Back and Neck Disorders Stowell Flashcards Preview

Clin Med II MHM - FINAL > Back and Neck Disorders Stowell > Flashcards

Flashcards in Back and Neck Disorders Stowell Deck (81):
1

What is the MC cause of work disability?

Low back pain

2

Cause of low back pain

Unable to determine in most cases

3

70-90% of low back pain cases are:

Nonspecific (aka mechanical)

4

Majority of low back pain cases resolve within:

4-12 wks

5

Various causes of low back pain

-Non specific (70%)
-Ortho pathology (25%)

6

Inflammatory arthritis causing low back pain is often a/w:

HLA-B27

7

What are examples of orthopedic pathology that can cause low back pain?

-Degenerative changes (OA)
-Disc herniation
-Compression fracture
-Spinal stenosis
-Trauma (fracture)

8

What clinical factors increase probability of neoplasm causing low back pain?

1. Previous history of non-skin cancer
2. Age over 50
3. Unexplained wt loss
4. Failure of conservative tx for LBP

9

Etiologies of infection causing low back pain?

-Post-traumatic
-Vascular insufficiency (DM)
-Hematogenous seeding (S aureus)

10

What clinical features suggest ankylosing spondylitis?

-Age less than 40
-Morning stiffness
-Duration more than 3 months
-Symptoms improve w/easy exercise
-Not relieved w/rest

11

What PE findings can be found with ankylosing spondylitis?

-Sacroiliac tenderness
-Limited chest expansion
-Limited lumbar ROM

12

Imaging findings of ankylosing spondylitis

-Grading of sacroilitis
-Bamboo sign (fusing of vertebral bodies)

13

Describe the HLA-B27 gene and its relation to AS

-Normal finding in 8% of Caucasians
-Only 2% of people w/the gene will develop AS
-So it is NOT diagnostic for AS
-Can be a finding though

14

What abnormal lab is found in 70% of patients with AS?

Elevated ESR

15

What is cauda equina syndrome (CES)?

-Compression of lower spinal nerve roots
-Impairs motor and sensory function to lower extremities and bladder
-MEDICAL EMERGENCY

16

What is the MC finding a/w CES?

Urinary retention

17

What is saddle anesthesia and what is it a/w?

-Unable to feel anything in body areas that sit on a saddle
-A/w CES

18

Define degenerative joint disease (DJD)

Term used interchangeably with osteoarthritis (OA)

19

Define degenerative disc disease

-Degenerative changes of disc
-Fissures develop
-Reduced ability to maintain fluid flow (loss of disc height)
-Can be a source of chronic LBP

20

Define ankylosis

-Joint stiffness d/t disease or surgery
-Union of proximal/distal bones of joint

21

Describe osteoarthritis

Gradual progression of disc degeneration and articular cartilage mechanical breakdown

22

What dynamic is altered in OA?

Cartilage/disc fluid (decreased ability to absorb/distribute mechanical stress)

23

What joint alterations occur with OA?

-Osteophytes (bone spurs)
-Spondylosis
-Spondylolisthesis
-Stenosis
-Decreased disc height

24

Why/how do osteophytes (bone spurs) form in OA?

-Secondary to facet joint dysfunction
-Body's way of trying to splint or limit use of joint
-Joints above and below will suffer additional/abnormal mechanical forces

25

Clinical features of OA

-Age over 50
-Gradual onset
-Worse in AM or after prolonged rest
-Relieved w/light activity

26

MOI for OA

-Prolonged postural activity (painting, gardening)
-Weekend warrior
-Grandparenting syndrome
*Usually not acute trauma

27

What is the common ROM pattern with OA?

-Extension (side bending) feels worse
-Flexion feels better

28

What imaging confirms OA?

Plain film x-ray (AP and lat)

29

How do labs present in OA?

Normal

30

What is a disc bulge?

-Herniated nucleus pulposa (HNP)
-May or may not compress/stretch a nerve root (asymp or symptomatic)

31

Define discogenic pain

Nociceptors in disc generate pain to back/LE

32

If a disc bulge compresses the nerve root, what is produced?

LE radiculopathy

33

Define radiculopathy

Spinal nerve root impingement d/t space occupying lesion in vertebral canal or IVF

34

MC lumbar radiculopathy

L5 and S1 followed by L4

35

Possible causes of radiculopathy

-Herniated nucleus pulposa
-OA
-Spondylolisthesis (severe)
-Lumbar spinal stenosis

36

Disc herniation w/radiculopathy ROM pattern

Flexion makes it worse (provokes radicular symptoms)

37

OA vs. disc herniation w/radiculopathy ROM patterns

-Flexion feels better in OA
-Flexion feels worse in radiculopathy

38

Motor and reflex findings of disc herniation w/radiculopathy

-Motor: weakness of myotome of involved nerve root
-Reflex: diminished DTR of involved nerve root

39

2 common neural tension tests to assess radicular symptoms

-Straight leg raise (supine)
-Slump test (sitting)

