Ankylosing Spondylitis

Question 1

Ank Spondylitis

Answer 1

Ankylos- stiffening
Spond- vertabra
Itis- inflammation

Autoimmune disease, genetic, by a environmental trigger

Question 2

Epidemiology

Answer 2

Young males (15-30)

Question 3

Onset

Answer 3

Incidious- low back and stiffness in SI first then low back
Pain is inflammatory, nocturnal

Can be mild to severe, and symptoms exacerbate and remission

Question 4

S&S

Answer 4

LBP, glute pain and stiffness
Loss of ROM (Shoulder mobility because of Tx stiffness blocking the scapular mvmt)
Postural abnormalities
Tenderness over sites of enthesitis (inflammation of muscle insertion)

Question 5

Postural changes in advance disease

Answer 5

Increased Tx Kyphosis
Decreased Lordosis
Eye upward gaze due to cervical spine flexion deformity
Fixed thoracic cage (acts like a restrictive disease)
Hip and knee flexion to maintain upright posture may lead to contractures

Question 6

Most common sites of enthesitis

Answer 6

Plantar fascia and Achilles

Question 7

Systemic S&S

Answer 7

Fatigue
Eye involvement (anterior uveitis/iritis inflammation of the eye)
Cardiovascular
Pulmonary

Question 8

S&S Systmein

Answer 8

Fatigue
Eye inflammation
Cardiovascular- electrical irregularities, slows HR
Pulmonary- Riggid Tx

Question 9

Radiographic Findings

Answer 9

Sacroiliitis
SIJ thin or not visible
Syndesmophytes (“Bamboo” spine, “Railroad track” Spine)
Thoracic Kyohosis
Enthesitis (Plantar fascia, ITB, Achilles)
Arthritis (hip arthritis)

Question 10

Subjective Ax

Answer 10

Risk factors (age, sex, family history)
Symptoms (stiffness, pain)

Question 11

Observation Ax

Answer 11

Observation (posture)
Spinal ROM
Peripheral ROM (shoulder, hip etc)
Chest Expansion measurements
Special tests
palpation
BASMI

Question 12

Bath ankylosing spondylitis metrology index (BASMI)

Answer 12

1) cervical rotation
2) tragic to wall
3) Modified Schober
4) finger to floor lateral flexion
5) intermalleolar distance

Chest expansion

Question 13

Modified New York Criteria

Answer 13

Clinical criteria
- LBP > 3mnths, improved with exercise not relieved by rest
- limitation of lumbar spine motion in both frontal and sagittal planes
- limitation of chest expansion

Question 14

rehab management

Answer 14

Education, cryotherapy, thermotherapy, massage, EPA
ROM (AVOID FLEXION)
Postural cues
Adaptive environment and assistive devices (blind spot mirrors due to Cx limitation)

Question 15

Cardioresp interventions

Answer 15

Aerobic
Deep breathing
Thoracic ROM
Energy conservation