Unit 2 - Backache & neckache Flashcards
What is non-nervous tissue of the spine referred as?
Spondylitides
abnormalities occurring in these are called spondylitis
What is the difference between:
- Local pain
- Referred pain
- Nerve root pain
Local - general pain in whole region (usually difficult to pinpont
Referred - back pain may be referred from back to buttock, thigh and leg (descending as far as mid-calf, but rarely below this)
Nerve root:
- nerve roots emerge from vertebrae through vertebral foramina (surrounded by facet joints and intervertebral discs)
- diseases affecting facet joints and discs may cause direct pressure on nerve roots & this causes disturbances such as pain in the spinal nerve originating from that particular nerve root
- commonly happens in foramina of lower lumbar region and so pain is perceived in the sciatic nerve (sciatica)
What are the characteristics of sciatica?
Pain in the leg, mainly down the back of the leg but almost always into the foot
May be exacerbated by coughing
What causes back sprains & how may it be managed?
Awkward twisting/poor lifting
Rest & simple analgesia
What causes mechanical backache & how may it be managed?
Spondylosis (degeneration of intervertebral disc leading to increased loading of facet joints, which then develop secondary OA)
Primary OA
Probably others that involve ligaments & muscles
Rest, physio, simple analgesia
What is spondylolisthesis?
Refers to slippage of one vertebra relative to the one below (commonly in lumbar spine)
What causes spondylolisthesis?
Congenital or acquired (usually following acute/fatigue fracture of pars interarticularis) bony abnormality which interferes with stability of facet joints & their associated elements
Presentation of spondylolisthesis?
Lower back pain (like mechanical)
Diagnosed through x-ray (severe slippage may be felt as a step)
Rarely causes neuro problems (movement in congenital might)
Management of spondylolisthesis?
Spinal corset
Rest, physio, analgesia
Surgical fusion if severe pain
What is the term for a pars interarticularis defect (fracture) without forward slipping of vertebra?
Spondylolysis
What is the cause of a prolapsed disc?
Abnormality in intervertebral disc which leads to prolapse of nucleus pulposus through annulus fibrosis
What area of the spine is mostly affected by prolapsed disc?
Between 5th lumbar vertebra & sacrum
Clinical presentation of prolapsed disc?
Back pain, leg pain (down back of thigh to foot)
Localising signs - muscle weakness, numbness
Sciatica
Management of prolapsed disc?
Ensure nerve supply to bladder & bowel are not damaged
Minimal rest, analgesia, NSAIDs (most recover spontaneously)
If pain very severe/persisting surgical intervention to remove disc required. Site of prolapse confirmed by myelogram (injecting radio-opaque material into spinal fluid & taking xrays - fluid will not flow where disc presses on nerve)
What is the presentation for bony root entrapment?
> 40, Hx of mechanical back pain, leg pain radiating to foot (worse with exercise)
Episodes usually acute & recurrent against a chronic history of back pain
