Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK Cortext > Spine > Flashcards

Spine Flashcards

1
Q

What is often enough to treat acute episodes of mechanical back pain?

A

Advice and analgesia with or without physiotherapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define mechanical back pain.

A

Recurrent relapsing and remitting back pain with no neurological symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the potential causes for mechanical back pain?

A

Obestiy, poor posture, poor lifting technique, lack of physical activity, depression, degenerative disc prolapse, facet joint OA and spondylosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is spondylosis?

A

Where U=IV discs lose water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What advice would you give someone with mechanical back pain?

A

They do not have a serious problem, urge them to maintain normal function and return to work early, bed rest not advised (leads to stiffness and spasm of back).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What patients MAY benefit from spinal stabilisation surgery?

A

Patients with single elvel OA or instability that haven’t improved despite physio/conservative management where there is no secondary gain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is acute disc tear painful and what makes it worse?

A

Periphery of IV disc is richly innervated, coughing (increases disc pressure).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the mainstay of treatment for acute disc tear and how long can it take for symptoms to resolve?

A

Analgesia and physiotherapy, 2-3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What occurs when disc material impinges on an exiting nerve root?

A

Pain and altered sensation in dermatomal distribution as well as reduced power in a myotomal distribution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the commonest site for disc prolapse to impinge nerves?

A

Lower lumbar spine with L4, L5 and S1 nerve roots contributing to sciatic nerve being compressed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first line treatment for sciatica?

A

Analgesia, maintaining mobility and physiotherapy. Drugs for neuropathic pain e.g. gabapentin can be used if leg pain is particularly severe.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is surgery (discectomy) indicated in sciatica?

A

Pain is not resolving despite physiotherapy and localising signs suggesting specific nerve root involvement and positive MRI evidence of nerve root compression. Contra-indication - secondary gain or psychological dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a potential neurological complication of facet joint OA?

A

Bony nerve root entrapment - osteophytes impinge on exiting nerve roots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a potential treatment for bony nerve root entrapment?

A

Surgical decompression with trimming of impinging osteophytes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is spinal stenosis and what causes it?

A

When the cauda equina has less space due to spondylosis and combo of bulging discs, bulging ligamentum flavum and osteophytosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the clinical presentation of spinal stenosis?

A

Person over 60 with neurological claudication.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the features of neurological claudication?

A

Claudication distance is inconsistent, pain is burning rather than cramping, pain is less walking uphill (spine flexion creates more space for cauda equina), pedal pulses are preserved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the treatment of spinal stenosis?

A

Similar to sciatica.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is cauda equina syndrome?

A

Where a very large central disc prolapse compresses all the nerve roots of the cauda equina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is cauda equina a surgical emergency?

A

Affected nerve roots include the sacral nerve root (mainly S4-5) controlling defecation and urination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can prolonged compression of the cauda equina cause?

A

Nerve damage requiring colostomy and urinary diversion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the signs/symptoms of cauda equina syndrome?

A

Bilateral leg pain, paraethesiae or numbness, saddle anaesthesia, urinary retention/incontinence, faecal incontinence/constipation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What exam is mandatory if you suspect cauda equina?

A

PR exam (considered negligent if you don’t do it).

24
Q

What imaging would you do urgently for suspected cauda equina?

A

Urgent MRI.

25
Q

Are all patients who get an urgent discectomy for cauda equina fine afterwards?

A

No, significant numbers of patients have residual nerve injury with permanent bladder and bowel dysfunction.

26
Q

What are the red flag signs/symptoms of back pain?

A

Back pain in <20 years or new back pain in >60 years, constant severe pain that is worse at night, systemic upset.

27
Q

What potential pathologies could cause back pain in a younger patient?

A

Younger children - infections. Adolescents - spondylolisthesis and primary bone tumours.

28
Q

What potential pathologies could cause back pain in an older patient?

A

Not bad - arthritic change, crush fracture.

Bad - neoplasia esp mets and multiple myeloma.

