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spine- CORTEX Flashcards

1
Q

what is mechanical back pain?

A

-recurrent relapsing and remitting back pain with no neurological symptoms

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2
Q

how does mechanical back pain usually present?

A
  • pain is worse with movement and relieved by rest

- NO RED FLAG SYMPTOMS PRESENT

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3
Q

how old are patients who tend to experience mechanical back pain?

A

20-60

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4
Q

what can cause mechanical back pain?

A
  • obesity
  • poor posture
  • poor lifting technique
  • lack of physical activity
  • depression
  • degenerative disc prolapse
  • facet joint OA
  • spondylosis
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5
Q

what is the treatment for mechanical back pain?

A

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!!

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6
Q

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!!

A

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

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7
Q

what is treatment for acute disc tear?

A

analgesia
Physioooooo

symptoms usually resolve but can take 2-3 months to settle

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8
Q

what is sciatica?

A

nerve pain in leg that is caused by irritation and/or compression of the sciatic nerve

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9
Q

where is the commonest site in the spine for sciatica to occur?

A

in the lower lumbar spine with the L4, L5 and S1 nerve roots contributing to the sciatic nerve

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10
Q

how does the pain from sciatica present?

A
  • a neurological burning or severe tingling (often like severe toothache)
  • radiate down the back of the thigh below the knee
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11
Q

if there was a L3/4 prolapse- what nerve root would be entrapped?

A

L4 root

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12
Q

if there was a L4/5 prolapse what nerve root would be entrapped?

A

L5

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13
Q

if there was a L5/S1 prolapse what nerve root would be entrapped?

A

S1 root

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14
Q

how would a patient present if they had L4 root entrapment?

A
  • pain down the medial ankle
  • loss of quadriceps power
  • reduced knee jerk
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15
Q

how would a patient present if they had L5 root pain?

A
  • pain down dorsum of foot

- reduced power extensor hallucis longus and tibialis anterior

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16
Q

what is the muscle highlighted green?

A

extensor digitorus longus

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17
Q

what is the muscle highlighted green?

A

anterior tibialis

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18
Q

how would a patient with S1 root entrapmen present?

A
  • pain at sole of foot
  • reduced power plantarflexion (extension of ankle)
  • reduced ankle jerks
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19
Q

what is first line treatment for sciatica?

A

-analgesia, maintain mobility and physiooooo

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20
Q

what drugs may be given if analgesia is not enough?

A

Gabapentin for neuropathic pain

21
Q

what is spinal stenosis?

A

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

22
Q

how is mechanical pain diagnosed?

A
  • clinical

- can do an Xray

23
Q

what condition can occur if an acute slipped disc presses on an exiting nerve?

A

sciatica! :0

24
Q

what is the gold standard diagnoses for acute disc tear?

25
what does claudication mean?
-pain caused by too little blood flow to muscles during exercise
26
what does intermittent claudication mean?
-the pain is not consistent, usually begins during exercise and ends with rest
27
how old do patients who suffer from spinal stenosis tend to be?
>60
28
how does spinal stenosis usually present?
- claudication (the distance is usually inconsistent) - pain is burning - pain is less walking uphill - pedal pulses are preserved
29
what are pedal pulses?
pulses in feet
30
what is treatment for spinal stenosis?
First line conservative: - physioooo!! - weight loss if indicated Second line: -decompression surgery
31
investigations for spinal stenosis?
-MRI (excluder peripheral arterial disease)
32
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
33
what usually causes cauda equina syndrome?
-a very large central disc prolapse
34
how does cauda equina syndrome present?
- bilateral sciatica - saddle anaesthesia (numbness around the sitting area and perineum) - altered urinary function - altered bowel function
35
what are the investigations for cauda equina syndrome?
- PR exam mandatory!! | - urgent MRI scan
36
what is the management for cauda equina syndrome?
-emergency surgery
37
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
38
what is cervical spondylosis?
age related wear and tear affecting the spinal discs in neck
39
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)
40
what is the treatment for cervical spondylosis?
-physio and analgesics
41
what conditions are related to cervical spine instability?
- down syndrome | - rheumatoid arthritis
42
what does the carpal tunnel contain?
-median nerve 4 x FDP (flexor digitorum profundus) 4x FDS (flexor digitorum superficialis FPL (flexor pollicis longus)
43
what can cause carpal tunnel syndrome?
-idiopathic secondary to : - RA - pregnancy - diabetes - chronic renal failure - hypothyroidism - fractures around the wrist
44
what special tests are done for carpal tunnel syndrome?
Phalen's test (holding wrists hyperflexed | Tinel's test (percussing over median nerve
45
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
46
what is cubital tunnel syndrome?
-a condition that involves the compression of the ulnar nerve at the elbow behind the medial epicondyle
47
how does cubital syndrome present?
-numbness, tingling and/or pain in the ring and small fingers, sometimes arm and part of hand too
48
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

MSK (64 decks)

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