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MSK Orthopaedics list > Cspine > Flashcards

Cspine Flashcards

1
Q

Cervical strain definition

A

whiplash, causes Muscular + ligamentous structures of the cervical spine to be stretched beyond physiologic capacity

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2
Q

Causes

A

sudden hyperextension followed by hyper-flexion of the neck.
Commonly from Rear end automobile collisions or Sports trauma

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3
Q

Clinical presentation

A

Neck pain
Persistent stiffness
Trapezial/upper back pain
Muscle spasm
Headaches
Limited ROM
Must be aware to the discomfort it causes patients, however it usually has a benign course + minimal long term sequelae (an aftereffect of an injury)

Our job to rule out morbid conditions, e.g. bony fracture from the large majority of cervical strains. Must be able to identify Ps with bone and neurologic pathology such as fractures, dislocations and spinal cord injuries that mimic the condition of a cervical strain

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4
Q

Prognosis

A

In at least 40% of people, there should be some resolution of symptoms by 6 weeks, and by 12 weeks, there should be complete resolution in at least 40% of people.
Approximately 50% of people fully recover within 1 year of WAD.

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5
Q

Degeneration definition

A

Spontaneous degeneration of either disc or facet joints

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6
Q

Causes

A

Accumulated wear and tear that occurs over a long period of time

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7
Q

Age groups affected

A

Elderly
By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels.
By the age of 60, more than 90% of people will show evidence of some disc degeneration

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8
Q

Risk factors

A
  • Ageing
  • Tough manual labour jobs
  • Vigorous sports e.g. rugby
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9
Q

Clinical presentation

A

Neck pain
Stiffness
Decreased ROM
Numbness, tingling, or even weakness in the neck, arms and shoulders are additional symptoms due to nerves in the cervical area becoming irritated or pinched
Ps should be asked to perform flexion, extension and rotational movements and report whether neck pain increases or decreases.

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10
Q

Prognosis

A

Symptoms worsen if left untreated
Treatment centred around reliving pain, wont fully treat/relive symptoms

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11
Q

Herniation definition

A

When the outer part (annulus fibrosus) gets tears or splits, the gel (nucleus pulposus) can poke out. This is what it means for a disk to become herniated. (think jam donut)

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12
Q

Causes

A

Traumatic events, some spontaneous cases
Most occur between C5 and T1

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13
Q

Age groups

A

More common in elderly due to wear and tear & less water in discs

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14
Q

Risk factors

A

Age
Lack of regular exercise
Tobacco use
Poor posture (i.e., incorrect lifting or twisting causing additional stress on the cervical spine)
Injury.

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15
Q

Clinical presentation

A

Frequent headaches
Limited ROM
Pain that originates around the paraspinal muscles radiates down one of the upper extremities
Paraspinal muscles may go into spasm, causing discomfort on palpation
Finger numbness and tingling
Can cause spinal cord compression, where disc material pushes directly on spinal cord

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16
Q

Prognosis

A

Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don’t respond to conservative treatment or your symptoms get worse, surgery may be recommended.

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17
Q

Stenosis definiton

A

A condition in which the spinal canal is too small for the spinal cord and nerve roots. This can cause damage to the spinal cord.

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18
Q

Causes

A

Bone spurs.
Herniated disks.
Thick ligaments - can become stiff and thick over time. Thick ligaments can push into the spinal canal.
Tumors - Rarely, tumors can form inside the spinal canal.
Spinal injuries.

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19
Q

Age groups

A

Most people with spinal stenosis are over age 50

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20
Q

Risk factors

A

Scoliosis or other spinal problems.

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21
Q

Clinical presentation

A

Numbness
Tingling or weakness in a hand, leg, foot or arm
Neck pain
Common to present vague neurological symptoms -
Problems with walking and balance
Bowl and bladder inconsistence
Ps expected to have hyperreflexia in the in their upper and lower extremities

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22
Q

Prognosis

A

Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery.

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23
Q

Cervical facet syndrome

A

A type of osteoarthritis that occurs when the structure of one or more of the vertebral facet joints begins to deteriorate

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24
Q

Causes

A

Disk degeneration and disk narrowing increase facet joint loading and consequently facet osteoarthritis

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25
Q

Age groups

A

50 and above

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26
Q

risk factors

A
  • Genetic disposition
  • Smoking
  • Either sedentary jobs at a computer or high levels of repeated muscle tension
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27
Q

Clinical presentation

A
  • Unilateral pain without radiation to the arm
  • Rotation and retroflexion are frequently painful or limited
  • Pain with pressure on the dorsal side of the spinal column at the level of the facet joints
  • Pain and limitation of extension
  • Absence of neurological symptoms
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28
Q

Prognosis

A

Can get better through manipulation and mobilisation

29
Q

Cervical Artery Dysfunction

A

Umbrella term for rare vascular problems of the neck, can involve the internal carotid and/or vertebral arteries.

30
Q

Age group

A

Internal most common 35-55
External 55 and above

31
Q

Causes

A

Acute injury or linked to other conditions.
Hyoid bone has also been described as a potential mechanical compressor of the internal carotid artery

32
Q

Risk factors

A

Whiplash in case history
Smoking habits, poor lifestyle such as diet/nutrition, overweight, previous stroke and vascular presentations like hypertension

33
Q

Clinical presentation

A

Neck and head pain.
Headaches.
Dizziness.
Blurred vision.
Balance disturbance.
Speech or swallowing issues.
Increase in blood pressure.
Facial numbness.
Nystagmus (involuntary eye movements).
Feeling sick or faint.
Loss of taste.

