spine- CORTEX Flashcards
what is mechanical back pain?
-recurrent relapsing and remitting back pain with no neurological symptoms
how does mechanical back pain usually present?
- pain is worse with movement and relieved by rest
- NO RED FLAG SYMPTOMS PRESENT
how old are patients who tend to experience mechanical back pain?
20-60
what can cause mechanical back pain?
- obesity
- poor posture
- poor lifting technique
- lack of physical activity
- depression
- degenerative disc prolapse
- facet joint OA
- spondylosis
what is the treatment for mechanical back pain?
REASSURANCE- dont worry gals its not serious!!
bed rest will lead to stiffening and spasms of the back so maintain normal function
PHYSIOOOOOŌ
ANALGESIA- pain relief woop!!
Ben has come in to the GP complaining of a sore back that is worse when he coughs :(( on further questioning you find out he is a farmer + gym lad (loves to lift heavy for the gains) . What is his diagnoses!!
Ben probably has an acute disc tear
acute disc tear usually happens from lifting heavy objects
Pain is usually worse on coughing as it increases disc pressure
what is treatment for acute disc tear?
analgesia
Physioooooo
symptoms usually resolve but can take 2-3 months to settle
what is sciatica?
nerve pain in leg that is caused by irritation and/or compression of the sciatic nerve
where is the commonest site in the spine for sciatica to occur?
in the lower lumbar spine with the L4, L5 and S1 nerve roots contributing to the sciatic nerve
how does the pain from sciatica present?
- a neurological burning or severe tingling (often like severe toothache)
- radiate down the back of the thigh below the knee
if there was a L3/4 prolapse- what nerve root would be entrapped?
L4 root
if there was a L4/5 prolapse what nerve root would be entrapped?
L5
if there was a L5/S1 prolapse what nerve root would be entrapped?
S1 root
how would a patient present if they had L4 root entrapment?
- pain down the medial ankle
- loss of quadriceps power
- reduced knee jerk
how would a patient present if they had L5 root pain?
- pain down dorsum of foot
- reduced power extensor hallucis longus and tibialis anterior
what is the muscle highlighted green?
extensor digitorus longus
what is the muscle highlighted green?
anterior tibialis
how would a patient with S1 root entrapmen present?
- pain at sole of foot
- reduced power plantarflexion (extension of ankle)
- reduced ankle jerks
what is first line treatment for sciatica?
-analgesia, maintain mobility and physiooooo
what drugs may be given if analgesia is not enough?
Gabapentin for neuropathic pain
what is spinal stenosis?
when there is narrowing of the spaces within the spine which can put pressure on the nerves causing lower back pain and pain in legs when walking
how is mechanical pain diagnosed?
- clinical
- can do an Xray
what condition can occur if an acute slipped disc presses on an exiting nerve?
sciatica! :0
what is the gold standard diagnoses for acute disc tear?
MRI
what does claudication mean?
-pain caused by too little blood flow to muscles during exercise
what does intermittent claudication mean?
-the pain is not consistent, usually begins during exercise and ends with rest
how old do patients who suffer from spinal stenosis tend to be?
> 60
how does spinal stenosis usually present?
- claudication (the distance is usually inconsistent)
- pain is burning
- pain is less walking uphill
- pedal pulses are preserved
what are pedal pulses?
pulses in feet
what is treatment for spinal stenosis?
First line conservative:
- physioooo!!
- weight loss if indicated
Second line:
-decompression surgery
investigations for spinal stenosis?
-MRI (excluder peripheral arterial disease)
what is cauda equina syndrome?
-a rare and severe type of spinal stenosis where all of the nerves in the lower back (cauda equina) suddenly become severely compressed
what usually causes cauda equina syndrome?
-a very large central disc prolapse
how does cauda equina syndrome present?
- bilateral sciatica
- saddle anaesthesia (numbness around the sitting area and perineum)
- altered urinary function
- altered bowel function
what are the investigations for cauda equina syndrome?
- PR exam mandatory!!
- urgent MRI scan
what is the management for cauda equina syndrome?
-emergency surgery
what are some red flags for back pain?
- back pain in younger patients (<20)
- new back pain in older patients (>60)
- constant
- severe
- worse at night
- fever
- night sweats
- fatigue
what is cervical spondylosis?
age related wear and tear affecting the spinal discs in neck
how does cervical spondylosis usually present?
-slow onset of stiffness and pain in neck which can radiate locally to shoulders and occiput (back of head)
what is the treatment for cervical spondylosis?
-physio and analgesics
what conditions are related to cervical spine instability?
- down syndrome
- rheumatoid arthritis
what does the carpal tunnel contain?
-median nerve
4 x FDP (flexor digitorum profundus)
4x FDS (flexor digitorum superficialis
FPL (flexor pollicis longus)
what can cause carpal tunnel syndrome?
-idiopathic
secondary to :
- RA
- pregnancy
- diabetes
- chronic renal failure
- hypothyroidism
- fractures around the wrist
what special tests are done for carpal tunnel syndrome?
Phalen’s test (holding wrists hyperflexed
Tinel’s test (percussing over median nerve
what is the treatment for carpal tunnel syndrome?
non-operative treatment:
- wrist splints at night to prevent flexion in the fetal position
- injection of steroids (2 at most)
Surgical:
-carpal tunnel decompression
what is cubital tunnel syndrome?
-a condition that involves the compression of the ulnar nerve at the elbow behind the medial epicondyle
how does cubital syndrome present?
-numbness, tingling and/or pain in the ring and small fingers, sometimes arm and part of hand too
what special test can be done for cubital tunnel syndrome and how is it performed?
Froment’s test- patient is asked to make a strong pinch between the thumb and index finger, the examiner then attempts to pull it out their hand. If the thumb does not stay straight and then it suggests the patient has damage to their ulnar nerve
