Spine Conditions Flashcards
what causes sciatica
prolapse of inter-vertebral discs within the lumbar region causing impingement of the sciatic nerve
how does sciatica present
sudden onset of lumbar back pain radiating to buttocks and knee
pain is burning and tingling
reduced back movements and positive straight leg raise
how is sciatica treated
mobilisation, analgesics and physiotherapy
discectomy if pain is not resolving
what is spinal stenosis
narrowing of the lumbar spine canal secondary to osteoarthritis
how does spinal stenosis present
spinal claudication - lasts for inconsistent distances
pain worsens downhill and relieved uphill (opposite of vascular claudication)
pedal pulses present
cauda equina is a surgical emergency true/false
true
what is cauda equina
large lumbar disc prolapse (S4/S5) compressing all nerve roots of the cauda equina
how does cauda equina present and what investigations are necessary
back pain with bilateral sciatica
saddle shape anaesthesia
alteration in bladder and bowel function - can be retention or incontinence
must do PR exam and urgent MRI to determine level of prolapse
how is cauda equina managed
urgent discectomy as nerve root compression can cause permanent damage
what is scoliosis
lateral curvature of the spine with Cobb angle greater than 10 degrees
what causes scoliosis
congenital, idiopathic, secondary to neuromuscular disease
what is kyphosis
thoracocervical flexion, less common than scoliosis
what causes kyphosis
ankylosing spondylitis, pagets disease, TB and polio
what forms the carpal tunnel
carpal bones and the flexor retinaculum (connective tissue)
what travels through the carpal tunnel
median nerve, flexor digitorum profundus x4, flexor digitorum superficialis x4 and flexor pollicis longus
what causes carpal tunnel syndrome
anything to increase pressure/fluid retention diabetes pregnancy hypothyroidism CKD RA
how does carpal tunnel syndrome present
pain and tingling in the hand in median nerve distribution (first 2 and a half fingers)
wasting of the thenar eminence
describe Tinels test
tapping over the median or ulnar nerve - positive test will indicate carpal or cubital tunnel syndrome respectively
what is Phalens test
putting hands in prayer position will elicit symptoms
which investigation can diagnose carpal and cubital tunnel syndrome
nerve conduction studies
how is carpal tunnel syndrome managed
splinting overnight to prevent flexion or steroid injection
if symptoms dont improve - surgical decompression by dividing transverse carpal ligaments
cubital tunnel syndrome is compression of what nerve
ulnar nerve
what are the causes of cubital tunnel syndrome
trauma
osteoarthritis and RA
describe Froments test
tests action of adductor pollicis by getting patient to grip paper between thumb and forefinger
how is cubital tunnel syndrome managed
NSAIDs and release of intra-muscular septae
