MSK - Osteoarthritis Flashcards
What are the (3) red flag conditions in bone?
- Infection
- Fracture
- Malignancy
List (8) classes of causes of low back pain
•Facet joint osteoarthritis
•Disc degeneration
•Disc herniation
–central (can cause canal stenosis) or
–posterolateral (can cause radicular impingement)
•Inflammatory back pain
–Ankylosing spondylitis, Psoriatic arthritis, Reactive arthritis / Reiter’s syndrome
•Fractures: Osteoporosis, malignancy, trauma
•Malignancy: Eg. breast, lung, prostate
•Infection: Discitis, osteomyelitis, epidural abscess
•Intra-abdominal pathology: AAA, renal, pelvic
What does a “scotty dog” on back XR indicate? When would the dog have a collar/broken neck?
The scotty dog sign refers to the normal appearance of the lumbar spine when seen on oblique radiographic projection
The summation shadows of 2 overlapping lumbar vertebrae in the oblique view plain Xray
If spondylolysis is present, the pars interarticularis, or the neck of the dog, will have a defect or break. It often looks as if the dog has a collar around the neck (or broken neck)
Describe spinal canal stenosis
- anatomical causes
- clinical syndrome
- what is compressed
- Anatomically is usually caused by a combination of facet joint OA + ligamentum flavum hypertrophy + disc herniation
- May cause the clinical syndrome of lumbar claudication, ie. Lumbar, buttock or thigh pain usually uni- but may be bilateral that is NOT present at rest but comes on with exercise, at a reproducible walking distance
- Nerve roots become compressed
What are the (4) features/risk factors for infection of low back?
- signs & symptoms of infection (e.g. fever)
- underlying disease process
- immunosuppression
- penetrating wound
What are the (2) features/risk factors for fracture of low back?
- History of trauma
- minor trauma (if >50yrs, history of osteoporosis & taking corticosteroids)
What are the (6) features/risk factors for tumour of low back?
- Past history of malignancy
- Age >50yo
- Failure to improve with treatment
- unexplained weight loss
- pain at multiple sites
- pain at rest
What are the (1) features/risk factors for aortic aneurysm causing low back pain?
Absence of aggravating features
What is the first line treatment for simple back pain as well as OA hip & knee?
Paracetamol
What is the mechanism by which oral NSAIDs cause serious side effects?
Cyclo-oxygenase 1 and 2 inhibition
55yo female increasing pain in the right buttock and groin on walking. The pain began about 2 years ago but was intermittent and not severe. In the last few months the pain is present when walking and limits her ability to climb stairs. The pain radiates to the lateral thigh.
- groin and thigh pain is worse with walking and better with rest
- She has stopped walking any distance due to the pain
- Paracetamol is helpful
- She is reluctant to take an NSAID as she had a gastric ulcer 2 years ago after taking diclofenac for back pain
Diabetic
Right hip examination
•Look - gait - Trendelenberg test negative
•Feel - no back or soft tissue tenderness
•Move - both hips move painlessly through a full ROM
DDx?
Spinal canal stenosis due to: •Facet joint osteoarthritis •Disc degeneration •Disc herniation –central (can cause canal stenosis) or –posterolateral (can cause radicular impingement)
25 yo male refugee from Iraq who presents with 2 days of lumbar back pain after lifting a heavy box.
pain is in the centre of his lumbar spine and radiates to both buttocks but not to the legs
•The pain is worse standing and walking but is better lying down
•Pain is rated 5/10 at rest, 8/10 movement
•Paracetamol is not helpful
No previous back pain
Back examination
–Look: slight loss of lumbar lordosis – no scoliosis
–Feel: exquisite tenderness in the mid paravertebral lumbar spine
–Move: reduction of all back movements
–Special tests: no abnormal neurological signs
Dx? Rx?
- You recommend ongoing activity and a heat pillow (eg. wheat bag) for treatment
- Provide with written material about acute back pain
- On review in 2 days his pain has improved by 50% and one week later has resolved completely
•Diagnosis – acute muscle spasm
Site & radiation of back pain
Site: localised or diffuse
Radiation:
- referred pain from MSK, visceral
- radicular pain from nerve root irritation
Aetiology of peripheral (appendicular) joint osteoarthritis
genetic determinants plus environmental factors such as trauma and obesity
Aetiology of “Degenerative” back conditions
start with traumatic disc pathology (vulnerability of discs to be damaged is also associated with genetics, but different determinants) with vertebral changes developing thereafter
