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Injuries and medical problems in sport > Spine problems > Flashcards

Spine problems Flashcards

1
Q

Disc problems overview

A
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2
Q

List the pain-producing structures in the back

A
  • nucleus polposus
  • annulus fibrosus
  • facet joints
  • ligaments
  • muscles
  • nerve (mechanical and chemical irritation)
  • synovium (facet joint capsule)
  • meninges
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3
Q

Back pain Sx red flags

A
  • FLAWS
  • Sx for cauda equina
  • Morning stiffness
  • Uncontrolled pain
  • Thoracic pain
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4
Q

What serious conditions can lead to back pain?

A
  • Cauda Equina
  • Pathological fracture
  • Cancer
  • Infection (TB)
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5
Q

Sx for cauda equina

A
  • Saddle anaesthesia
  • Disturbed gait
  • Progressive neuro, bladder/bowel/sexual dysfunction
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6
Q

Back pain PMHx/SHx red flags

A
  • <20 or >50
  • Hx IVDU
  • Hx cancer
  • Immunosupression
  • TB contacts
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7
Q

Yellow flags back pain- Psychosocial factors for poor prognosis

A
  • Depression, social withdrawal
  • Fear avoidance
  • reduced activity
  • expectation that passive not active treatment will be useful
  • social/financial problems
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8
Q

Function vertebrae

A
  • protect cord and nerves
  • posture and locomotion
  • supports bodyweight above pelvis
  • partly rigid axis for head to pivot on
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9
Q

Label the vertebra

A

Lumbar vertebra

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10
Q

What are the basic steps to spine examination?

A

1) Obs + inspection inc gait
2) Neurology inc slump or SLR
3) palpate muscles and SP/SIJ
4) assess movement different levels- ROM
5) Special tests

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11
Q

Pharmacological Mx back pain principles

A
  • NSAIDs - ibuprofen/naproxen
  • Spasms- short course diazepam
  • Codeine + paracetamol (SE advice)
  • Sciatic pain- neuropathic meds eg amitriptyline
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12
Q

Impact of smoking on back pain

A
  • strong Ax with LBP and sciatica

- poorer surgical outcomes

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13
Q

Conservative Mx back pain

A

Exercises and daily activity
• Heat
• + Psychological support (complex protracted cases)

Movement is an essential component of Mx-

  • changes pressure distribution in joints/muscles/nerves
  • keeps muscles and ligaments strong
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14
Q

Mx neuropathic pain

A

1) Neuropathic meds:
- amitriptyline, duloxetine, gabapentin, pregabalin
- Tramadol- acute ‘rescue therapy’
- capsaicin cream localised

2) Nerve root blocks
3) Decompression surgery

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15
Q

Causes of cord compressions

A
  • Tumour/lesions (primary/secondary)
  • Trauma
  • Spinal stenosis (eg by spondylolisthesis- vertebral compression fracture)
  • inflam/infection (pagets, TB)
  • disc herniation
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16
Q

Where can cord compression occur?

A

Anywhere- cord, conus medullaris, cauda

C4/5/6- v flexible so most vulnerable

Acute cord compression higher than conus/cauda

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17
Q

Sx of acute cord compression

A
  • UMN SIGNS
  • back pain>leg
  • signs of infection/cancer

occurs above conus/cauda

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18
Q

Symptoms cauda equina/conus medullaris syndrome

A
  • saddle anaesthaesia/parasthesia
  • LBP, unilateral/bilateral radicular pain
  • bladder/bowel/sexual dysfunction
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19
Q

Signs cauda equina/conus medullaris syndrome

A
  • perianal/perineal sensory loss
  • loss of sphincter tone
  • severe/progressive neuro deficit, mostly LMN but can be mixed UMN/LMN
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20
Q

Mx cauda equina

A
  • Imaging ED- MRI goldstandard

- urgent ortho spinal referral for decompression

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21
Q

conus medullaris vs cauda equina syndrome

A

conus medullaris:

  • less common + severe
  • bilat + symmetric
  • fasciculations
  • knee reflex still present
  • early, marked bladder/rectal/sexual Sx
  • more sudden onset
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22
Q

neurogenic bowel or bladder questions to ask

A 
Can you feel it filling? 
Urge? 
Make it in time? 
Flow problems? 
Incontinence?
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23
Q

non- spinal lower back pain ddx

A

Retroperitoneal structures e.g.

  • AAA
  • renal pyelonephritis/calculus
24
Q

cancer/infection Sx back pain

A
  • night pain
  • systemic Sx
  • thoracic Sx
  • inc age
  • Hx ca
  • recent infection eg UTI, surgical procedure
  • Fever/septic
  • Postural deformity
  • point tenderness
  • +/- neurology
25
Q

Sx pathological fracture

A
  • severe pain- rest and night
  • RF- osteoporosis, AN, cancer
  • sport- rowing, synchronised swimmer (pars/sacral resp)

Need high index of suspicion

26
Q

Mx pathological fracture

A
  • analgesia
  • surgery - unstable, deformity, Rx pain
  • vertebroplasty/fusion
27
Q

Inflammatory back pain Sx

A
  • morning stiffness
  • Insidious onset then chronic
  • young, female
  • Hx/FHx AI disease
  • sacroilitis common initial pres
28
Q

Signs inflammatory back pain

A
  • Pain on SIJ palpation

- FABER test- leg flexed, abducted and externally rotated

29
Q

Ix inflam back pain

A
  • bloods- CCP, RF, ANA

- MRI/xray

30
Q

Where does mechanical back pain most commonly occur?