40

Imaging for diagnosis of disc herniation w/radiculopathy

Not indicated! Unless red flags or need to rule in or out other

41

Non-surgical management of disc herniation w/radiculopathy

-OTC pain meds (often not good enough)
-Steroid taper
-Epidural steroid injections
-McKenzie Method (centralization technique by PTs and chiropractors)
-Patient education for coping

42

Surgical management of disc herniation w/radiculopathy

-Micro-discectomy
-Discectomy

43

Pros of surgical management of disc herniation w/radiculopathy

-Pts w/dominant leg pain can have excellent results
-85-90% return to full function

44

Cons of surgical management of disc herniation w/radiculopathy

Up to 15% of patients have continued back pain that may limit their return to full function

45

Define spinal stenosis

Narrowing of vertebral canal and/or IVF

46

Causes of spinal stenosis

-Disc, tumor, cyst
-Congenital narrowing
-OA

47

How does spinal stenosis present?

-Age over 55-60 yrs
-Radiating leg pain that gets worse with downhill walking (extension worsens it)
-LE symptoms consistent w/neurogenic claudication (relieved forward flexion)
-May or may not have back pain

48

Surgical treatment of spinal stenosis

-X stop implant
-Laminectomy (decompress the nerves)
-Fusion (if unstable segments)

49

Describe X stop implant

-Spinal stenosis surgery
-Titanium wedge inserted b/w spinous processes
-Outpatient procedure
-Permanent but does not attach to bone or ligaments

50

Define spondylolysis

Defect in pars interarticularis of a vertebra

51

Define spondylolisthesis

-Defect in pars interarticularis of a vertebra
-WITH anterior displacement of the vertebra

52

Define spondylosis

Stiffening or fusing of joint (often from degenerative changes)

53

Classifications of spondylolisthesis

Type 1: congenital
Type 2: isthmic (classic presentation of adolescent patient)
Type 3: degenerative
Type 4: traumatic
Type 5: pathologic

54

Who are those affected by spondylolisthesis?

-Adolescents
-Athletes in extension type sport (football, gymnastics, figure skating)

55

When do symptoms usually develop in spondylolisthesis?

Usually around a growth spurt

56

How does spondylolisthesis present clincially?

-Extension is worse
-Straight leg raise positive

57

Diagnosis of spondylolisthesis

-Need to order plain film oblique view!
-Scotty dog defect

58

Treatment of spondylolisthesis

-Rest and remove provoking activity
-Pain management
-Bracing only if severe
-Protocols for return to sport

59

Grading of spondylolisthesis

1 = 0-25%
2 = 25-50%
3 = 50-75%
4 = 75-100%
5 = 100+%

60

Define scoliosis

Lateral curve of the spine (at least 10 degrees) with a rotational deformity

61

What is the MC spinal deformity?

Scoliosis

62

Define structural scoliosis

-Bony deformity
-Curve NOT reducible w/flexion or lateral flexion

63

Define non-strucutral scoliosis

-Fixed (curve NOT reducible)
-Non-fixed (curve reducible w/flexion or lat flexion)

64

Define functional scoliosis

-Flexible
-Curve able to be reduced partially or completely w/flexion or lateral flexion

65

Types of scoliosis

-Structural
-Non-structural
-Functional

66

Causes of scoliosis

-Idiopathic
-Congenital
-Neurouscular
-Misc (tumor, abscess)

67

Types of idiopathic scoliosis

-Infantile (under 3 yo, majority resolve spontaneously)
-Juvenile (3-9 yo, high rate of progression and lead to severe deformity)
-Adolescent (80-90% of idiopathic cases, onset at puberty)

68

Describe adolescent idiopathic scoliosis

-Puberty (10-13 yo)
-Female 3.6 to male 1

69

Diagnosis of scoliosis

-Postural screen (look from posterior and lateral)
-Forward flexion test (look for rib hump)

70

Treatment of scoliosis curves greater than 20-25 degrees

May need bracing and exercise

71

Treatment of scoliosis curves greater than 45 degrees

Cannot be effectively braced

72

Treatment of scoliosis curves greater than 45-50 degrees

May need surgery

73

How often do we monitor younger patients w/scoliosis?

Every 4-6 months

74

Describe bracing in scoliosis

-Goal is to stop worsening curve
-Wear 23 hours a day (some just at night)
-May have to wear months to years

75

How does cervical myelopathy present?

Hyperreflexia of DTRs
Hoffman's sign (finger flexor reflex)

76

Most cervical spine fractures occur where?

C2 or C6-7

77

Most fatal cervical spine injuries occur where?

C1-C2

78

Jefferson fracture and types

C1 fracture
-Posterior arch (MC)
-Burst

79

Hangman's fracture

Pedicle of C2 resulting from hyperextension injury

80

Cervical compression fracture types

I: simple wedge fx
II: teardrop
III: comminuted burst body fx
IV and V: complex involving posterior elements

81

MC locations of cervical disc herniation w/radiculopathy

-C7 (60%)
-C6 (25%)