Spine and UL Flashcards by Ailsa Campbell

Symptoms of mechanical back pain

Recurrent relapsing and remitting back pain
No neuro symptoms
Worse on movement, relieved by rest

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Causes of mechanical back pain

Obesity
Poor posture/lifting technique
Depression
Lack of physical activity
Disc prolapse
Degenerative OA

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Treatment of mechanical back pain

Analgesia
Physio
Surgery (single level)

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Symptoms of disc tear

After lifting heavy object

Severe pain, worse on coughing

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Treatment of disc tear

Analgesia
Physio
2-3 months

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Sciatica

NP herinates and presses on SC = pain, altered sensation , reduced reflexes
Burning/tingling pain to buttock and thigh

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Lateral vs. Central prolapse

Lateral: upper nerve root
Central: lower nerve root or cauda equina

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Treatment of disc prolapse/sciatica

Analgesia, physio
Gabapentin
Discectomy

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Spinal stenosis

Cauda equina has less space due to bulging disc/ligamentum flavum/osteophytes

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Symptoms of spinal stenosis

Over 60 years

Claudication - worse downhill, variable, burning pain, pedal pulses preserved

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Treatment of spinal stenosis

Weight loss, analgesia, physio

Decompression

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Cauda equina syndrome

Central disc prolapse affecting sacral nerve roots S4-5 (urination and defecation) = surgical emergency
Bilateral leg pain, paraesthesiae/numbness, saddle anaesthesia, urinary retention/incontinence, faecal incontinence/constipation

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Investigations and treatment of cauda equina syndrome

PR exam
Urgent MRI
Urgent discectomy

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Red flags

Less than 20 years or over 60 years
Constant severe pain, worse at night
Systemic upset (fever, night sweats, weight loss, fatigue)

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Symptoms of osteoporotic crush fractures

Spontaneous fracture of vertebral body
Acute pain, kyphosis
Conservative or balloon vertebroplasty

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Cervical spondylosis

Degeneration of IVD, OA of facet joints
Slow onset pain and stiffness, radiates to occiput and shoulders
Physio, analgesia, shaving, decompression

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Cervical spine instability seen in:

Down syndrome (C1/2)
RA

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Impingement syndrome

Painful arc 60-120
Tendonitis, bursitis, ACJ OA, hooked acromion, RC tear
Pain to deltoid and upper arm

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Treatment of impingement syndrome

NSAIDs, analgesia, physio, subacromial steroid, decompression

Adhesive capsulitis

Frozen shoulder - capsule and glenohumeral ligments stiff and contracted
Progressive pain and stiffness (pain first then stiffness)
Age 40-60, resolves 18-24 months
Loss of ER
Physio, analgesia, NSAIDs, anaesthetic

Aetiology of adhesive capsulitis

Injury, surgery
Diabetes
Hypercholesterolaemia
Dupuytren’s

Acute calcific tendonitis

Acute onset severe shoulder pain due to Ca deposition in supraspinatus
Seen on xray proximal to greater tuberosity
Subacromial steroid and LA, Ca resorbs with time

Treatment of instability

Physio

Surgery (Bankart - reattaches labrum)

Biceps tendonitis

Inflammation of long head of biceps = anterior shoulder pain
Pain on resisted contraction
Popeye deformity if ruptures
Surgicla division, reattachment

SLAP lesions

Tear in labrum where long head of biceps attaches | Tentomy/resection/repair

What passes through carpal tunnel

9 flexor tendons (FDS + FDP + FPL) | Median nerve

Causes of CTS

RA, fluid retention (pregnancy, CKD, hypothyroid), Colles fracture

Symptoms of CTS

Pain and tingling in lateral 3.5 digits, worse at night Loss of sensation, weakness of thumb Thenar muscle wasting

Tinel's test

Percuss over median nerve

Phalen's test

Hold wrist hyperflexed

Treatment of CTS

splints | decompression surgery

Cubital tunnel syndrome

Compression of ulnar nerve at medial epicondyle Paraesthesia medial 1.5 digits Due to osbornes fascia or tightness of intermuscular septum as nerve passes between FCU positive fromonts test

Triceps inserts onto

Olecranon process = extends elbow

What flexes elbow?

Brachialis and biceps

What performs supination and pronation?

Biceps and supinator | Pronator teres and pronator quadratus

Common extensor origin

Lateral epicondyle | Tennis elbow

Common flexor origin

Medial epicondyle | Golfer's elbow

Dupuytren's

Proliferative CT disorder where palmar fascia undergoes hyperplasia to form nodules and cords Type III collagen produced instead of type I Myofibroblasts cause contracture Males, FH, alcoholic cirrhosis, diabetes

Peyronie's disease

Accopmanies dupuytren's | Fibromatosis affecting penis

Ledderhose disease

Accompanies dupuytren's | Fibromatosis affecting feet

Up to how many degrees contracture can be tolerated at MCP in dupuytrens?

30 degrees | Fasciectomy or fasciotomy

Trigger finger

Flexor tendonitis = nodular enlargement A1 pulley Clicking, catches, pain Steroid, surgery

Ganglion cyst

Mucinous filled cysts adjacent to tendon or synovial joint Hand and wrist, knee (Baker's) Localised pain, irritation, cosmesis Firm, smooth, rubbery, translumiante

Giant cell tumour of tendon sheath

Palmar surface of PIP of index and middle fingers Can erode into bone Multinucleate giant cells and haemosiderin Excision

Features of OA

Bouchards and Heberdens nodes | Squaring of thumb

Features of RA

Ulnar deviation Z shaped thumb Swan neck Boutonnieres