Spine, Neck and Shoulder

Question 1

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

Answer 1

back pain

Question 2

What are the vast majority of cases of back pain?

Answer 2

mechanical

Question 3

What can back pain be related to?

Answer 3

obesity
lack of physical activity
early osteoarthritis (spondylosis)

Question 4

What make mechanical back pain better and worse?

Answer 4

better with rest, worse on movement

Question 5

What is spondylosis?

Answer 5

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

Question 6

What can spondylosis lead to?

Answer 6

secondary OA

Question 7

Is bed rest advised in mechanical back pain?

Answer 7

no - can lead to stiffness/spasm

Question 8

Do patients with mechanical back pain benefit from surgery?

Answer 8

Yes some, but not normally done

Question 9

What type of surgery is done in mechanical back pain?

Answer 9

spinal stabilization

Question 10

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

Answer 10

acute disc tear in out annulus fibrosis

Question 11

What is pain like in acute disc tear?

Answer 11

worse on coughing (this increases disc pressure)

Question 12

Mainstay of treatment for acute disc tear?

Answer 12

physio, analgesia

normally resolves in 2-3 months

Question 13

What is sciatica?

Answer 13

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

Question 14

Treatment of sciatica?

Answer 14

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

Question 15

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

Answer 15

surgical decompression

Question 16

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

Answer 16

spinal stenosis

Question 17

How old are sufferers in spinal stenosis?

Answer 17

tend to be over 60

Question 18

WHow does spinal stenosis present?

Answer 18

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

Question 19

What happens to pedal pulses in spinal stenosis?

Answer 19

are preserved

Question 20

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

Answer 20

spontaneous crush fractures of vertebral body

Question 21

Treatment for osteoporotic crush fractures?

Answer 21

conservative although sometimes balloon vertebroplasty

Question 22

What is cauda equine syndrome?

Answer 22

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

Question 23

Is cauda equine a surgical emergency?

Answer 23

Yes

Question 24

Describe the signs and symptoms of cauda equina syndrome.

Answer 24

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

Question 25

What is a mandatory examination for cauda equina?

Answer 25

PR exam

Question 26

What investigations should be done for cauda equina?

Answer 26

urgent MRI

Question 27

What should be done in cauda equina to treat?

Answer 27

urgent discectomy

Question 28

Name 4 red flags in terms of back pain.

Answer 28

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

Question 29

What will patients complain of in cervical spondylosis?

Answer 29

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

Question 30

Mainstay of treatment for cervical spondylosis?

Answer 30

physio, analgesics

Question 31

What can occur in cervical disc prolapse?

Answer 31

neck pain | potential nerve root decompression

Question 32

What are symptoms of nerve root compression?

Answer 32

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

Question 33

What is a surgery option for cervical disc prolapse?

Answer 33

discectomy

Question 34

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

Answer 34

Down's syndrome | RA

Question 35

Subluxation of what may occur in RA?

Answer 35

atlanto-axial subluxation

Question 36

What is the shoulder joint called?

Answer 36

gleno-humeral joint

Question 37

What type of joint is the shoulder?

Answer 37

ball and socket

Question 38

What does the shoulder joint depend on for stability?

Answer 38

surrounding muscles, mainly rotator cuff

Question 39

Which 3 muscles attach to the greater tuberosity?

Answer 39

supraspinatus, infraspinatus and teres minor muscles

Question 40

Which muscle attaches to the lesser tuberosity?

Answer 40

subscapularis

Question 41

What is the principal internal rotator?

Answer 41

subscapularis

Question 42

What is the function of the rotator cuff muscles collectively?

Answer 42

pulling humeral head into glenoid to allow for abduction

Question 43

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

Answer 43

instability

Question 44

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

Answer 44

rotator cuff tears and frozen shoulders

Question 45

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

Answer 45

glenohumeral joint OA

Question 46

What is impingement syndrome?

Answer 46

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

Question 47

What are causes of impingement/painful arc syndrome?

Answer 47

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

Question 48

Describe symptoms and signs of painful arc.

Answer 48

pain radiates to deltoid and upper arm | Tenderness below lateral edge of acromion

Question 49

Which tests recreates pain in painful arc?

Answer 49

Hawkins test (internally rotate shoulder)

Question 50

Describe a classic history of rotator cuff tear.

Answer 50

sudden jerk with subsequent pain and weakness

Question 51

What are the types of rotator cuff tear?

Answer 51

partial or full thickness

Question 52

Wasting of which muscle occurs with rotator cuff tear?

Answer 52

supraspinatus

Question 53

How are tears confirmed?

Answer 53

ultrasound or MRI

Question 54

What is adhesive capsulitis?

Answer 54

frozen shoulder

Question 55

What characterizes frozen shoulder?

Answer 55

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

Question 56

Describe a classic history of frozen shoulder.

Answer 56

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

Question 57

Who are particularly prone to frozen shoulder?

Answer 57

diabetics

Question 58

What else is frozen shoulder linked to?

Answer 58

high cholesterol | Dupuytren's disease

Question 59

In which condition are gleno humerna steroids given?

Answer 59

frozen shoulder

Question 60

In which condition would you give subacromial injections?

Answer 60

painful arc

Question 61

What are the 2 patterns of instability.

Answer 61

1. Traumatic | 2. Atraumatic

Question 62

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

Answer 62

Ehlers-Danlos, Marfan's

Question 63

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

Answer 63

Bankart repair to stabilize shoulder

Question 64

What is acute calcific tendonitis?

Answer 64

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

Question 65

What can cause radiation of pain to the shoulder?

Answer 65

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