spine conditions Flashcards
what is an abdominal aortic aneurysm (AAA)?
dilation of the abdominal aorta (>3 cm)
what is the pain referral pattern of AAA?
loin to groin
what are s&s of AAA?
abdominal/flank pain
loin or groin pain
signs of shock: pale, clammy hands, rapid pulse, SOB, dizziness, weakness
pulsatile abdominal mass
asymmetrical pulses
what is the management for AAA?
3-4,4cm: monitor anual US
4,4-5,4 cm: 3 monthly US
>5,4: surgery
what is ankylosing spondylitis?
a type of inflammatory arthropathy which is most common in young males (15-30 years)
what are s&s of AS?
morning stiffness >30 min
LBP/pelvis/SIJ pain
pain improves with exercise
worse with rest
night pain
alternating buttock pain
peripheral enthesitis
which signs are present during physical exam in AS?
limited chest expansion (<7.5 cm)
limited schober’s test (<4-5cm)
what other conditions might be associated with AS?
conjunctivitis
aortic insufficiency
pulmonary fibrosis
what are the x-ray findings in AS?
romanus lesion
shiny corners
vertebral body squaring
non-marginal syndesmophytes
which blood tests can be done to diagnose AS?
FBC
HLA B27
ESR (erythrocytes sedimentation rate)
what are the s&s for cauda equina syndrome?
back pain
pain radiation down both legs
loss of urinary control or sensation
saddle anaesthesia
erectile dysfunction
LL weakness
decreased SMR
what are s&s of degenerative disc disease?
local back pain
relieved by rest, worse with activity
reduced ROM
sensation of weakness of the back
stiffness
what is DISH?
diffused idiopathic skeletal hyperostosis: ossification of ligaments, tendons and joint capsules
which ligaments are most commonly affected by DISH?
MC: anterior longitudinal ligament (ALL)
2nd MC: posterior longitudinal ligament (PLL)
which population type is most at risk for DISH?
male
>50
diabetes
alcoholism
obesity
hypertension
what are s&s of DISH?
often asymptomatic
stiffness
dysphagia
what are s&s of a compression fracture?
local spasm and swelling
tenderness
local flexion deformity
pain on percussion vibration
which physical exam test would be possible with a compression fracture?
supine sign
what are the x-ray findings for a NEW compression fracture?
anterior wedging (if posterior wedging –> pathological fracture)
zone of impaction
step off deformity
what are the x-ray findings for an OLD compression fracture?
anterior wedging
NO step off zone
what is a chance/seatbelt fracture of the spine?
a transverse fracture across the TPV, laminae and articular process due to a violent forced flexion with distraction force (lap seatbelt during MVA)
what are x-ray findings of a chance/seatbelt fracture?
widening of the intertransverse process space above level of fx
anterior-superior bone fragment
is a chance/seatbelt fracture stable or unstable?
UNSTABLE!
besides AAA, which other condition refers to the loin and groin area?
kidney stones/nephritis
who is most at risk for kidney stones?
males 30-60
hypercalcaemia
what are s&s for kidney stones?
intense pain on side of abdomen
pain may mimic MSK pain
loin to groin pain
nausea
polyuria
dysuria
haematuria
what is the management for kidney stones?
small stones: pass through urine
large stones: broken down by US/laser
what other condition can kidney stones cause?
urinary tract infection UTI
what is Maigne’s syndrome?
condition affecting the cutaneous nerve T12-L2
what are the s&s of Maigne’s syndrome?
manipulable lesion of TL junction
UL or BL pain over iliac crest, TL and/or groin
hypersensitivity on iliac crest (+ve skin rolling)
local muscle guarding
what is multiple myeloma?
malignant proliferation of plasma cells within the bona marrow
who is most at risk MM?
male
>60
afro-caribbean
what are the most common s&s of MM?
often asymptomatic
anaemia
renal impairment
fatigue
weight loss
hypercalcaemia
what will the blood tests indicate in MM?
hypercalcaemia
hyperuricemia
abnormal protein electrophoresis
what is the most common site for a radiculopathy?
