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

Back and Neck Disorders Stowell Flashcards

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1
Q

What is the MC cause of work disability?

A

Low back pain

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2
Q

Cause of low back pain

A

Unable to determine in most cases

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3
Q

70-90% of low back pain cases are:

A

Nonspecific (aka mechanical)

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4
Q

Majority of low back pain cases resolve within:

A

4-12 wks

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5
Q

Various causes of low back pain

A
  • Non specific (70%)

- Ortho pathology (25%)

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6
Q

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

A

HLA-B27

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7
Q

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

A
  • Degenerative changes (OA)
  • Disc herniation
  • Compression fracture
  • Spinal stenosis
  • Trauma (fracture)
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8
Q

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

A
  1. Previous history of non-skin cancer
  2. Age over 50
  3. Unexplained wt loss
  4. Failure of conservative tx for LBP
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9
Q

Etiologies of infection causing low back pain?

A
  • Post-traumatic
  • Vascular insufficiency (DM)
  • Hematogenous seeding (S aureus)
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10
Q

What clinical features suggest ankylosing spondylitis?

A
  • Age less than 40
  • Morning stiffness
  • Duration more than 3 months
  • Symptoms improve w/easy exercise
  • Not relieved w/rest
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11
Q

What PE findings can be found with ankylosing spondylitis?

A
  • Sacroiliac tenderness
  • Limited chest expansion
  • Limited lumbar ROM
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12
Q

Imaging findings of ankylosing spondylitis

A
  • Grading of sacroilitis

- Bamboo sign (fusing of vertebral bodies)

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13
Q

Describe the HLA-B27 gene and its relation to AS

A
  • 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
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14
Q

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

A

Elevated ESR

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15
Q

What is cauda equina syndrome (CES)?

A
  • Compression of lower spinal nerve roots
  • Impairs motor and sensory function to lower extremities and bladder
  • MEDICAL EMERGENCY
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16
Q

What is the MC finding a/w CES?

A

Urinary retention

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17
Q

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

A
  • Unable to feel anything in body areas that sit on a saddle

- A/w CES

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18
Q

Define degenerative joint disease (DJD)

A

Term used interchangeably with osteoarthritis (OA)

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19
Q

Define degenerative disc disease

A
  • Degenerative changes of disc
  • Fissures develop
  • Reduced ability to maintain fluid flow (loss of disc height)
  • Can be a source of chronic LBP
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20
Q

Define ankylosis

A
  • Joint stiffness d/t disease or surgery

- Union of proximal/distal bones of joint

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21
Q

Describe osteoarthritis

A

Gradual progression of disc degeneration and articular cartilage mechanical breakdown

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22
Q

What dynamic is altered in OA?

A

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

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23
Q

What joint alterations occur with OA?

A
  • Osteophytes (bone spurs)
  • Spondylosis
  • Spondylolisthesis
  • Stenosis
  • Decreased disc height
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24
Q

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

A
  • 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
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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%)

Clin Med II MHM - FINAL (16 decks)

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