Back And Neck Pain Flashcards
(108 cards)
1
Q
Back symptoms are the most common cause of disability in those ____ years old
A
2
Q
___% of persons will have back pain at some point in their lives
A
70%
3
Q
Tough cartilaginous ring that surrounds central gelatinous nucleus pulposus which composes the intervertebral disks
A
Annulus fibrosis
4
Q
Intervertebral Disk are responsible for ___% of spinal length and allow the bony vertebrae to move easily upon each other
A
25%
5
Q
Intervertebral disk are made of
A
Nucleus pulposus surrounded by a tough cartilaginous ring , the annulus fibrosis
6
Q
Where the disks are largest and movement is greatest
A
Cervical and lumbar regions
7
Q
Absorbs the shock of the bodily movements such as walking and running
A
Anterior spine
8
Q
- Protects the spinal cord and nerve roots in the spinal canal
- consists of vertebral arches and processes
A
Posterior spine
9
Q
Pain sensitive structure of the spine
A
- Periosteum of the vertebrae
- Dura
- Facet joints
- annulus fibrosus of the intervertebral disks
- Epidural veins and arteries
- Longitudinal ligaments
10
Q
Most frequent causes of back pain
A
RADICULOPATHY Fracture Tumor Infection Referred pain from visceral structures
11
Q
Is a common cause of neck, arm, low back, buttocks and leg pain
A
Nerve root injury (RADICULOPATHY )
12
Q
Caused by injury to pain sensitive structures that compress or irritate sensory nerve endings
The site of pain is near the affected part of the back
A
Local pain
13
Q
Pain that may arise from the abdominal or pelvis visceral primarily accompanied by back pain and usually
UNAFFECTED BY POSTURE
A
Pain referred to the back
14
Q
Pain may be located in the back or referred to the buttocks or legs
A
Pain of spine origin
15
Q
Pain tend to refer pain to the lumbar region, groin or anterior thighs
A
Diseases affecting the upper lumbar spine
16
Q
Diseases that tend to produce pain referred to the buttocks, posterior thighs, calves or feet.
A
Diseases affecting the lower lumbar region
17
Q
Pain that is typically sharp and radiates from the low back to a leg within the territory of a nerve root
A
RADICULAR PAIN
18
Q
In radicular pain, pain may increase in postures that stretch out nerves and nerve roots. Sitting with the legs outstretched places traction on the _____ and ____ because the nerve passes to the _____
A
- Sciatic nerve, L5 and S1 roots
2. Posterior to the hip
19
Q
Burning or electric quality of pain favors:
Referred pain or Radiculopathy
A
RADICULOPATHY
20
Q
Diseases that have referred back pain upon palpating of the abdomen
A
Pancreatitis and abdominal aorta aneurysm
21
Q
An electrical shock down the spine with neck flexion, suggesting involvement of the spinal cord
A
LHERMITTE’S SIGN
22
Q
Motor vehicle accidents, violent crimes or falls account for ___% of cervical spinal cord injuries
A
87%
23
Q
Canadian C spine rule recommends imaging following neck trauma to patients who are
A
> 65 years old
Limb paresthesia
Dangerous mechanism for injury ( diving accident, bicycle collision with tree or parked car, fall from height >3ft or five stairs)
24
Q
Diagnostic procedure of choice for detection of acute fractures following severe trauma in cervical spine
A
CT SCAN
25
Preferred diagnostics when traumatic injury to the vertebral arteries or cervical spinal cord is suspected
MRI with magnetic resonance angiography
26
Rapid flexion and extension of the neck usually during automobile accidents
Whiplash injury
27
___% of persons reporting whiplash injury acutely have persistent neck pain 1 year later
50%
28
Imaging of the cervical spine is useful when symptoms persist for
> 6 weeks following the injury
29
Extension and lateral rotation of the neck narrow the ipsilateral intervertebral foramen and may produce radicular symptoms
SPURLING'S Sign
30
Herniated cervical disks are responsible for __% of cervical radiculopaties
25%
31
May produce neck pain that radiates into the back of the head, shoulders or arms or maybe source of headaches in the posterior occipital region supplied by C2-C4 nerve roots
Osteoarthritis of the cervical spine / cervical spondylosis
32
In cervical spondylosis, _____ is the study of choice to define anatomical abnormalities of soft tissues in the cervical regions including the spinal cord.
MRI
But CT SCAN is adequate to assess bony Spurs, foraminal narrowing, lateral recess stenosis or OPLL.
