Spine Conditions

Question 1

what causes sciatica

Answer 1

prolapse of inter-vertebral discs within the lumbar region causing impingement of the sciatic nerve

Question 2

how does sciatica present

Answer 2

sudden onset of lumbar back pain radiating to buttocks and knee
pain is burning and tingling
reduced back movements and positive straight leg raise

Question 3

how is sciatica treated

Answer 3

mobilisation, analgesics and physiotherapy

discectomy if pain is not resolving

Question 4

what is spinal stenosis

Answer 4

narrowing of the lumbar spine canal secondary to osteoarthritis

Question 5

how does spinal stenosis present

Answer 5

spinal claudication - lasts for inconsistent distances
pain worsens downhill and relieved uphill (opposite of vascular claudication)
pedal pulses present

Question 6

cauda equina is a surgical emergency true/false

Answer 6

true

Question 7

what is cauda equina

Answer 7

large lumbar disc prolapse (S4/S5) compressing all nerve roots of the cauda equina

Question 8

how does cauda equina present and what investigations are necessary

Answer 8

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

Question 9

how is cauda equina managed

Answer 9

urgent discectomy as nerve root compression can cause permanent damage

Question 10

what is scoliosis

Answer 10

lateral curvature of the spine with Cobb angle greater than 10 degrees

Question 11

what causes scoliosis

Answer 11

congenital, idiopathic, secondary to neuromuscular disease

Question 12

what is kyphosis

Answer 12

thoracocervical flexion, less common than scoliosis

Question 13

what causes kyphosis

Answer 13

ankylosing spondylitis, pagets disease, TB and polio

Question 14

what forms the carpal tunnel

Answer 14

carpal bones and the flexor retinaculum (connective tissue)

Question 15

what travels through the carpal tunnel

Answer 15

median nerve, flexor digitorum profundus x4, flexor digitorum superficialis x4 and flexor pollicis longus

Question 16

what causes carpal tunnel syndrome

Answer 16

anything to increase pressure/fluid retention 
diabetes 
pregnancy 
hypothyroidism 
CKD 
RA

Question 17

how does carpal tunnel syndrome present

Answer 17

pain and tingling in the hand in median nerve distribution (first 2 and a half fingers)
wasting of the thenar eminence

Question 18

describe Tinels test

Answer 18

tapping over the median or ulnar nerve - positive test will indicate carpal or cubital tunnel syndrome respectively

Question 19

what is Phalens test

Answer 19

putting hands in prayer position will elicit symptoms

Question 20

which investigation can diagnose carpal and cubital tunnel syndrome

Answer 20

nerve conduction studies

Question 21

how is carpal tunnel syndrome managed

Answer 21

splinting overnight to prevent flexion or steroid injection

if symptoms dont improve - surgical decompression by dividing transverse carpal ligaments

Question 22

cubital tunnel syndrome is compression of what nerve

Answer 22

ulnar nerve

Question 23

what are the causes of cubital tunnel syndrome

Answer 23

trauma

osteoarthritis and RA

Question 24

describe Froments test

Answer 24

tests action of adductor pollicis by getting patient to grip paper between thumb and forefinger

Question 25

how is cubital tunnel syndrome managed

Answer 25

NSAIDs and release of intra-muscular septae