the spine Flashcards
what happens when disc material presses on an exiting nerve root
pain and altered sensation in. a dermatomal distribution as well as reduced power in a myotomal distribution
where is the most common site for disc material to press on a root
lower lumbar spine, L4 L5 and S1
what is the type of pain in sciatica
a neuralgic burning or severe tingling pain radiating down the back of the thigh to below the knee.
what happens in L3/4 prolapse
- L4 root entrapment
- pain down to medial ankle, loss of quadriceps power, reduced knee jerk
what happens in L4/5 prolapse
- L5 root entrapment
- pain down dorsum of foot, reduced power extensor hallicus longus and tibialis anterior
what happens in L5/S1 prolapse
- S1 root entrapment
- pain to sole of foot, reduced power planarflexion, reduced ankle jerks
first line treatment for sciatica
- analgesia
- maintaining mobility
- physiotherapy
- occasionally gabapentin
when is surgery indicated for sciatica
when pain is not resolving despite physiotherapy and there are localising signs suggesting a specific nerve root involvement and positive MRI evidence of nerve root compression
what can OA of the facet joints result in
osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica
what is spinal stenosis
when with spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis, the cauda equina has less space
give features of the pain in spinal stenosis
claudication
- the claudication is distance and inconsistent
- pain is burning
- pain is less walking uphill
- pedal pulses are preserved
what is cauda equina syndrome
when a very large central disc prolapse can compres all the nerve roots of the cauda equina producing cauda equina syndrome
why is cauda equina syndrome a surgical emergency
as affected nerve roots include the sacral nerves which control urination and defaecation
symptoms of cauda equina syndrome
- bilateral leg pain
- paraesthesiae
- numbness
- saddle anaesthesia
- altered urinary function
- incontinence
- faecal incontinence and constipation
investigations for cauda equina syndrome
- RECTAL EXAM
- urgent MRI
what causes spontaneous osteoporotic crush fractures
severe osteoporosis
what do crush fractures cause
acute pain and kyphosis
symptoms of spondylosis in the cervical spine
- slow onset stiffness
- pain in neck which can radiate to shoulders and occiput
treatment for spondylosis in cervical spine
analgesics and physio
symptoms of nerve root compression
-shooting neuralgic pain down a dermatomal distribution with weakness and loss of relfexes
what will acute and degenerative disc prolapse cause in the cervical spine
neck pain and potentially nerve root compression
what can a large central prolapse of the cervical spine cause
can compress the cord leading to a myelopathy with upper motor neurone symptoms and signs.
what conditions are associated with atraumatic cervical spine instability
- down syndrome
- rheumatoid arthritis
what are children with down syndrome at risk of developing
atlanto‐axial (C1/C2) instability with subluxation potentially causing spinal cord compression
how can rheumatoid arthritis cause atlanto-axial subluxation
due to destruction of the synovial joint between the atlas and the dens and rupture of the transverse ligament
what can cause lower cervical subluxations
destruction of the synovialfacet joints and uncovertebral joints again with potential for cord compression (myelopathy) with upper motor neuron signs (
what are some upper motor neuron signs
wide based gait, weakness, increased tone, upgoing plantar response
which nerve passes through the carpal tunnel
the median nerve
presentation of carpal tunnel syndrome
- parathesiae in median nerve
- worse at night
- loss of sensation and sometimes weakness in the thumb
- clumsiness in hand
non-operative treatment of carpal tunnel syndrome
- wrist splints at night
- injection of corticosteroid
surgical treatment of carpal tunnel syndrome
-division of the transverse carpal ligament under local anaesthetic
what is cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle
symptoms of cubital tunnel syndrome
- paraesthesiae in the ulnar 1 1/2 fingers
- tinels test positive
