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Y2 MSK > Back pain > Flashcards

Back pain Flashcards

1
Q

What is vertebral osteomyelitis

A

Infection of the vertebra

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2
Q

Risk factors of vertebral osteomyelitis

A

People who inject drugs
Diabetes
GI infections
Infective endocarditis
UTi
Post operative

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3
Q

Cause of vertebral osteomyelitis

A

Haematogenous spread of infection from distant infections

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4
Q

Most common causative pathogen of vertebral osteomyelitis

A

S aureus

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5
Q

Complications of vertebral osteomyelitis

A

Vertebrae collapse -> kyphosis or flat vertebra

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6
Q

Symptoms of vertebral osteomyelitis

A

Insidious onset of Constant lumbar pain

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7
Q

Signs of vertebral osteomyelitis

A

Spinal tenderness
Paraspinal muscle spasm
Neuropathy (in severe case)

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8
Q

Investigations for vertebral osteomyelitis

A

Bloods - CRP
MRI
Blood cultures

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9
Q

Management of vertebral osteomyelitis

A
  1. CT guided biopsy
  2. High dose IV antibiotics
  3. Surgery if indicated
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10
Q

The response of vertebral osteomyelitis to IV antibiotics is assessed by

A

Clinical
CRP level

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11
Q

When is surgery indicated

A

No response to antibiotic therapy
Vertebral collapse
Neurological deficit

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12
Q

Surgical management for vertebral osteomyelitis

A

Debridement
Stabilization
Fusion of adjacent vertebrae

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13
Q

What is Pott disease

A

Vertebral osteomyelitis + intervertebral disci tis from TB

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14
Q

Risk factors

A

Immunosuppression
Skin and soft tissue infection
pulmonary TB

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15
Q

Symptoms of Pott disease

A
  • Often no systemic symptoms
  • Back pain
  • Lower limb weakness/paraplegia
  • Kyphotic deformity
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16
Q

Onset of symptoms of Pott disease

A

Insidious, slow

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17
Q

Investigations for Pott disease

A

Xray / MRI
check for immunosuppression / HIV

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18
Q

Management for Pott disease

A

TB treatment
Analgesia
Surgery

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19
Q

Describe TB treatment

A

isoniazid + rifampicin + ethambutol + pyrazinamide for 2 months
Isoniazid + rifampicin for another 4 months

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20
Q

What is mechanical back pain

A

Recurrent relapsing and remitting back pain with no neurological symptoms

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21
Q

Risk factors for mechanical back pain

A

20-55
Obese
Poor posture
Poor lifting technique
Lack of physical activity
Depression
Spondylosis
Degenerative disc prolapse

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22
Q

What is spondylosis

A

intervertebral discs lose water with age causing less cushioning and increased pressure on the facet joints

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23
Q

Spondylosis can cause

A

secondary facet joint OA

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24
Q

Symptoms of mechanical back pain

A

Pain in lumbosacral region, buttocks and thighs
Mechanical pain - worse at activity, at night
No red flag symptoms
Flare ups

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25
Q

Where is the pain in mechanical back pain felt at

A

Lumbosacral region
buttocks
thighs
(rarely below knee)

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26
Q

Management of mechanical back pain

A

Lifestyle advice
Analgesia - NSAID
Physiotherapy

27
Q

What lifestyle advice is given to someone with mechanical back pain

A

Walk 30 minutes a day
Weight control

28
Q

Where does acute disc tear occur at

A

Outer fibrous layer of intervertebral disc (annulus fibrosus)

29
Q

What usually causes acute disc tear

A

After lifting a heavy object

30
Q

Pain in acute disc tear is worse when

A

coughing, because it increases disc pressure

31
Q

Investigators for acute disc tear

A

MRI

32
Q

Management for acute disc tear

A

Analgesia
Physiotherapy
Self resolving - 2-3 months

33
Q

What is sciatica

A

Pain due to compression of any of the 5 nerve roots of sciatic nerve

34
Q

What are the nerve roots of sciatic nerve

A

L4-S3 (L4,5, S1,2,3)

35
Q

Where is the pain of sciatica felt at

A

Lumbar spine
Buttocks
Posterior thigh
Posterior leg

36
Q

Which nerve roots are the most commonly compressed in sciatica

A

L5
S1

37
Q

Motor innervation of sciatic nerve

A

Posterior thigh
Hamstring portion of adductor Magnus
All muscles of the leg and foot via its branches

38
Q

Branches of the sciatic nerve

A

Tibial nerve
Common fibular nerve

39
Q

Branches of the tibial nerve

A

Medial plantar nerve
Lateral plantar nerve

40
Q

Branches of the common fibular nerve

A

Superficial fibular nerve
Deep fibular nerve
Sural nerve
Lateral sural nerve

41
Q

Causes of sciatica

A

Prolapsed disc
Bone spurs
Spondylolisthesis
Tumour
Fractures
Piriformis syndrome

42
Q

Which structure of the intervertebral disc is the most likely to herniate and cause sciatica

A

Nucleus pulposus

43
Q

Pathophysiology of sciatica

A
  1. Intervertebral discs loosing water and weakening due to aging
  2. The discs become prone to prolapse
  3. Defect in annulus fibrosus allows the nucleus of the disc to herniate during strenuous physical activity
  4. Prolapsed disc impinges on nerve roots of sciatic nerve
44
Q

Symptoms of sciatica

A

Unilateral leg pain greater than back pain
Sharp pain
Pain radiating to foot
Numbness in those areas

45
Q

Do all patients have back pain in sciatica

A

No

46
Q

Clinical signs of sciatica

A

Foot drop
Numbness

47
Q

Investigations for sciatica

A

Clinical

48
Q

Management of sciatica

A

Analgesia
Surgery if recurrent

49
Q

Facet joint OA can cause

A

Osteophytes impinging on nerve roots

50
Q

Management of osteophytes impinging on nerve roots

A

Surgical decompression
Trimming of osteophytes

51
Q

Peripheral vascular disease and spinal stenosis can both cause claudication in lower legs. How do you differentiate

A

Pain is burning in SS whereas pain is cramping in PVD
Pulses are preserved in SS whereas pulse in PVD is absent

52
Q

What is cauda equina syndrome

A

Compression of the nerve roots at cauda equina ( base of spinal cord)

53
Q

Cauda equina level of spine

A

L1-L5

54
Q

Most common cause of cauda equina syndrome

A

Large disc herniation at L4/L5 and L5/S1 level

55
Q

Symptoms of cauda equina syndrome

A

Bilateral leg pain
Groin pain
Loss of bowel or bladder control
Sexual dysfunction
Weakness in legs

56
Q

Clinical signs of cauda equina syndrome

A

Loss of anal sphincter tone in PR exam

57
Q

Investigations for cauda equina syndrome

A

Urgent MRI

58
Q

Management for cauda equina syndrome

A

Urgent discectomy

59
Q

What is cervical spondylosis

A

Degenerative disease of cervical spine

60
Q

Cervical spondylosis most commonly affects which age group

A

Elderly, above 50

61
Q

Symptoms of cervical spondylosis

A

Neck pain
neck stiffness
Pain radiating to shoulders and occiput

62
Q

Clinical signs of cervical spondylosis

A

Upper limb weakness
Sensory changes

63
Q

Management of cervical spondylosis

A

Physiotherapy
Analgesics
Surgical decompression if severe and recurrent

64
Q

Cervical disc prolapse usually affects

A

C7 nerve root - at C6/7 discs
C8 nerve root - at C7/T1 discs

Y2 MSK (19 decks)

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