Week 9 Flashcards
Describe metastatic bony tumor
-malignant lesion that did not start in the bone, but spread to it
-Skeleton is the third most common sight for metastasis after lung and liver
-most common type of bony tumor age 45-50
What are the most common site for bony metastasis?
-proximal humerus to the proximal femur and structures of the rib cage, thoracic spine, lumbar spine, pelvis
-Pain is the hallmark sign, especially for LBP, neck/shoulder/hip pain
Where are primary bony tumors more likely to occur?
-In the long bones of the skeleton, unlike metastatic bony tumor site, which are more common in the axial skeleton
-Many occur near the growth plate
-more common in children, adolescence, young adults
-typically present to PT with knee or hip pain
Patient demographics related to Spinal malignancy
• Spinal metastatic malignancies occur more commonly in people aged 45-50 years and older
• *A previous history of cancer carries high risk for a metastatic spinal malignancy. Primary malignancies that commonly metastasize to the spine include:
• Breast
• Prostate
• Lung
• Kidney
• Thyroid
relatively rare cause of back pain
Pain history information related to spinal malignancy (location, onset)
-Pain location: central or midline, back pain, often a deep, dull ache; most common and thoracic and lumbar spine; within the vertebral body, pedicle
-Onset: insidious, but progressive overtime
- average length of time from when doll ache starts to the malignancy being diagnosed is 9 months
Aggravating versus alleviating factors for pain
-aggravating factors: since the tumor is in bone, it will get worse with weight-bearing activities (the more weight-bearing, the more intense the pain will be)
-Alleviating factors: avoid or minimize weight-bearing activities
- mechanical pain pattern* typically won’t get relief with changing position; may have night pain
Physical examination findings for patient with spinal malignancy
-unexplained weight loss of 5 to 10% of body weight typically over a 3 to 6 month period; may also include fatigue, malaise, low-grade fever
*response to treatment is important part of screening process
What is the diagnostic gold standard for imaging for spinal malignancies?
-MRI, followed by CT scan if MRI is contraindicated
Which of the following is true related to a metastatic bony
tumor?
A.) The patient is 18 years old
B.) The tumor is often located in the lumbar spine
C.) The common initial clinical manifestation is high fever
D.) The tumor started in the vertebral column
B
Patient demographics for spinal infection
-A current history of co-morbidities that result in
the patient being or becoming
immunocompromised such as:
• Diabetes
• Rheumatoid arthritis
• HIV/Aids
• Alcohol abuse
• Long term use of steroids
-In addition, a current history of:
• Pre-existing infections. It may be days to weeks
before the back pain symptoms become noticeable
• Spinal surgery, especially with repeated revisions.
Symptoms usually surface within days of the
procedures
• Intravenous drug use
• Tuberculosis
*Carries increased risk of developing an infection
causing back pain.
Pain location and onset for spinal infection
-Location: Central) or midline, back pain, often a deep, dull and diffuse ache
-possible neurological sensory and motor deficits
-onset: insidious, but progress progressive over overtime
- average length of time from when the dull ache starts to the infection being diagnosed is a few days to a few weeks
- pain may be during night and typically doesn’t get relief with changing positions
Aggravating versus alleviated factors for spinal infection
-Aggravating: since the infection is in the intervertebral disc or vertebral body, weight-bearing activities will worsen pain (the more weight-bearing, the more intense of the pain)
-Alleviating: avoid or minimize weight-bearing activities
Physical examination findings for spinal infection
-fatigue, fever, unexplained weight loss of 5 to 10% of body weight over a 3 to 6 month timeframe
-Pain provocation with palpation, vibration, percussion over the spine process
-all movements may be painful; mechanical pain pattern
Describe some information about cauda equina syndrome
-The cauda equina consists of 20 nerve roots coming off the conus medullaris at the base of the spinal cord.
-These nerve roots are associated with critical function of the lower extremities, and bowel, bladder and sexual function
-Cauda equina syndrome is associated with compression of these neural structures.
Patient demographics related to Cauda Equina syndrome
-current history of the following carry risk for
developing cauda equina syndrome:
• Herniated intervertebral disc
• Lumbar spinal stenosis
• Lumbar spinal surgical procedure
*Anyone of these entities can cause compromise to
the cauda equina
Chief complaint related to pain and onset for Cauda Equina syndrome
Pain history:
-acute and sudden onset with possible lower extremity radicular pain, or the pain may be relatively mild and localized to the back
-lower extremity paresthesia, numbness within the saddle region (L4-S1)
-lower extremity weakness
-onset: the acute onset may be associated with an event, for example, heavy lifting that has caused a herniated disc
Physical examination findings for Cauda Equina syndrome
• If the cauda equina syndrome is associated with
lumbar spinal stenosis the symptoms may worsen
with trunk extension movements and activities a d
improve with trunk flexion.
• Frank neurological deficits may be noted
*review of systems: urinary incontinence and/or retention, Fecal incontinence and/or constipation, sexual dysfunction or loss of genitalia sensation
Which of the following is true related to cauda equina
syndrome?
a. The peak age of onset is between 15-25 years
b. Pain maybe acute and severe, or slow with gradual
progression
c. Cauda equina syndrome is a very common condition in
primary care settings
d. Cauda equina syndrome is a non-emergency condition,
does not warrant an immediate patient referral
B
