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Year 2- MSK > The Thoracic and Lumbar spine > Flashcards

The Thoracic and Lumbar spine Flashcards

1
Q

Red flags: Metastatic Spinal Cord compression

A
  • Referred back pain is band-like
  • Escalating pain
  • Heavy legs
  • Lying flat increases back pain
  • Agonising pain
  • Gait disturbances
  • Sleep disturbed
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2
Q

Red flags: Multiple Myeloma

A
  • Dull ache and pain on palpation- back, ribs or pelvis
  • Tiredness
  • Extreme thurst
  • Blurred vision
  • Bone fragility: fracture, cord compression
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3
Q

Spinal infection (Tuberculosis,Osteomyelytis, Discitis)

A

-Weight loss
-Loss of appetite
-Localised spinal pain
-Extreme night sweats
-Fevers
-Malaise
- Continuous pain

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4
Q

Red flags: Spondyloarthropathy

A

Less than 45 years with
- Spinal pain reduces with activity
- Waking on second half of night
- Buttock pain
- Stiffnes in morning for more than 45 mins
- Swollen fingers
- Red eyes
- Psoriasis

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5
Q

Red flags: Osteoporotic Compression fracture

A
  • Sudden severe back pain
  • Pain worse on standing/walking/change of position
  • Relieved by resting
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6
Q

Red flags: CES

A
  • Loss of sensation in saddle area
  • Altered sexual function
  • Bilateral leg pain
  • Bladder or bowel changes
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7
Q

Red flags: AAA

A
  • Abdominal pain
  • Palpable, pulsatile mass
  • Passing out, SOB
  • Severe low back pain/ flank pain worse on exertion
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8
Q

What is Lumbar Spine Radiculoathy?

A

Compression of the nerve roots which exit the spine at level L1-S4
Incorporates sciatica as the nerve roots that make up the sciatic nerve are affected too

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9
Q

What can cause compression of nerve roots to cause lumbar radiculopathy?

A
  • Herniated discs
  • Spondylolisthesis (vertebrae slips)
  • Lumbar stenosis (narrowing of vertebral canal)
  • Trauma
  • Cancer
  • OA
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10
Q

Signs and symptoms of lumbar radiculopathy

A
  • Unilateral or bilateral leg pain into lower limb
  • Lower back pain often present
  • Positive straight leg raise
  • Neurological deficits: numbness, tingling, myotomal weakness, changed sensation
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11
Q

What is Lumbar spondylolisthesis /restrolisthesis

A

Spondylolisthesis (forward movement of a vertebrae)
Retrolisthesis (backward movement of vertebrae)

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12
Q

Causes and risk factors of Lumbar spondylolisthesis /restrolisthesis

A
  • Trauma
  • Fracture
  • Arthritis
  • Tumour
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13
Q

Symptoms of Lumbar spondylolisthesis /restrolisthesis

A
  • Can be asymptomatic
  • LBP with or without leg pain and neuro symptoms
  • Descriptions of catching pain during movement
  • Noticeable step in the lumbar spine on palpation
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14
Q

What is lumbar spine stenosis? Risk factors?

A

Narrowing of the spinal canal and is characterized by symptoms being relieved by forwards flexion and worsened with extention
Risk factors:
- Age e.g age related changes
- Females are more likely

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15
Q

Causes of lumbar spine stenosis

A
  • Congenital stenosis and spondylolisthesis
  • Lateral recess and foraminal stenosis
  • Central spine stenosis (causing neuro claudication)
  • OA, RA
  • Trauma/injury to spine
  • Tumour
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16
Q

Symptoms of Lumbar spine stenosis

A

-Present with LBP with or without leg pain
-Neurological symptoms with leg pain being the most prominent symptom
-Describe walking and standing as a cause for their symptoms
-Relieved by forward flexion

17
Q

Management of Lumbar spin conditions

A

Advice - GP, heat treament, sleeping with pillow between legs, return to normal activity, avoid bed rest
Reassurance (usually settles within 4-6weeks)
Symptoms not going or getting worse
Physio: manual therapy, exercise, spinal mobs, massage
Referral for pain meds (nerve root blockers)
Consider neurosurgery

Research: Raymond Ostelo
- Exercise therapy for complaints longer than 6-8wks
- all advice above recommended plus exercise if leg pain is most dominant symptom

18
Q

What is non-specific LBP

A

Lower back pain that can’t be attributed to a specific pathoanatomical structure and has a mechanical pattern

19
Q

Risk factors for LBP

A

Obesity
Physical inactivity
Occupational factors
Depression and other psychological conditions
Lifestyle

20
Q

Red flags for LBP

A

Cauda equina
Spinal fracture
Cancer
Infection

21
Q

Signs and symptoms of mechanical LBP

A
  • Mechanical in nature
  • Pain local to lumbar but can radiate in a non-dermatomal distribution into hip, buttock, LL
  • Pain associated with pins and needles but NO dermatomal or myotomal deficit
22
Q

Management of mechanical LBP

A

Advice: GP for pain relief, avoid bed rest, encourage activity
Reassurance: not usually structure damage, usually resolves in a period of weeks
All backed up by evidence
Failure to improve within 4 weeks or at risk of chronic:
Physio: exercise, spinal mobs, manipulation or massage
Pain management service
All backed up by evidence as well as psychosocail interventions
Research: Chris Mayer et al

23
Q

What is thoracic spine pain

A

Difficult to distinguish the pathoanatomical origin of non-specific thoracic pain

24
Q

Causes of non-specific thoracic spine pain

A
  • Muscle strain (overuse/sport)
  • Postural
  • Vertebral fracture
  • Structural abnormalities
  • Degenerative changes
25
Q

Thoracic spine is most common area for bone metastases. What are the most common primary cancer that can spread to the spine

A
  • Breast cancer
  • Prostate cancer
  • Lung cancer
  • Myeloma
26
Q

Risk factors of non-specific thoracic spine pain

A
  • Postural changes
  • Increased back pack weight
  • Poorer mental health
  • White collar workers
27
Q

Signs and symptoms of non-specific thoracic spine pain

A
  • Aggravated by movements, postures, activities
  • Usually pain local to the thoracic spine
  • Referred pain to ribs, chest and arms
  • Visceral referral from non MSK conditions e.g cardiac
  • No associated motor deficit
  • Pain may be reproduced with movement in the opposite direction
  • Tenderness on palpation of intervertebral joints
28
Q

Management of non-specific thoracic spine pain

A

(0-12 weeks)
Advice: GP, encourage activity, change positions regularly
Physio: stretch, strength, ROM, postural exercise, manual therapy
Reassurance usually resolves in a few weeks
(more than 12 weeks)
Provide MDT pain management programme
Pain clinic

Research: NLM, Marco Risetti et al
- Exercise and education was found to be beneficial in the short term, and long term treatment of TSP.
- Manual techniques (spinal manipulation, spinal mobilisation and soft tissue mobilisation) only as short term treatment.
A multimodal treatment with these and some psychosocial management was shown to be beneficial

29
Q

What are the red flags to look out for in lumbar and thoracic assessments?

A
  • Cauda Equina
  • Metastatic cord compression
  • Multiple myeloma
  • Spinal infection
  • Spondyloarthropathy (ankylosing arthritis)
  • Osteoporotic stress factor
  • AAA

Year 2- MSK (10 decks)

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