A
  • lumbar
  • may or may not involve nerve root
  • diskogenic/facet joint pain
31
Q

Symptoms acute spinal cord compression/discogenic back pain

A
  • unilateral, leg pain radiating below knee (L5)
  • leg Sx > back Sx
  • parasthesia, weakness
  • cough/sneeze/heavy lift inc. pain
  • worse on FLEXION
32
Q

Clinical features acute spinal cord compression/diskogenic back pain

A
  • loss of reflexes in nerve root distribution
  • list to contralateral side from pain
  • straight leg raise <30 deg, positive slump test
  • acute muscle spasm on palpation
33
Q

Mx acute spinal cord compression/diskogenic back pain

A
  • analgesia
  • weak opiod short course
  • Benzo
  • physio
  • surgical decompression
34
Q

Facet joint pain is usually caused by what condition

A

degenerative arthropathy

35
Q

Sx facet joint pain

A
  • chronic
  • older
  • aggravated by EXTENSION and LATERAL FLEXION
  • +/- nerve root Sx
  • decreased ROM
  • tender on palpation
36
Q

Ix facet joint pain

A
  • MRI gold standard
  • CT
  • Bone
37
Q

Mx facet joint pain

A
  • as for arthritis and chronic LBP

- facet joint injection (diagnostic and therapeutic)

38
Q

Types of spondylolisthesis/spondylolysis

A

Type 1: dysplastic/congenital
Type 2: pars defect (lytic i.e. stress fracture, acute fracture)
Type 3: degenerative
Type 4: traumatic
Type 5: pathological 2/2 bone disease eg osteogenesis imperfecta, pagets

39
Q

Who is affected by stress fracture of pars interarticularis?

A
  • Young athletes
  • hyperextension + rotation
  • fast bowlers, gymnasts
40
Q

Sx stress fracture of pars interarticularis

A

Unilateral LBP

  • pain aggravated with extension
  • may have single episode precipitated pain
  • may be aSx if stress
  • excessive lumbar lordosis + HS tightening
  • unilat tenderness on palpation
41
Q

Ix for stress fracture pars interarticularis

A
  • oblique- scotty dog
  • SPECT bone scan
  • MRI less sensitive
42
Q

Most common site for spondylolisthesis

A

L4/5

43
Q

What is spondylolithesis and what is required for it to occur?

A

Slipped vertebra

requires bilateral pars defect

44
Q

Sx spondylolisthesis

A
  • LBP +/- leg pain
  • +/- claudication if central stenosis
  • palpable dip
  • compensatory muscle spasms in HS
  • decreased ROM
  • lordosis
45
Q

Ix for spondylolisthesis

A

Lateral XR- grade slippage

46
Q

Mx spondylolithesis

A
  • relative rest
  • analgesia
  • PT
  • avoid contact sport
  • if progresses (rare)- surgery
47
Q

signs and symptoms lumbar spinal stenosis

A
  • elderly (affects 11% population)
  • LBP
  • Parasthesia and pain on prolonged standing/walking
  • neuro exam- plantars and Hoffmans, Romberg
48
Q

Most common primary malignancies that metastasise to the spine

A

thyroid, lung, breast, renal, and prostate

haematological malignancies eg myeloma

49
Q

Lumbar spinal stenosis causes

A
  1. ligamentum flavum hypertrophy
  2. facet degeneration- osteophyte formation
  3. disc herniation
50
Q

Mx lumbar spinal stenosis

A

Conservative = analgesia, exercises to improve spine mobilisation. Degenerative condition- aim to stabilise rather than cure

If severe and Rx to conservative Mx - surgical decompression =/- fusion

51
Q

Torticollis

A

‘cricked neck’

pain and difficulty turning head C4-7

Can be apophyseal or diskogenic

52
Q

Burners and stingers

A

traction injury to brachial plexus
contact sport
burning/stinging sensation down arm

53
Q

scheuermann’s disease

A

excessive thoracic kyphosis, most commonly adolescent males

54
Q

causes of thoracic back pain

A
  • scheuermann’s disease
  • costovertebral and costotransverse joint disorders (inflam arthritidies or mechanical)
  • other: chest, cardiac, oesophagus
55
Q

if no neuro red flags Mx back pain

A
  • tell to move
  • reassure
  • analgesia with NSAIDs
  • PT
  • no imaging
56
Q

criteria for learning disability paralympics

A

IQ below 70-75
Intellectual disability must have been observed in developmental period (0-18 yrs.)

Must be receiving 2 out of

  • Special education
  • Special accommodation
  • Special employment
  • Special protection
  • Respite care
  • Financial support
57
Q

Lesion above T6 max HR

A

Cannot go above 120-130 because no sympathetic drive to the heart

Injuries and medical problems in sport (17 decks)

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