A
  • within 18 weeks
  • ideally after the physical examination
  • and after treatment
36
Q

What is vertebroplasty?

A
  • involves injecting polymethylmethacrylate (PMMA) cement into collapsed vertebral body
37
Q

What is kyphoplasty?

A
  • employs a balloon tamp to create a cavity in a vertebral body and to restore vertebral body height
38
Q

What are vertebral compression fractures secondary to?

A
  • Osteoporosis
  • Osteolytic metastases
  • Multiple myeloma
  • Vertebral haemangioma
39
Q

What is flat back syndrome

A
  • loss of ability to compensate for thoracic kyphosis by increasing lumbar lordosis
40
Q

What are some complications of crush fractures?

A
  • Pain
  • Deformity
  • Mortality
  • Reduced pulmonary function
  • Impaired functional status
  • QoL
41
Q

What is radiofrequency tumour ablation

A
  • ablation method for small tumours
  • high energy radio waves are inserted into the tumour
  • this is done by the insertion of a thin needle- like probe into the tumour through the skin
  • heat destroys the tumour
42
Q

What are facet joint injections

A
  • minimally invasive procedure
  • ## physician inserts small amount of local anaesthetics in the facet joint to improve the pain
43
Q

What is fluoroscopy?

A

A from of real time x-ray/CT that is used to guide the placement of the needle into the facet joint

44
Q

What are peri- neural injections

A
  • also known as nerve root block/injection

- relieves pain by delivering anti-inflammatory medication to an inflamed nerve

45
Q

What is a lumbar discography

A

injection that helps doctors to locate a painful disc before performing a lumbar fusion surgery in patients whose pain didn’t improve with conservative treatment

46
Q

Back pain is a diagnosis. TRUE OR FALSE

A

False- it is only a description of patients symptoms

47
Q

Cauda equina syndrome red flags

A
  • Bilateral sciatica
  • Difficult urinary retention
  • Faecal incontinence
  • Perianal, perineal and genital sensory loss
  • Severe or progressive bilateral neurological defect of the legs such as motor weakness with knee extension
48
Q

Spinal fractures red flags

A
  • sudden onset of severe central spinal pain (relieved by lying down)
  • history of major trauma
  • people with osteoporosis
  • use of corticosteroids
49
Q

Infection red flags

especially if CRP and WCC are raised

A
  • fever
  • TB
  • Diabetes
  • History of intravenous drug use
  • HIV infection
  • Use of immunosuppressants
50
Q

Management in absence of long term antibiotics is not associated with a good outcome. TRUE OR FALSE

A

FALSE

it is associated with a good outcome

51
Q

Malignancy red flags

A
  • being >50 years
  • gradual onset of symptoms
  • severe unremitting pain when the person is supine
  • localised spinal tenderness
  • unexplained weight loss etc.
  • history of cancer
52
Q

Is there always a pathological process for back pain?

A

No - BACK PAIN is the leading cause of disability worldwide

53
Q

What is the epidemiology of low back pain in the UK?

A

16% Of women

11% of men

54
Q

What is the difference between disease and illness ?

A

Disease - objective biological event that involves disruption of specific body structures/organ systems caused by pathological or physiological changes

Illness- subjective experience or self- attribution that a disease is present (yields physical discomfort)

55
Q

What does pain at the back of the thigh mean, (when the leg is stretched during a spinal examination)

A

Hamstring muscle pain

56
Q

What does a shooting pain down the leg indicate?

A

Sciatica

57
Q

How would you test for sensation (spinal exam)

A

Go over the dermatomes on the skin with a cotton wool 15-20 times to ensure you have been over all the dermatomes

You can also do a neurotip procedure but it involves a needle (Not required for year one)

58
Q

What are yellow flags

A

Yellow flags are pyschosocial factors shown to be indicative of long term chronicity and disability: A negative attitude that back pain is harmful or potentially severely disabling

59
Q

What are some yellow flags in back pain patients

A
  1. Attitude - does the patient feel that with the appropriate help and self management they will return to normal activities?
  2. Beliefs - e.g a feeling that something serious is causing their problems
  3. Compensation - is the patient awaiting payment for an accident etc?
  4. Emotions
  5. Family - e.g over or under bearing support
  6. Diagnosis - inappropriate communication can lead to patients misunderstanding what is meant
60
Q

What is the role of physiotherapists when managing people with back pain?

