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Injuries in Sport > Spine > Flashcards

Spine Flashcards

1
Q

Function of the spine

A

Protects the cord and nerves
Posture and locomotion
Supports BW above pelvis
Partial rigidity for head to pivot on

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2
Q

Back pain impact

A

8/10 affected
leads to most sick days
2nd most common reason for primary care visit
high cost to NHS

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3
Q

What are the pain producing structures

A

Nucleus pulposus, Annulus fibroses, Facet joints and Synovium of facet capsule, Ligaments, Muscles, Nerves, Meninges

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4
Q

Red flags for neck and back pain

A

> 50/ <20 yo
fever and night sweats
travel/ TB contacts
immune suppression
IVDU
Recent bact infection or surgical procedure
Morning stiffness
Saddle anaesthesia/ bladder/ bowel [cauda equina]
Sexual dysfunction, disturbed gait, progressive neuro deficits
Uncontrolled pain
Thoracic pain

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5
Q

Yellow flags for neck and back pain

A

Negative attitude, depression, social withdrawal
Fear avoidance and reduced activity levels
Belief that passive rather than active treatment will be beneficial
social/ financial problems

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6
Q

Masquaraders of neck and back pain

A

AAA, Renal (e.g. pyelonephritis)

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7
Q

NICE Guidelines (2018) Treatment for back pain

A

STaRT Back Screening Tool

Self-management advice

  • Daily activity
  • Cold/heat therapy
  • psychological support

Medication

  • NSAIDS (not paracetamol alone)
  • Codeine as weak opioid
  • Diazepam for muscle spams (Short course)
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8
Q

NICE Guidelines (2018) Treatment for back pain - SCIATICA

A

Neuropathic meds

  • Amitriptyline, Duloxetine, Gabapentin
  • Tramadol –> Acute rescue therapy
  • Capsaicin cream (local)

+ NRB
+ Decompression surgery

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9
Q

Cord Compression

A

Cord, conus, or cauda

Causes:

  • tumour/ lesions
  • trauma
  • spinal stenosis
  • infection/ inflammation
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10
Q

Characteristics of acute cord compression

A 
Above conus/ cauda
UMN signs
back pain > leg
infection and Ca risk
=> Oncological/ orthopaedic emergency
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11
Q

Cauda Equina Syndrome

A 
LBP + unil or bilat radicular pain
saddle anaesthesia/ parasthaesia
bowel dysfunct, loss of anal sphincter tone
perianal/ perineal sensory losss
bladder dysfunction, incontenence
sexual dysfunction
progressive neurological deficit

Mx: Surgical emergency - decompression

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12
Q

Cancer/ Infection

A 
Night pain
systemic Sx, fever, septic
thoracic pain (DDx thoracic aneurysm)
IVDU 
Hx of cancer or recent infection
immunosuppression
postural deformity
point tenderness +/- neurology

Ix - MRI gold standard, plain radiograph to exclude fracture

Mx - Rx cause, Abx, Referral to ortho or oncology

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13
Q

Fracture

A

Severe pain - rest + night

Assess for risk factors e.g. osteoporosis, Ca
Specific sports - rowing => pars stress fracture, synchronised swimmers => sacral stress fracture

Mx - pain control by ortho, surgery if unstable/ deformity/ ongoing pain; vertebroplasty/fusion

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14
Q

Inflammatory causes of back pain

A

Medical acute back pain presenting with morning stiffness (>30min), common in young
insidious onset and chronic
other inflammatory features
Sacroilitis as initial presentation (MRI gold stand)

Ix:

  • FABER (Patrick’s) test - positive with pain at hip, lumbar, sacroiliac joint
  • Palpate SIJ
  • Seronegative + bloods
  • XR/ MRI

Mx: Rheumatology + NSAIDs

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15
Q

Facet Joint Pain

A

Discogenic!
Mostly lumbar +/- nerve root involvement
>35yo (degenerative changes)
Clinical Sx correlate image => adjust treatment