33
Synovitis of the atlantoaxial joint c1 and c2, may damage the transverse ligaments of the atlas, producing forward displacement of the atlas on the axis
Atlantoaxial subluxation
34
Radiological evidence of atlantoaxial subluxation occurs in ___% of RA patients
30%
35
Rheumatoid arthritis in atlantoaxial subluxation
| imaging modality of choice
MRI
36
Neck pain and less commonly atlantoaxial subluxation
Ankylosing spondylosis
37
Presents as acute posterior occipital or neck pain prior to outbreak of vesicles
Acute herpes zoster
38
Neck pain referred from the heart with coronary artery ischemia
CERVICAL ANGINA SYNDROME
39
Thoracic outlet contains:
```
Fist rib
The subclavian artery and vein
Brachial plexus
The clavicle
Lung apex
```
40
Is an uncommon disorder resulting from compression of the lower trunk of the brachial plexus or ventral rami of them C8 or T1 nerve roots
True neurogenic thoracic outlet syndromes ( TOS)
41
Cause most often by an anomalous band of tissue connecting an elongate transverse process at c7 with the first rib
True neurogenic thoracic outlet syndromes ( TOS)
42
Signs include weakness and wasting of the intrinsic muscle of the hand and diminished sensation on the palmar aspect of the fifth digit
True neurogenic thoracic outlet syndromes ( TOS)
43
Absence of ankle reflexes can be a normal finding in persons older than age ___ years
60 years or a sign of bilateral S1 radiculopathy
44
The correlation between ct and emg for localization of nerve root injury is between
65-73%
45
_____ of asymptomatic patients have a lumbar disk protrusion detected by CT AND MRI scans
1/3
46
Signifies injury of multiple lumbosacral nerve roots within the spinal canal distal to the termination of the spinal cord at L1-L2
Cauda equina syndrome
47
Low back pain, weakness and are flexor I the legs, saddle anesthesia or loss of bladder function
Cauda equina syndrome
48
Due to a ruptured lumbosacral interventebral disk, lumbosacral spine fracture, hematoma within the spinal canal, compressive tumor or other mass lesions
Cauda equina syndrome
49
Narrowed lumbar spinal canal and is frequently ASYMPTOMATIC
Lumbar spinal stenosis
50
___% of acquired Lumbar spinal stenosis
75%
51
Congenital forms of LSS characterized by short and thick pedicels that produce both spinal canal and lateral recess stenosis
Achondroplasia and idiopathic
52
Also known as osteoarthritis spine disease, which typically occurs in later life and primarily involves the cervical and lumbosacral spine
SPONDYLOSIS
53
Patients often complains of back pain that increases with movement and is associated with stiffness and is better when inactive
Spondylosis
54
The anterior slippage of the vertebral body, pedicles and superior articular facets, leaving the posterior elements behind
Spondylolithesis
55
Most frequent nerve root injury in Spondylolithesis
L5 root
56
In Spondylolithesis, tenderness may be elicited near the segment that has "slipped" forward
(most often L4 on L5 or occasionally L5 on S1)
57
Most common neurologic symptom in patients with systemic cancer and is the presenting symptom in ___%
Back pain 20% in cancers
58
When is surgery considered for Spondylolithesis
Pain symptoms that do not respond o conservative mgt
In cases of progressive neurologic deficit
Postural deformity
Slippage 50%
Scoliosis
59
Most common cause of back pain in cancer
Vertebral body metastases
60
Cancer related back pain tends to be
Constant
Dull
Unrelieved by rest
Worse at night
61
Once metastasis is found , ____ of patients usually reveals additional tumors
1/3
62
Preferred for soft tissue modalities in cancer patients
MRI but most rapidly availed imaging modality is best because early diagnosis is crucial
63
Back pain unrelieved by rest, spine tenderness over involved area, elevated ESR
Vertebral osteomyelitis
64
Most common cause of vertebral osteomyelitis
Staphylococci
Others: Tuberculosis (Potts disease)
Urinary tract, skin and lungs
65
When intervertebral disk is affected by infection
Diskitis
66
Presents with back pain, aggravated by movement or palpation, fever, radiculopathy, or signs of spinal cord compression.
Best delineated by MRI
Spinal epidural abcess
67
Due to fibrosis following inflammation within the subarachnoid space and due to nerve root adhesions and presents with back and leg pain associated with focal motor, sensory or reflex changes.
Lumbar adhesive arachnoiditis
68
Lumbar adhesive arachnoiditis MRI RESULTS
MRI shows clumped nerve roots or loculations of CSF within the thecal sac
69
Self limited injury associated with lifting heavy object, a fall or a sudden deceleration. Confined to lower back without radiation to buttocks or legs.
