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year 2 - musculoskeletal > spine conditions > Flashcards

spine conditions Flashcards

1
Q

lower back pain red flags

A
  • < 20 or > 55
  • night pain
  • thoracic pain
  • constant or progressive pain
  • pain worse when lying down
  • bilateral or alternating sciatica
  • progressive neurological symptoms
  • medical history of immunosuppression or malignancy
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2
Q

what is mechanical back pain

A

back pain in absence of neurological dysfunction

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3
Q

mechanical back pain risk factors

A
  • obesity
  • trauma
  • osteoarthritis
  • disc prolapse
  • acute disc tear (pain worse on coughing)
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4
Q

mechanical back pain presentation

A
  • lumbar pain
  • radiation to buttock but not to below knees
  • sudden onset, worse on activity and relieved by rest
  • recurrent episodes of similar back pain
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5
Q

mechanical back pain diagnosis

A

x-ray (if no symptomatic improvement within 6-8 weeks)

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6
Q

mechanical back pain management

A
  • exercise after 48 hours
  • analgesia
  • physiotherapy
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7
Q

sciatica pathophysiology

A
  • develops due to prolapse of IV discs within the lumbar region impinging on the sciatic nerve, with L4/L5 and the L5/S1 discs being most likely to prolapse
  • results in pain and altered sensation in a dermatomal distribution and weakness in a myotomal distribution
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8
Q

L3/L4 disc prolapse leads to radiation of pain to where

A

medial ankle

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9
Q

L4/L5 disc prolapse leads to radiation of pain to where

A

dorsum of foot

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10
Q

L5/S1 disc prolapse leads to radiation of pain to where

A

sole of foot

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11
Q

if there is L3/L4 disc prolapse, what nerve root has been entrapped

A

L4

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12
Q

if there is L4/L5 disc prolapse, what nerve root has been entrapped

A

L5

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13
Q

if there is L5/S1 disc prolapse, what nerve root has been entrapped

A

S1

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14
Q

L3/L4 disc prolapse leads to weakness where

A
  • knee extension
  • reduced right knee jerk
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15
Q

L4/L5 disc prolapse leads to weakness where

A
  • dorsal flexion
  • extension of big toe
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16
Q

L5/S1 disc prolapse leads to weakness where

A
  • plantar flexion
  • ankle jerk
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17
Q

sciatica presentation

A
  • sudden onset lumbar back pain with radiation to buttock and to below the knee
  • pain that is burning and tingling
  • neurological disturbance (numbness, tingling and weakness)
  • reduced back movements
  • positive straight leg raise
18
Q

sciatica diagnosis

A

PR to rule out cauda equina

19
Q

sciatica management

A
  • mobilisation, analgesia and physiotherapy
  • surgery only in some chronic cases
20
Q

cauda equina syndrome cause

A

caused by large lumbar disc prolapse that compresses all of the nerve roots of the cauda equina (especially S4 and S5)

21
Q

cauda equina syndrome presentation

A
  • back pain with bilateral sciatica (leg pain, numbness, weakness and tingling)
  • saddle anaesthesia
  • alteration in bladder and bowel function (retention or incontinence)
22
Q

cauda equina syndrome diagnosis

A
  • PR exam
  • urgent MRI
23
Q

cauda equina syndrome management

A
  • prompt surgical intervention
  • surgical emergency –> prolonged compression of the nerve roots can cause permanent damage and lead to need for colostomy and urinary diversion
24
Q

spinal stenosis is most common in

A

> 60s

25
Q

spinal stenosis cause

A

develops as a result of osteoarthritis (causes narrowing of lumbar spine canal)

26
Q

spinal stenosis presentation

A
  • spinal claudication (burning pain on walking, with onset of pain being brought on by inconsistent distances and resulting in need to stop and rest)
  • negative straight leg raise
  • pain on examination
  • preservation of distal pulses
27
Q

spinal stenosis management

A
  • analgesia, physiotherapy and steroid injections
  • decompression surgery
28
Q

osteoporotic fracture presentation

A
  • acute onset back pain
  • kyphosis
  • chronic back pain
29
Q

osteoporotic fracture diagnosis

A

x-ray showing wedge shapes and crushed vertebrae

30
Q

osteoporotic fracture management

A

usually conservative with bone protection to avoid further fractures

31
Q

cervical spine pain causes

A
  • spondylosis
  • osteoarthritis
  • disc prolapse
32
Q

cervical spine pain presentation

A
  • neck pain
  • radiation of pain to shoulder and occiput
  • upper limb neurological symptoms
33
Q

cervical pain management

A
  • usually conservative
  • surgical treatment is nerve decompression
34
Q

cervical spine instability causes

A

C1/C2 subluxation e.g. in Down Syndrome or rheumatoid predisposing conditions

35
Q

cervical spine instability management

A

may require surgical stabilisation to prevent spinal cord compression

36
Q

scoliosis is more common in

A

women

37
Q

scoliosis causes

A
  • congenital
  • idiopathic
  • secondary to neuromuscular disease
38
Q

what is scoliosis

A

lateral curvature of the spine to > 10 degrees with secondary curvature of the spinal column

39
Q

scoliosis management

A
  • physiotherapy
  • bracing
  • corrective exercises
  • surgical management usually only used for cosmetic reasons
40
Q

kyphosis causes

A
  • ankylosing spondylitis
  • Paget’s disease
  • TB
  • polio
  • secondary fractures (malignancy, osteoporosis)
41
Q

what is kyphosis

A

thoracocervical flexion

42
Q

kyphosis presentation

A

patient hunched forward

year 2 - musculoskeletal (20 decks)

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