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16
Q

Acute Nerve Root Compression

A

Discogenic pain - due to acute disc prolapse or facet joint osteophyte

Unilateral radicular pain; leg pain > back
tingly/ weakness
aggravated by sneezing, coughing, heavy lifting
numbness, loss of reflexes
worse on flexion (NB facet worse on extension)
limp to contralateral side

O/E - SLR <30 degrees, Slump test positive, Acute muscle spasm on palpation

Mx

  • Paracetamol and NSAIDs
  • Codeine short course
  • Benzos
  • Amitriptyline, gabapentin [neuropathic]
  • PT
17
Q

Facet joint - Chronic

A 
Older people due to degenerative changes
aggravated by extension + lat flexion/ abduction
\+/- nerve root Sx
decreased ROM
Tender to palpation

Ix - MRI gold stand, CT, Bone scan

Mx - Same for arthritis, Facet joint injection (diagnostic and therapeutic)

18
Q

Facet Joint fracture types

A 
1 - Dysplatic/ congenital
2 - Pars defect (lytic)
3 - Degenerative
4 - Traumatic
5 - Pathological secondary to bone disease
19
Q

Pars Interarticularis Stress Fracture

A

Young athletes e.g. fast bowlers
Due to hyperextension and rotation

unilateral LBP
aggravated by movement especially extension
excessive lumbar lordosis and hamstring tightening
palpation unilateral tenderness

Ix

  • Oblique radiograph: ‘scottie dog’ sign
  • SPECT/ BONE SCAN

Mx - Relative rest, analgesia, PT, correction of technique

20
Q

Spondylolisthesis

A

Most common at L5
Due to bilateral pars defect

Traumatic or congenital
LBP +/- leg pain; claudication if central stenosis
palpable dip
compensatory muscle spasm of hamstring
decreased ROM + increased lumbar lordosis
when L5 nerve in lat recess => weak EHL

Ix - Lateral XR; grade slippage (I-IV)

Mx - Relative rest, analgesia, PT, Grade III and IV => AVOID contact sports; If progresses then ortho referral

21
Q

Lumbar Spinal Stenosis

A

Elderly
3 mechanisms of injury: central disc, ligamentum flavum hypertrophy, degenerative facets

LBP
Claudicant (neurogenic) - leans forward to relieve Sx
O/E Neuro - plantars, hoffmans, romberg

Mx - Surgical decompression +/- fusion, injection (for radicular; no epidural)

22
Q

Torticollis (Wry Neck) - 2 types

A

Sudden onset neck pain, deformity, decreased ROM
Acute or chronic
Trauma, subluxed C1/2, drugs, osteomyelitis, retropharyngeal abscess, epiglottitis, epidural abscesses

Ix - XR/CT, bloods, referral

  • Apophyseal*
  • Young adults/ children => assess for trauma
  • Acute
  • C2/3 locking
  • Mx: PT mobilisation and manipulation, analgesia
  • Discogenic*
  • Gradual/ after sleeping
  • Most common
  • C4-7
  • Mx: self-resolve up to 4/52, analgesia, muscle relaxants, PT (NO manipulation)
23
Q

Stingers/ Burners

A

Traction injury of the brachial plexus
Rugby tackle/ front row

Burning transient pain, paraesthesia, weakness
usually C5/6
recurrent

Full neuro exam

Mx - Self-resolved with hrs to days, immobilise if in doubt, no RTP until full resolvement

24
Q

Scheuermann’s

A

Thoracic pain
adolescent males
thoracic kyphosis (e.g. computer games)
multiple end-plate irregularities in >=4 vertebral bodies

25
Q

Masqueraders of thoracic pain

A

chest, cardiac, oesophagus

26
Q

Other causes of back pain

A 
degenerative scoliosis
asolescent idiopathic scoliosis
sacralisation of L5/ Labarisation of S1 (formation of pseudoarthrosis)
Coccygeal pain
Baastrups (kissing spine)

Injuries in Sport (13 decks)

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