34
Q

Prognosis

A

Not fully curable but symptoms can be minimised

35
Q

Trigger points

A

Hyperrritable spot, a palpable nodule in the taut bands of the skeletal muscles’ fascia.
Direct compression or muscle contraction can elicit jump sign, local tenderness, local twitch response and referred pain which usually responds with a pain pattern distant from the spot

36
Q

Causes

A
  • Acute trauma or repetitive micro trauma, leading to developmental stress on muscle fibres
  • Lack of exercise
  • Acute sports injuries
37
Q

Age groups

A

Common in men between 30 and 55 with lack of exercise

38
Q

Risk factors

A

Occupational or recreational activities that produce repetitive stress on a specific muscle/group commonly cause chronic pain leading to trigger points
Prolonged poor posture
Joint problems

39
Q

Clinical presentation

A

Regional persistent pain, decreased ROM
Muscles used to maintain body posture, neck, shoulders and pelvic floor muscles
Tension headaches, tinnitus
Muscle weakness or imbalance
Painful movement and/or movement that sometimes can exacerbate symptoms.
Postural abnormalities and compensations.

40
Q

Prognosis

A

Can loosen through treatment

41
Q

Acute disc prolapse

A

Slipped disc pressing on a nerve root

42
Q

Causes

A

Sudden unguarded flexion and rotation
Predisposed abnormality of disc with increased nuclear tension

43
Q

Age groups

A

30-50

44
Q

Risk factors

A

Genetics, smoking, ageing, improper lifting

45
Q

clinical presentation

A
  • Pain and stiffness in the neck
  • Pain radiating to scapular region and occiput
  • Pain and paraesthesia in one lower limb, radiating to the outer elbow, back of wrist, index and middle fingers
  • Neck may be tilted forwards and sideways
  • Muscles tender and movements restricted
  • Arm can be examined for signs of nerve root irritation or compression
46
Q

Prognosis

A

Can improve through treatment

47
Q

Pyogenic infection

A

local inflammation of skin, soft tissue and bodily parts which are mainly caused by invasion and multiplication of pathogenic microorganism

48
Q

Causes

A

Pathogen, usually staphylococcus, reaches the spine via the blood stream.
Initially destructive changes are limited to the intervertebral disc space and the adjacent parts of vertebral bodies
Later, abscess formation occurs and pus may extend into spinal canal or soft tissue planes of the neck

49
Q

Age

A

Can affect any age

50
Q

Risk factors

A
51
Q

Clinical presentation

A
  • Pain in the neck, often associated with muscles spasm and stiffness
  • Severely limited neck ROM
  • Blood tests may show a leucocytosis and an elevated erythrocyte sedimentation rate
52
Q

Prognosis

A

Antibiotic treatment works best in the early stage
Rest

53
Q

Tuberculosis

A

spinal infection caused by tuberculosis

54
Q

Causes

A
  • Blood borne infection that localises in the intervertebral disc and the anterior parts of the adjacent vertebral bodies
  • As bone crumbles the Cspine collapses into kyphosis
  • Retropharyngeal abscess forms and points behind sternomastoid muscle at the side of the neck
55
Q

Age

A

Usually children

56
Q

Risk factors

A
57
Q

Clinical presentation

A
  • Neck pain and stiffness
  • Retropharyngeal abscess (in neglected cases) causes difficulty swallowing. Shows as swelling in posterior triangle of neck
  • Neck extremely tender, all movements limited
  • In late cases there may be obvious kyphosis
  • X-rays show narrowing of disc space and erosion of adjacent vertebral bodies
58
Q

Prognosis

A

Immobilisation of the neck in a brace for 6-18 months and antituberculosis drugs

59
Q

Rheumatoid arthritis

A

Long-term condition that causes pain, swelling and stiffness in the joints. The condition usually affects the hands, feet and wrists.

60
Q

Age

A

Mainly women, elderly

61
Q

Risk factors

A

Family history.
Smoking. C
Excess weight.

62
Q

Clinical presentation

A

Neck pain and noticeable restriction
Tender, warm, swollen joints
Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and loss of appetite
Lower limb weakness due to cord compression in extreme cases

63
Q

Prognosis

A

No cure for rheumatoid arthritis, early treatment and support (including medicine, lifestyle changes, supportive treatments and surgery) can reduce the risk of joint damage and limit the impact of the condition.

64
Q

Ankylosing Spondylitis

A

inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse.

65
Q

Causes

A

No known specific cause, though genetic factors seem to be involved.

66
Q

Age

A
  • Teenagers and young adults
  • 2x more common in men
67
Q

Risk factors

A

Gut inflammation, suggesting a potential origin in the gut. It’s thought disruption to the microbiome in your gut may play a role in its development.
Smoking.

68
Q

Clinical presentation

A

Neck pain and stiffness, some years after onset of backache
Neck gradually becomes rigid and kyphotic, some movement preserved at atlantooccipital and atlantoaxial joints
Pain that’s worse in the morning or after sitting for a long time
A rigid spine that curves forward
Tiredness
Swelling in your joints
Trouble taking deep breaths

69
Q

Prognosis

A

No treatment can only manage symptoms

MSK Orthopaedics list (11 decks)

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