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MSK Pathology > Spine, Neck and Shoulder > Flashcards

Spine, Neck and Shoulder Flashcards

1
Q

Name one of the most common reasons for ill health resulting in time off work.

A

back pain

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2
Q

What are the vast majority of cases of back pain?

A

mechanical

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3
Q

What can back pain be related to?

A

obesity
lack of physical activity
early osteoarthritis (spondylosis)

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4
Q

What make mechanical back pain better and worse?

A

better with rest, worse on movement

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5
Q

What is spondylosis?

A

where intervertebral discts lose water content with age, leading to less cushioining and increased pressure on fact joints

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6
Q

What can spondylosis lead to?

A

secondary OA

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7
Q

Is bed rest advised in mechanical back pain?

A

no - can lead to stiffness/spasm

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8
Q

Do patients with mechanical back pain benefit from surgery?

A

Yes some, but not normally done

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9
Q

What type of surgery is done in mechanical back pain?

A

spinal stabilization

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10
Q

What type of tear causing back pain typically occurs after lifting a heavy object (eg lawnmower)?

A

acute disc tear in out annulus fibrosis

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11
Q

What is pain like in acute disc tear?

A

worse on coughing (this increases disc pressure)

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12
Q

Mainstay of treatment for acute disc tear?

A

physio, analgesia

normally resolves in 2-3 months

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13
Q

What is sciatica?

A

Disc tear occurs, gelatinous nucleus pulposis herniates through tear, impinging on nerve root

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14
Q

Treatment of sciatica?

A

analgesia, maintaining mobility, physio, occasionally drugs for neuropathic pain eg Gabapentin

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15
Q

What can be done surgically in bony root entrapment caused by OA of the facet joints?

A

surgical decompression

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16
Q

What is the condition called when in spondylosis, the lumbar spine has less space?

A

spinal stenosis

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17
Q

How old are sufferers in spinal stenosis?

A

tend to be over 60

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18
Q

WHow does spinal stenosis present?

A

claudication (pain in legs on walking) which is inconsistent
burning pain (rather than cramping)
pain less severe walking up hill

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19
Q

What happens to pedal pulses in spinal stenosis?

A

are preserved

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20
Q

What can happen in severe osteoporosis leading to acute pain and kyphosis?

A

spontaneous crush fractures of vertebral body

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21
Q

Treatment for osteoporotic crush fractures?

A

conservative although sometimes balloon vertebroplasty

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22
Q

What is cauda equine syndrome?

A

very large central disc prolapse can compress all nerve roots of cauda equina

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23
Q

Is cauda equine a surgical emergency?

A

Yes

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24
Q

Describe the signs and symptoms of cauda equina syndrome.

A

Bilateral leg pain
Paraesthesiae/numbness
Saddle anaesthesia (numbness around sitting area and perineum)
Urinary retention most common or can be incontinence

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25
Q

What is a mandatory examination for cauda equina?

A

PR exam

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26
Q

What investigations should be done for cauda equina?

A

urgent MRI

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27
Q

What should be done in cauda equina to treat?

A

urgent discectomy

28
Q

Name 4 red flags in terms of back pain.

A
  1. Back pain in younger patient - refer/MRI
  2. New back pain in older patient - crush fracture, metastases, myeloma
  3. Constant, severe pain, worse at night - suggestive of tumour
  4. systemic upset - fever, night sweats, weight loss, fatigue etc. - underlying infection or tumour
29
Q

What will patients complain of in cervical spondylosis?

A

slow onset stiffness and pain in neck, can radiate to shoulders and occiput

30
Q

Mainstay of treatment for cervical spondylosis?

A

physio, analgesics

31
Q

What can occur in cervical disc prolapse?

A

neck pain

potential nerve root decompression

32
Q

What are symptoms of nerve root compression?

A

shooting neuralgic pain down dermatomal distribution with weakness and loss of reflexes
Lower root tends to be affected

33
Q

What is a surgery option for cervical disc prolapse?

A

discectomy

34
Q

Name 2 conditions in which autraumatic cervical spine instability may occur.

A

Down’s syndrome

RA

35
Q

Subluxation of what may occur in RA?

A

atlanto-axial subluxation

36
Q

What is the shoulder joint called?

A

gleno-humeral joint

37
Q

What type of joint is the shoulder?

A

ball and socket

38
Q

What does the shoulder joint depend on for stability?

A

surrounding muscles, mainly rotator cuff

39
Q

Which 3 muscles attach to the greater tuberosity?

A

supraspinatus, infraspinatus and teres minor muscles

40
Q

Which muscle attaches to the lesser tuberosity?

A

subscapularis

41
Q

What is the principal internal rotator?

A

subscapularis

42
Q

What is the function of the rotator cuff muscles collectively?

A

pulling humeral head into glenoid to allow for abduction

43
Q

In a young patient, what is the usual source of shoulder pain?

A

instability

44
Q

In a middle aged patient, what is the usual source of shoulder pain?

A

rotator cuff tears and frozen shoulders

45
Q

In elderly, what is a more likely source of shoulder pain?

A

glenohumeral joint OA

46
Q

What is impingement syndrome?

A

painful arc syndrome: tendons of rotator cuff are compressed during movement, causing pain

47
Q

What are causes of impingement/painful arc syndrome?

A 
tendonitis
subacromial bursitis
acromioclavicular OA with inferior osteophyte
A hooked acromion
rotator cuff tear
48
Q

Describe symptoms and signs of painful arc.

A

pain radiates to deltoid and upper arm

Tenderness below lateral edge of acromion

49
Q

Which tests recreates pain in painful arc?

A

Hawkins test (internally rotate shoulder)

50
Q

Describe a classic history of rotator cuff tear.

A

sudden jerk with subsequent pain and weakness

51
Q

What are the types of rotator cuff tear?

A

partial or full thickness

52
Q

Wasting of which muscle occurs with rotator cuff tear?

A

supraspinatus

53
Q

How are tears confirmed?

A

ultrasound or MRI

54
Q

What is adhesive capsulitis?

A

frozen shoulder

55
Q

What characterizes frozen shoulder?

A

progressive pain and stiffness of shoulder in patients aged 40-60

56
Q

Describe a classic history of frozen shoulder.

A

initial pain, subsiding as stiffness increases, which then thaws out over time (12 months ish)

57
Q

Who are particularly prone to frozen shoulder?

58
Q

What else is frozen shoulder linked to?

A

high cholesterol

Dupuytren’s disease

59
Q

In which condition are gleno humerna steroids given?

A

frozen shoulder

60
Q

In which condition would you give subacromial injections?

A

painful arc

61
Q

What are the 2 patterns of instability.

A
  1. Traumatic

2. Atraumatic

62
Q

Name 2 conditions which can cause ligamentous laxity, which can lead to instability (atraumatic)?

A

Ehlers-Danlos, Marfan’s

63
Q

In traumatic instability, what surgery may be used with recurrent dislocations?

A

Bankart repair to stabilize shoulder

64
Q

What is acute calcific tendonitis?

A

acute onset of severe shoulder pain with calcium deposition in supraspinatus tendon

65
Q

What can cause radiation of pain to the shoulder?

A

neck problems
angina pectoris
Diaphragmatic irritation (eg bilary colic, hepatic or subphrenic abscess)

MSK Pathology (17 decks)

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