L5-S1
what are s&s for a lumbar radiculopathy?
LBP
hip pain
groin pain
unilateral leg pain
LMNL: decreased DTR, atrophy, fasciculations, weakness and hypotonia
what is the most common cause of a lumbar radiculopathy?
disc herniation
what are s&s of SIJ sprain?
pain over SIJ (UL or BL)
which tests are positive in SIJ sprain?
Gaenslens
Fabere
thigh thrust
SIJ distraction
SIJ compression
Sacral thrust provocation
SIJ instability tests
what is scheuermann’s disease?
kyphosis in juvenile population (11-17 yrs)
what are s&s of scheuermann’s disease?
pain and stiffness (lower Lx)
increasing kyphosis over 1-2 months
pain during forward flexion
pain comes on towards end of day
short hamstrings and pecs
what are the x-ray findings in scheuermann’s disease?
schmorl’s nodes
elongated VB’s
anterior wedging
disc height loss
what will be seen in the adams forward bending test in patients with scoliosis?
functional scoliosis: rib hump decreased on flexion
structural: rib hump doe snot improve with flexion
what is the management of scoliosis?
NON-skeletally mature:
<20°: observe
20-30°: observe and brace progressive
30-45°: brace
>45°: surgical referral
skeletally mature:
<45°: conservative management
>45°: surgical referral
what are spondyloarthropathies?
inflammatory arthropathies affecting the spine and etheses
which conditions coexist commonly with spondyloarthropathies?
conjunctivitis
inflammatory bowel disease
aortic insufficiency
which conditions are part of seronegative spondyloarthropathies?
AS
psoriatic arthritis
inflammatory bowel disease
reactive arthritis/ reiter’s syndrome
enteropathic arthritis
which conditions commonly present with enteropathic arthritis?
ulcerative colitis
crohn’s disease
what are s&s of enteropathic arthritis?
morning stiffness >30 min
improvement with exercise
worse with rest
waking during the night
(radiographically identical to AS)
which joints are most commonly affected in psoriatic arthritis?
DIP
PIP
MCP (swollen fingers)
SIJ
what is a common finding in psoriatic arthritis?
periostitis (mouse ear erosion)
which conditions commonly present with reactive arthritis/ reiter’s syndrome?
STI (chlamydia)
infections (salmonella, shigella etc)
what is commonly seen in patients with reactive arthritis/reiter’s syndrome?
Reiter’s triad:
1. urethritis
2. conjunctivitis
3. arthritis
(can’t see, can’t pee, can’t dance with me)
what is the most common site for reactive arthritis?
achilles tendinits (lover’s heel)
what is another common finding in reactive arthritis?
swollen fingers (dactylitis)
what are the radiographic findings for AS and enteropathic arthropaties?
BL and symmetrical sacroiliitis
marginal syndesmophytes
bamboo spine
disco-vertebral hanges (romanus lesion, shiny corners, VB squaring)
what are the radiographic findings for psoriatic arthritis and reactive arthritis?
BL and Asymmetrical sacroiilitis
non-marginal syndesmophytes
periostitis (psoriatic arthritis)
what is a spondyloysis?
stress fracture through the pars interarticularis of the lumbar spine
which athletes are most at risk for a spondylolysis?
sports that require extension under load (gymnasts, weight lifters etc.)
what are the 5 types of spondylolysis?
I. dysplastic (congenital)
II. isthmic (stress fracture)
III. degenerative
IV. traumatic (acute fx in other areas than pars)
V. pathologic
VI. iatrogenic (post-surgical fusion)
what are s&s of spondylolysis?
often asymptomatic
LBP
pain in buttocks
worse with standing/ walking/ extension
relieved by sitting
increased lordosis
tight hamstrings
waddling gait
step off deformity
what physical examination tests are positive with spondylosysis?
single leg hyperextension
McGill
what are s&s of facet sprain?
local pain around spinal level
guarding, hypertonicity of surrounding muscles
instability (+ve McGills)
functionally poor movement patterns