SPAINS AND STRAINS
70
Most traumatic fractures of the lumbar vertebral bodies result from the injuries producing ____
*burst fracture
Anterior wedging or compression
71
____ of compression fractures seen in radiology are asymptomatic
Two thirds 2/3
72
Most common non traumatic vertebral body fractures are due to
postmenopausal or senile osteoporosis
73
___% risk of additional vertebral fracture at 1 year following fist vertebral fracture is
20%
74
Abnormally increased bone density often due to Paget's disease is readily identifiable on routine X-ray and assoc with increase ALKALINE PHOSPHATASE in an otherwise healthy older person.
OSTEOSCLEROSIS
75
Shown to reduce the incidence or risk of osteoporotic fractures and are the preferred treatment to prevent additional fractures
ANTIRESORPTIVE DRUGS
esp BIPHOSPHONATES
example ALENDRONATE)
76
Urgent SURGERY is recommended for px with
CES or spinal cord compression
77
CES or spinal cord compression symptoms
Bowel or bladder dysfunction
Diminished sensation in a saddle distribution
Sensory level on the trunk
Bilateral weakness and spasticity
78
Most common reason for recommending surgery
SCIATICA
79
Is a bony defect in the vertebral pars interarticularis caused by a stress microfracture in a congenital abnormal segment
SPONDYLOLYSIS
80
Most common cause of persistent low back pain in adolescents and often associated with sports related activities
Occurs up to ____% in adolescents
SPONDYLOLYSIS 6%
81
Refers to the abnormal curvature in the coronal (lateral) plane of the spine
Scoliosis
82
Scoliosis plus an additional forward curvature of the spine
Kyphoscoliosis
83
A failure of closure of one or several vertebral arches posteriorly
Spina bifida occulta
84
* Progressive cauda equina disorder
* Myelopathy may be the initial manifestation
* often in a young adult who complains of perineal or perianal pain
Tethered cord syndrome
85
In Tethered cord syndrome, MRI studies reveals
* Low lying conus below L1 and L2
| * Short and thickened filum terminale
86
The sudden appearance of lumbar pain in a patient receiving anticoagulants suggests
Retroperitoneal HEMORRRHAGE
87
Classic clinical train of abdominal pain, shock and back pain occurs in ___% of AAA
20%
88
In AAA, abdominal Examination Reveals a pulsating mass ___%
50-75%
89
Upper abdominal diseases
T8 to L1-L2
90
Lower abdominal diseases
L2-L4
91
ALBP risk factors history
```
Pain worse at rest or at night
Prior history of cancer
History of chronic infection
History of trauma
Incontinence
Age>70 years
IV DRUG Use
Glucocorticoid use
History of rapidly progressive neurological deficit
```
92
Acute lumbar back pain of ____________
___% expect full recovery with ALBP w/o leg pain
2/3 improved after___ weeks
93
First line treatment options for ALBP
Acetaminophen and NSAIDs
94
Chronic LBP defined as pain lasting for _____
| Accounts for ___% of total back pain cost
>12 weeks
| 50%
95
Mainstay treatment of CLBP
Exercise therapy
96
Medication for CLBP
Acetaminophen
NSAIDs
Tricyclic antidepressants
97
Osteoarthritis of the cervical spine that may produce neck pain that radiates into the back of the head, shoulders or arms,
May be the source of headache in the posterior occipital region
Supplied by c2-c4 nerve roots
Cervical spondylosis
98
Roots most commonly affected in cervical spondylosis
C7 and C6
99
Coffin the diagnosis of TOS
EMG and nerve conduction studies
100
Compression of the subclavian artery by a cervical rib
Arterial Thoracic outlet syndrome
101
BP IS REDUCED ON THE AFFECTED LIMB
Arterial Thoracic outlet syndrome
102
Confirms the diagnosis of Arterial Thoracic outlet syndrome
Ultrasound
103
Treatment of Arterial Thoracic outlet syndrome
Thrombolysis or anticoagulation (non-invasive)
| And surgical excision of the cervical rib compressing the the subclavian artery
104
Due to subclavian vein thrombosis resulting in the swelling of the arm and pain
VENOGRAPHY diagnostic test of choice
VENOUS TOS
105
Disputed TOS ___%
95%
106
In disputed TOS most prominent pain
Chronic arm and shoulder pain
107
Severe shoulder pain, wasting and weakness of the supraspinatus and infraspinatus muscles
Supra scapular neuropathy
108
Acute onset of severe shoulder pain or scapular pain followed typically by weakness of proximal arm and shoulder girdle muscles
Acute brachial neuritis
