Spine Flashcards
What is mechanical backpain?
A relapsing/remitting condition that does not cause neurological symptoms.
It will be worse on movement (and will be relieved on rest).
What factors may cause mechanical back pain?
Obesity
Poor posture/Lifting technique
Facet joint OA
Spondylosis
Degenerative disc prolapse
What is spondylosis?
A loss of water content in the intervertebral discs with age - less cushioning, thus increased pressure on facet joints.
How is mechanical back pain treated?
Analgesia
Physiotherapy
Do not advise bed rest as this may worsen symptoms.
How may an acute disc tear present?
Classically after heavy lifting
Pain will be worse on coughing
May take 2/3 months to settle - advise analgesia and physiotherapy.
What may result from nerve root impingement?
Pain and altered sensation in the corresponding dermatome/myotome.
Which roots are most commonly affected by nerve root impingement?
L4
L5
S1
These contribute to the sciatic nerve - producing sciatica.
How is sciatica treated?
Analgesia
Physiotherapy
Some may also need neuropathic pain killers. The aim is to maintain mobility.
How is bony nerve root entrapment treated?
Surgical decompression and trimming of osteophytes.
What may cause nerve root entrapment?
Osteoarthritis
Osteophytes will impinge on the exiting nerve root.
What is spinal stenosis?
Spondylosis and bulging discs results in less space for the cauda equina to pass through.
Results in compression/irritation at multiple nerve roots.
What spinal condition may cause claudication?
Spinal stenosis
How is spinal stenosis-related claudication differentiated from vascular claudication?
Distance of onset inconsistent
Pain is less when walking uphill
Pain burns rather than cramps
Why is pain relieved in spinal stenosis when walking uphill?
As flexion creates more space for the spinal cord.
Are pulses lost in spinal stenosis?
No, these are preserved.
Issue is solely neurological - there is no vascular involvement.
How is spinal stenosis treated?
Initial management is conservative.
If fails to improve, surgery may be needed to decompress.
Aim is to prevent onset of cauda equina.
What is cauda equina syndrome?
When a large disc prolapse occurs, resulting in the compression of ALL nerve roots of the cauda equina.
This is a medical emergency.
How does cauda equina present?
Bilateral leg pain, paraesthesia, numbness
Saddle anaesthesia
Faecal incontinence
Initial urinary retention, then eventual incontinence (indicates poor prognosis)
How is cauda equina diagnosed?
PR exam (shows reduced tone)
MRI scan
What are red flags of back pain?
Pain in those under 20 years old
Nerve-type back pain in those over 60 years old
Nature pain (i.e. worse at night)
Systemic upset
In which conditions as cervical instability seen?
Down syndrome
Rheumatoid arthritis
What structures form the carpal tunnel?
Carpal bones
Flexor retinaculum
Which nerve is affected in carpal tunnel syndrome?
Median nerve
What gender are more likely affected by carpal tunnel syndrome?
Women
What may cause carpal tunnel syndrome?
Idiopathic
Rheumatoid arthritis
Colles’ fracture
How does carpal tunnel syndrome present?
Paraesthesia of the thumb and radial 2.5 fingers.
This is typically worse at night, and is associated with a loss of sensation/weakness/clumsiness of the median nerve area of the hand.
How is carpal tunnel syndrome diagnosed?
Tinel’s test
Phalen’s test
Nerve conduction studies
What is Tinel’s test?
Upon percussion of the median nerve, symptoms are exerted.
What is Phalen’s test?
Upon holding the wrist in a hyper-flexed position, symptoms are exerted.
How is carpal tunnel syndrome treated?
Trial conservative management initially for 6 weeks (splinting and steroid injections).
If no resolution, then surgical decompression.
What may cause carpal tunnel syndrome?
Idiopathic
Pregnancy
Oedema
Lunate fracture
Rheumatoid arthritis
What is cubital tunnel syndrome?
Compression of the ulnar nerve at the elbow (behind the medial epicondyle)/
How does cubital tunnel syndrome present?
Paraesthesia over the 4th and 5th fingers.
Will initially be intermittent, before becoming constant. Tinel’s test over the cubital tunnel will elicit symptoms.
What is Froment’s sign?
When patient is asked to hold a piece of paper between their thumb and index finger.
As you try to pull away, if an ulnar nerve palsy is present, then the patient will not be able to maintain their grip.
