Spine Flashcards
What is the definition of mechanical back pain?
Defined as a relapsing and remitting back pain that doesn’t result in any neurological symptoms.
What factors contribute to the development of mechanical back pain?
Obesity, osteoarthritis, lack of physical activity, poor lifting and poor posture.
Treatment of mechanical back pain?
Analgesics and physiotherapy.
Bed rest is recommended. True/false.
False, bed rest can lead to further stiffness and spasm of the back.
What are the facet joints?
The joints of the spine that make the back flexible and enable the person to bend and twist.
What causes bony nerve root entrapment?
OA of the facet joints can result in osteophytes (bony spurs) impinging on the exiting nerve roots. This results in sciatica and nerve root symptoms.
How can bony nerve root entrapment be managed?
Surgical decompression (and trimming of the osteophytes) can be performed to reduce this.
Spinal stenosis is worst when walking downhill. True/false
True. Spinal stenosis is worse when walking downhill. Peripheral
vascular disease is worse when walking uphill.
What are some other differences between claudication of spinal stenosis and PVD
Pedal pulses (pulses in feet) are present in spinal stenosis.
Pain is a burning sensation rather than a cramping sensation.
Cauda equina syndrome is a medical emergency. True/false
True, it will impinge on the sacral nerve roots causing a lack of control of defaecation and urination. Prolonged compression of this can lead to permanent damage.
A rectal examination should be omitted in suspected cauda equina syndrome. True/false
False, a PR exam is an essential part of the diagnosis.
What are the red flag symptoms of back pain?
In patient under 20 years old.
In patient over 60 years old.
If the pain affects bowel or urinary function.
Any systemic upset e.g. fevers, vomiting etc.
Pain that is constant/severe/worse at night.
What is cervical spondylosis?
Refers to the age-related wear and tear that affects the spinal discs. This occurs as a result of increased pressure, accelerating osteoarthritis in the facet joints. Patients will have slow onset stiffness and pain in the neck which will radiate locally to the shoulders and occiput.
Physiotherapy and analgesia are key to management.
What are some examples of peripheral nerve root compression neuropathies?
When certain nerve roots are compressed affecting the peripheral nerves in the limbs. Examples include carpal tunnel syndrome and cubital tunnel syndrome.
What is carpal tunnel syndrome and what nerve is affected.
The median nerve. Most cases of carpal tunnel are idiopathic however it can occur secondary to rheumatoid arthritis. Patient will present with paraesthesia (numbness) of the thumb and radial 2.5 fingers and wasting of the thenar eminence.
Typically worse at night.