A
  • educating patients on how their muscles, back etc work
  • try to pick out what patients meaningful activities are
  • get them to understand what their achievable activities are

-

61
Q

Psychological side effects of pain

A

-low mood

depression

loss of independence

irritability

anxiety

anger

62
Q

Social side effects of pain

A
  • diminished social life
  • impact on intimate relationships
  • decreased recreational activities
63
Q

Physical function side effects of pain

A
  • reduced mobility
  • reduced fitness
  • sleep disturbances
  • fatigue
  • changes in appetite
  • changes in weight
  • sexual function
  • medical side effects
64
Q

Societal side effects of pain

A
  • affects work/education
  • increased health care use
  • misuse of substances & increased alcohol intake
65
Q

What is denervation

A

Damage to peripheral nerves

66
Q

What happens if the upper motor neurones get damaged

A
  • Causes spasticity (tight or stiff muscles)

- however peripheral nerves remain normal

67
Q

What is the function of the upper motor neurone

A

e motor system that is confined to the central nervous system (CNS) and is responsible for the initiation of voluntary movement and muscle tone (amount of tension in a muscle)

68
Q

What happens when the sensory neurones get damaged

A

loss of sensation

69
Q

What are the broad division of sensory neurones

A

Discriminative touch - ability to distinguish subjects, shapes, surfaces with fingers (information rely by large myelinated nerve fibres

Pain and temperature (small and thin, unmyelinated nerve fibres rely the information)

70
Q

Patterns/signs of denervation

A
  • loss of function in root distribution

- loss of function in distribution of named nerve

71
Q

What are the two elements in the spinal nerve (structural elements) that cause significant problems = denervation

A

Pathology of myelin (made of Schwann cells)

Damage to axons

72
Q

What causes damage to axons/ denervation

A

Direct injury

  • compression (common, e.g ulnar nerve compression at elbow)
  • transection
  • stretching

Diseases (peripheral neuropathy)

  • diabetes, b12 deficiency
  • inflammation, autoimmune conditions
  • infection, HIV, leprosy
  • drugs and toxins
  • inherited
73
Q

How are peripheral neuropathies described

A

Length dependent - denervation and loss of function in a length dependent manner (affects the most distal parts of the body - starts at the feet and works it way up)

Non length dependent
(patchy process, can affect long and short nerves, usually caused by inflammatory conditions)

Mono neuropathy
- named nerve that is damaged e.g median nerve at wrist

Radiculopathy
- damage is at the root

74
Q

What is axonotmesis

A

Damage to axon (only a few axons damaged)

- can recover but slow and may be incomplete

75
Q

What is a neurotmesis

A
  • complete transection of a nerve
  • recovery requires grafting transection
  • recovery requires axon regrowth - usually 1mm/day
76
Q

What is a medical condition called that causes axon loss

A

Peripheral neuropathy

77
Q

How long does it take for myelin to reform?

A

approx. 3 months

78
Q

What is neuropraxia

A
  • implies damage to a nerve in the form of myelin (temporary)
79
Q

What does demyelination cause?

A
  • slow conduction

- conduction block

80
Q

What is wallerian degeneration

A

occurs after axonal injury in both the peripheral nervous system (PNS) and central nervous system (CNS).

81
Q

What are the effects of motor nerve denervation

A
  • atrophy (reduction in size of a cell, organ or tissue)
    (neuromuscular junction builds the muscle - without it = muscle wastage)
  • weakness
    -paralysis
82
Q

What are the effects of sensory nerve denervation

A
  • numbness
  • pain
  • paraesthesia
83
Q

Effect of denervation in muscles

A
  • start to generate spontaneous motor activity
    e. g cramps, fibrillations and fasciculation
  • muscles remain viable for up to 2 years without a nerve supply after which they fibrose and cannot return to normal function

Musculoskeletal System (14 decks)

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