Upper and lower limb conditions(FCM)

Question 1

What are red flags for back pain? (6 things)

Answer 1

1. Incontinence
2. Trauma to the back
3. Saddle anaesthesia
4. History of cancer
5. Signs of infection
6. Progressive motor or sensory loss

Question 2

What symptoms would you expect in mechanical back pain? (5 things)

Answer 2

1. Morning stiffness <15mins
2. Worse with certain activities
3. Onset after injury
4. Fluctuating symptoms
5. Overuse is a risk factor

Question 3

What symptoms would you expect in inflammatory back pain? (5 things)

Answer 3

1. Morning stiffness >1 hour
2. Better with movement
3. Onset is insidious
4. Progressive symptoms
5. Typically younger patients

Question 4

What is Ankylosing spondylitis and what X-ray findings are expected?

Answer 4

Its a chronic inflammatory joint disease of the spine.

It affects the sacroiliac joints.
You will expect to see a Bamboo spine on x-ray (thickening of the spine and discs)

Question 5

What causes caudal equina and what is the treatment for it?

Answer 5

Compression of the spinal nerves due to swelling or slipped disc (90% of cases) this causes sx such as saddle anaesthesia

Tx:
Immediate decompression of the spinal nerves

Question 6

How would a herniated nucleus pulposus present (slipped disc)?

Answer 6

1. Unilateral leg pain worse than back pain
2. Pain radiates to the foot or toes
3. Pain worse when sitting
4. Numbness and paraesthesia in the leg/ foot or toes
5. Changes in motor, sensory or reflexes
6. limited to one nerve root

Note:
theres 50% recovery from an acute attack in 6 weeks

Question 7

What is the main difference between the pain associated with spinal stenosis and a herniated disc?

Answer 7

Stenosis:
Bilateral leg pain.
Pain is better when leaning forward

Disc:
Unilateral leg pain
Pain worse when sitting

Question 8

If a patient has an absent patella reflex, impaired hip flexion and a sensory deficit in the anterior/ medial thigh, what nerve root is affected?

Answer 8

L3

Question 9

If a patient has an absent patella reflex, impaired knee extension and a sensory deficit in the anterior leg/ medial foot, what nerve root is affected?

Answer 9

L4

Question 10

If a patient has an absent medial hamstring reflex, impaired dorsiflexion and a sensory deficit in the lateral leg/ dorsal foot, what nerve root is affected?

Answer 10

L5

Question 11

If a patient has an absent achilles tendon reflex, impaired Plantarflexion and a sensory deficit in the posterior leg/ lateral foot , what nerve root is affected?

Answer 11

S1

Question 12

What is a symptom can cause spinal stenosis and a herniated disc ?

Answer 12

Sciatica

Question 13

What is avascular necrosis and how would the patient present ? (3 things)

What are some risk factors for this? (5 things)

How is it treated?

Answer 13

Loss of blood supply to the femoral head causing bone death.

Sx:

• Sx tend to be chronic
• groin pain radiating to the leg
• Pain despite analgesia

RF:

• Alcoholism
• Steroid use
• Chemotherapy
• Sickle cell anaemia
• Immunosuppressant drugs

T:
Total Hip replacement

Question 14

What condition causes an externally rotated leg, a limp, knee pain and groin pain in overweight adolescent boys ?

• What causes it?
• Treatment?

Answer 14

• SCFE
• Occurs due to the growth plate slipping due to the patient growing
• Treated with surgery

Question 15

How would you differentiate Legg calve perches from a SCFE? (2 points each)

Answer 15

SCFE:

• Bilateral leg affected
• Adolescent boys

LCP:

• Unilateral leg affected
• Boys ages 4-8