Spine Flashcards
Specific back pain
Id dis proces cause. Eg trauma neop infec inflamm spondyloarthropathy metabolic- OM, OP, thyr
Non specific
No identifiable cause. Eg
Age degen mediated by genetics
NOT arthritis
red flags indic possible serious underlying dis
Non mech pain Throacic pain Fever, rigors Diffic passing urine, urinary retention Bilateral sciatica Nocturnal pain Hx malig New pain under 16 or over 55 Unexpl wl LT steroid use Recent sig infec Saddle anaes Reduc anal tone Widespread or progressive neurology
Cauda equina red flags
Diffic passing urine, urinary reten Bilateral sciatica Saddle anaes Reduc anal tone Widesp neurology
Cord compression red flags
Non mech pain Throacic pain Diffic passing urine, urinary reten Hx malig Widesp or prog neurology
Spinal infection rd flags
Non mech pain
Fever/rigors
LT steroids
Recent sig infec
Yellow flags
Bio psycho social model
Indics of poor outcomes
Attitude- poor coping strategies Beliefs- neg beliefs Compensation Diagnosis Emotions- distress, behav and psych barriers to recov. Family Work
Occupational black flags
Obstacles to recovery
Industrial inj/litigation
Poor work satisfaction/indust relations
Repetit manual work
Imaging
XR lim use eg immed post trauma, after rod insert, surgical planning.
XR NOT exclude spinal fracs.
MRI for serious underly prob- T2 CSF and discs bright. T1 better for bm, foramina, post op change.
UMN lesion
SC or brain pathol
Hypertonia Hyper reflexia Ext plantar resp Clonus Hoffmans (UL clonus/spasticity indic cervical cord or brain inj- test by flick digit)
LMN lesion
Spinal N root pathology, cauda equina
Wasting Hypotonia Fasciculation Hyporeflexia Flexor plantar resp
MRC power grade
0 no power 1 flicker 2 active movem wth gravity elim 3 active movem ag grav not resis 4 active movem ag some resis but not full pow 5 full pow
HPC
Pain- squitarps Weakness, numb, parasthesia Sphincter disturb Deformity Stiffn Gait change Manual dexterity Flags Func- work, ADL, sport Tx tired- physio, orthotics, meds, acupunc, massage, TENS.
Examination
-look- asymm, scoliosis, wasting, scars, kyphosis, lordosis, gait, walk heels L5 and toes S1.
-feel-
spinous processes esp C7, supra scap T3, infra scap T7, iliac crest L4, PSIS S2
paraspinal musc
SIJ
-move-
C spine flex ext occiput and C1, rot C1 and C2, lat flex C2-C7.
T spine sitting rot
L spine flex ext, modofied schrober, lat flex.
Special tests
-Schrober test of lumbar flexion- horiz line LS junc, other line 10cm above. Flex should incr dist at least 5cm.
-N tension-
C spine spruling sign- passive lat flex 30 deg tow affected side then downw axial comp. pos if pain radiates in direc ipsilat corresp dermatome.
L spine SLR and flex knee.
-LS N root irritation-
SLR- sensitve.below 30 deg N root NOT stretched.record angle when pain starts.
Sciatic str test- at full SLR, doriflex ankle, pos if pain worsens.
Crossover sign- contralat SLR causes pain in affected leg. Specific.
neuro exam
Tone
Power- C5 shoulder abduc, C6 elbow flex, C7 elbow ext, C8 finger flex, T1 finger abduc, L2 hip flex, L3 knee ext, L4 ankle dorsiflex, L5 EHL, S1 ankle plantarflex. MRC grade.
Reflexes- C5 bicep, C6 brachio/supin, C7 triceps, L4 knee, S1 ankle, UMN babinski and clonus.
Sensation
Proprioception
DRE- perianal sensat, anal tone, volunt contrac.
ASIA scale cord inj
A- compl. No sensory or motor func in S4-5.
B- sensory incompl. Sensory func preserved below NLI, incl S4-5.
C- motor incompl. Motor func preserved at the most caudal sacral segments for volunt anal contrac. Under half key musc funcs below NLI have musc grade at least 3.
D- motor incompl but at least half key musc funcs below NLI have grade over 3.
E- normal motor and sensory.
cord comp causes
Bone displ Disc prolapse Local tum Abcess Haematoma
Neck pathol
C1 and 2 frac
Cervical spondylosis- degen annulus and bony spurs narrow SC and IV foramina.
Cervical spondylolisthesis- displ verteb upon one below.
Prolapse disc us C5/6, C6/7
Cervical rib costal proc C7
Torticollis SCM dam
Whiplash sudd ext rebound flexion.
Back pathol
Disc herniation often L4-S1
Retroperitoneal- duod ulcer, AAA
Local infec or systemic TB causing osteolyelitis
Neop eg myeloma, panc CA
Bone mets eg breast, brinchus, kidn, thyr, prostate.
Kyphosis eg scheurmans, OP, spina bif, CA, TB, polio, pagets, ankylosing spondylitis.
Scoliosis lat curvat with rot eg idio, neuro, myopathic, marfans, tum, OP, infec.
Spondylolisthesis.
Lumbar spinal stenosis us L5 displ on S1.
Spondyloarthropathy
Simple low back pain
Cauda equina
Spinal tum
Pyogenic infec
Spinal TB us affs T10-L1
Surg indics
Instabil (gait inv etc)
Neurology
Fail conservative
?diff diag