29
Q

Why is constant, severe pain that is worse at night a bad sign?

A

Tends to be pain from tumour or infection.

30
Q

What kind of spinal fractures can people with osteoporosis get?

A

Spontaneous crush fractures.

31
Q

What do osteoporitic crush fractures cause symptoms wise?

A

Acute pain and kyphosis.

32
Q

What symptom to a minority of patients with osteoporotic crush fractures go on to get?

A

Chronic pain due to altered spinal mechanics.

33
Q

What is the usual treatment for osteoporotic crush fractures and what has been trialled?

A

Conservative, maybe balloon vervoplasty for patients with chronic pain (good results initially but long term results have not been fully evaluated and small risk of neurological injury).

34
Q

What are the symptoms for cervical spondylosis?

A

Slow onset neck pain and stiffness which can radiate locally to shoulders and occiput.

35
Q

What is the mainstay of treatment for cervical spondylosis?

A

Physiotherapy and analgesics.

36
Q

What other problems can cervical spondylosis cause and how can this be managed?

A

Osteophytes impinging on exiting nerve routes, may require decompression for severe symptoms resistant to conservative management.

37
Q

In cervical disc prolapse what nerve root is usually affected?

A

The lower nerve root.

38
Q

What symptoms does a large cervical disc prolapse cause?

A

Myelopathy with upper motor neurone symptoms and signs.

39
Q

How is cervical disc prolapse treated?

A

Conservative management, discectomy if resistant (MRI again may show false positives).

40
Q

In what conditions can atraumatic cervical spine instability occur in?

A

Down syndrome and RA.

41
Q

What causes atlanto-axial subluxation in RA?

A

Destruction of the synovial joint between the atlas and the ends and rupture of the transverse ligament.

42
Q

What is the treatment for A-A subluxation?

A

Less severe - collar.

Severe - surgical fusion.

43
Q

What is the difference between cervical nerve root compression and peripheral nerve compression neuropathies?

A

They will cause symptoms and signs affecting peripheral nerve sensory and motor territories rather than dermatomal and myotomal distributions.

44
Q

What forms the carpal tunnel and what passes through it?

A

Carpal bones and flexor retinaculum. Median nerve and 9 flexor tendons in synovial covering.

45
Q

What are some causes of secondary carpal tunnel syndrome?

A

RA, conditions resulting in fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroidism), fractures around wrist (Colles fracture).

46
Q

Are women or men more affected by CTS?

A

Women.

47
Q

What is the presentation of CTS?

A

Parathesiae in median nerve innervated digits (thumb and radial 2 1/2 fingers) which is usually worse at night, loss of sensation and sometimes weakness of the thumb and clumsiness in areas of the hand supplied by the median nerve.

48
Q

What examination findings would there be in CTS?

A

Demonstratable loss of senation and/or muscle wasting of the thenar eminenece (chronic severe cases).

49
Q

How can you reproduce symptoms of CTS?

A

Tinel’s test (percussing over median nerve) or Phalen’s test (holding the wrists hyper-flexed).

50
Q

What investigation can confirm CTS?

A

Nerve conduction studies.

51
Q

What are the conservative treatments for CTS?

A

Conservative - wrist splints at night to prevent flexion, corticosteroid injection.

52
Q

What us the surgical management of CTS?

A

Division of transverse carpal ligament under local anaesthetic (highly successful but risk of damage to median nerve).

53
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area).

54
Q

What is the presentation of cubital tunnel syndrome?

A

Paraethesiae in the ulnar 1 1/2 fingers and maybe weakness of the ulnar nerve innervated muscles.

55
Q

What tests can you do to assess cubital tunnel syndrome?

A

Tinel’s test over cubital tunnel and Froment’s test.

56
Q

What causes cubital tunnel syndrome?

A

Right band of fascia forming the roof of tunnel (Osborne’s fascia) or due to tightness at untermuscular septum as nerve passes through or between the two heads at the origin of flexor carpi ulnaris.

MSK Cortext (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions