Back/Spine - MSK

Question 1

kyphosis

Answer 1

degenerative, or compression deformities, or compression fractures

Question 2

lordosis

Answer 2

typically muscle spasm/tightness
flat back
Leaning back - big belly - oh my lord

Question 3

Spondylosis

Answer 3

“degenerative wear-and-tear changes of the spine”

• fractures or insufficiencies
• degenerative (from facet and disc degen)
• <20yo isthmic (atheletes, gymnasts, linesman, repetitive strain type injury)
• congenital (born that way)
• traumatic
• pathologic (cancer, infectious destruction)

Question 4

Degenerative Disc Disease

Answer 4

-discs dry out and collagen wears -> become flat and brittle
-allows vertebrae to come closer together
-facet joints rub more -> pain
-foramenal stenosis -> radicular pain
l-igamentum flavum buckles in -> central stenosis
-collagen tears, sinovertebral nerve grows into a pressurerized area, nucleus (acid) meets nerve -> inflammation (Internal Disc Dispuption and Discogenic Pain)
-tears -> continued degeneration -> bulge (pushes on structures, namely posterior longitudinal ligament and dural sac) + herniations (pushes on stuff and tons of inflammation) -> radicular pain + radiculopathy

Question 5

Cauda Equina Syndrome

Answer 5

-encroahment upon the lower lumbosacral roots
progressive weakness, bowel or bladder -incontinence, +/-urinary retention with distended bladder, saddle anesthesia, absent anal wink reflex, dec anal tone

Question 6

Sacroiliac Joint Dysfunction

Answer 6

• buttock, beltline and below pain
• tender PSIS, + Patrick’s, Gaenslen’s, Femoral Shear, SIJ compression, SIJ distraction
• typically unilateral
• usually due to some asymmetry, typically ankle/foot/knee/hip disorders, or pelvic muscle weakness, or spine pathology/unilateral spasm

Question 7

Seronegative Spondyloarthropathies

Answer 7

• Ankylosing Spondylitis
• 3m long. If 4 positive = 95% specific.
• XR and rheum referral. NSAIDs.
• Reiter’s Syndrome
• Psoriatic arthritis
• Assoc with Inflammatory Bowel Dz

Question 8

Piriformis Syndrome

Answer 8

• radicular pain with buttock pain, reproduced with + FAIR testing
• tight/irritated piriformis irritates the sciatic
• rare
• close to sciatic nerve