Flashcards in Lecture 3.1 Deck (34):
What are the 2 main types of back pain?
Mechanical pain (muscles prains or disk prolapse)
Compressive pain (compression of a nerve root)
Relative to their vertebrae which disks are the largest disks in the body?
Cervical disks are largest relative to the vertebral bodies
What vertebrae are susceptible to anterior shearing forces?
Cervical and lumbar spine are particularly susceptible to anterior shearing forces
What region of the vertebral column are common sites of damage?
Upper cervical and lumbosacral regions are common sites of damage.
What is the benefit of having bigger disks?
Bigger disk permits greater movement.
What disk is the largest disk of the body (in absolute terms)?
Largest disk is the lumbosacral disk.
What vertebrae permit rotation?
Thoracic vertebrae permit rotation in the coronal plane. This rotation is limited by the ribs.
Cervical vertebrae don't typically permit rotation. But the atlantoaxial vertebrae do.
What are the consequences of hyperflexion of the back?
Hyperflexion stretches sciatic nerve and may cause nerve root pain.
What is the consequence of hyperextension of the back?
Hyperextension increases stress on facet joints and may cause compression at the intervertebral foramen, particularly if there are osteophytes near that region.
What structures in the back can extend?
Extension of the back happens in the lumbar spine.
Can the spinal cord perform lateral flexion?
Small degree of lateral flexion in thoracic spine which is limited by the ribs
What is the function of erector spinae in the back?
A prime mover responsible for returning flexed trunk upright.
They work eccentrically to control flexion.
They are not able to control flexion from a fully flexed posture.
What is the function of transversospinalis? Where are they located?
These muscles are found between transverse and spinous processes.
They are short stabiliser muscles. They create minimal movement and control each segment on the spinal cord alone.
What intrinsic back muscles fatigue with long period of standing?
What is the function of the anterior abdominal wall muscles?
Muscles of anterior abdominal wall function to resist tension from abdominal viscera. They insert onto lumbar fascia of the back muscles assisting back in their function.
What are the steps of typical back pain?
1) Injury to back structure
2) Muscle innervated by same nerve spasms
3) overlying skin becomes highly sensitized
What structures are innervated by the recurrant meningeal nerve?
Recurrant meningeal nerve supplies outer 1/3 of the disk and the dura of the spinal cord.
Why are nerve roots more likely to get compressed than the spinal cord?
Nerve roots get compressed rather than the spinal cord due to posterior longitudinal ligament and its expansions directing the expansion to the nerve root.
What are the causes of compressive pain?
Herniated disk or stenosis
Which nerve is injured when a disk prolapses?
The nerve passing below disk prolapse.
Where are the most common sites of disk herniation?
L4/5 and L5/S1
What are the symptoms of a pathogenic disk prolapse?
Pain, restricted movement at certain sites, and other signs such as muscle wasting of certain muscles.
What are the more common injuries to the cervical spine?
Common injury to cervical spine include trauma related in F/E +/- impinging nerve roots in vertebral canal. Eg whiplash injury with acceleration of head in an antero/posterior direction.
What are likely structures to be damaged as a result of whiplash injuries? When are these structures most endangered?
Facet joint capsule + articular surfaces + supporting ligaments. These structures are particularly endangered in hyperextension.
What are the likely problems that can result from water loss from intervertebral disks?
Osteophytes can develop due to irritation of the edges of vertebrae caused by them rubbing against each other. This can cause stenosis and narrowing of intervertebral foramen.
What prosthetics may be used to replace vertebrae?
cobalt polyethylene disks have been designed to replace degenerated disks.
What are likely degenerative changes that can happen in the cervical spine, what is the consequence of their action?
Uncinate processes may come in contact with age and as a result may create bony proliferation and in turn these can irritate the nerve roots and the vertebral arteries.
Hypertrophy of intracanal structures
What are the symptoms of nerve compression at lumbar or sacral spine?
Deep ching pain radiating to thighs aggravated by activity.
Incontinence of urine and loss of sphincter tone.
Loss of sensation around vulva or anus.
What are the symptoms of cauda equina compression?
Loss of reflexes for pelvic viscera.
Sensory loss involving sacral nerve. (saddle anaesthesia)
What are the possible degenerative consequences in elderly that can result from a fracture in the front of vertebrae?
Excess kyphosis (due to fracture at the front of underlying vertebra.)
What is ankylosing spodylitis?
Ankylosing spondylitis (AS) is a type of inflammatory arthritis that targets the joints of the spine. It first affects the sacroiliac (SI) joint, where the spine attaches to the pelvis, and then starts to affect other areas of the spine.
What are other causes of back pain?
Cardiovascular problems (eg. aortic aneurism)
Neoplasia (growth of new tissue eg tumours)
What is a hangman fracture?
Hangman fracture is fracture of the pars interaricularis of c2