Ortho unit 2

Question 1

Spondylitides

Answer 1

non nervous tissue of spine

Question 2

spondylitis

Answer 2

abnormalities in the spondylitides

Question 3

pain in the spine

Answer 3

locally, referred, along the length of a nerve arising from an affected nerve root

Question 4

local back pain

Answer 4

tends to be related to a whole region

Question 5

referred pain

Answer 5

back pain may be referred to the buttock, thigh and leg, descending as far as mid calf but rarely below this

Question 6

Nerve root pain

Answer 6

diseases affecting the facet joints and the discs may cause direct pressure on, or inflammatory reactions and swelling of, the nerve roots

Question 7

common nerve root pain

Answer 7

foramina of lower lumbar region- sciatica-

Question 8

what is sciatica characterised by

Answer 8

pain in the leg, mainly down the back of the leg but almost always into the foot- may be exacerbated by coughing

Question 9

localising signs

Answer 9

tingling, loss of sensation and muscle weakness

Question 10

back sprains

Answer 10

good loading- reduce distance between back and the weight- less leverage and reduced spinal loading

Question 11

how can back sprains be distinguished from back pain of neurological cause

Answer 11

absence of signs of nerve compression

Question 12

management of back sprain

Answer 12

brief period of rest followed by gradual return to normal activities. Anti inflammatory drugs can relieve symptoms but analgesia is usually sufficient

Question 13

mechanical backache

Answer 13

recurrent back sprains

Question 14

possible causes of mechanical backache

Answer 14

spondylosis- degeneration of IV disc leading to increased loading of the facet joints, which then develop secondary arthritis
primary OA- facet joints are likely to be as prone to primary OA as any other synovial joint

Question 15

clinical presentation of mechanical backache

Answer 15

tends to recur, no known cure, rest, physic and medication will help sufferer through a bad episode. Osteopaths and chiropractors can provide some easing of the condition by manipulation

Question 16

spondylolisthesis

Answer 16

slippage of one vertebra relative to the one below- commonly seen in the lumbar spine- caused by bony abnormality which interferes with the stability of the facet joins and their associated bony and ligamentous elements

Question 17

aetiology of spondylolisthesis

Answer 17

may be congenital or acquired so can occur at any age- adult forms are thought to be acquired. Appears to be acquired after an acute or fatigue fracture of the pars inter articularis

Question 18

clinical presentation of spondylolisthesis

Answer 18

low back pain- almost identical to mechanical

Question 19

diagnosis of spondylolisthesis

Answer 19

x ray, in severe slippage a step may be felt at the affected area. Condition v rarely causes near problems, even when the slippage is major- except in congenital cases- movement may be sufficient to damage nerves

Question 20

management of spondylolisthesis

Answer 20

spinal corset may help relieve pain, otherwise management similar to mechanical back pain. Most sufferers don’t require surgery unless experiencing severe pain- surgical fusion of the 2 vertebrae may be required

Question 21

spondylolysis

Answer 21

pars interarticularis defect such as a fracture seen on radiograph without forward slipping of the vertebra- can exist without causing pain. Pain experienced- conservative measures, pain severe- spinal fusion may be required

Question 22

disc prolapse

Answer 22

can occur in lumbar or cervical spine

Question 23

clinical presentation of disc prolapse

Answer 23

classical symptoms occur in people under 40, more common in men. Acute backache, leg ache, sometimes leg ache alone with back ache developing later. Sufferers may describe a single event of strain/lifting, it also may arise spontaneously

Question 24

characteristic symptom of disc prolapse

Answer 24

legate passing down the back of the thigh and leg into the foot

Question 25

aetiology of disc prolapse

Answer 25

abnormality of IV disc- leads to prolapse of the nucleus pulposus through the annulus fibrosis. If it protrudes backwards and laterally- impinges on the nerve root. Extrudes posteriorly- impinges on the spinal cord or caudal equina

Question 26

discs most affected by disc prolapse

Answer 26

between sacrum and 5th lumbar vertebra- explains why disc prolapses are often called sciatica- peripheral nerve arising from nerve roots emerging beneath 4th and 5th lumbar vertebrae

Question 27

management of disc prolapse

Answer 27

ensure nerves supplying bladder and bowel aren’t damaged. Rest, gentle and progressive mobilisation, analgesics, anti inflammatory drugs

Question 28

management of disc prolapse

Answer 28

most recover spontaneously- disc material absorbed by cells released from the blood stream- if pain persists surgical intervention to remove material is required- site of disc prolapse must be confirmed by injecting radio opaque material into the spinal fluid- won’t be able to flow where prolapsed disc presses on nerve- technique- myelography, image produced- myelogram

Question 29

bony root entrapment

Answer 29

person of either sex, usually over 40, pre history of mechanical back pain. Develop new symptoms of pain radiating to the foot, usually made worse by exercise- spinal claudication

Question 30

bony root entrapment clinical presentation

Answer 30

episodes usually acute and recurrent against a chronic history of back pain. Episodes may remain mild or progress to affect the patients lifestyle. Physio is unlikely to help, should pain be severe then surgery may be necessary

Question 31

cause of bony root entrapment

Answer 31

bony overgrowth around the vertebral foramina where the roots emerge. Cause would appear to be secondary to degenerative changes in the adjacent facet joints- may degenerate from primary OA or as a result of disc degeneration

Question 32

management of bony root entrapment

Answer 32

Removal of bone needed to free trapped nerve roots- may result in disturbance in spinal stability and lead to a need for fusion of the affected vertebrae

Question 33

cervical spondylosis

Answer 33

over 40s, more common in females, dull neck ache often referred to the shoulders and upper arms. Tingling of arms- assumed to be entrapment of nerve roots

Question 34

spondylosis

Answer 34

a painful condition of the spine resulting from the degeneration of the intervertebral discs.

Question 35

management of cervical spondylosis

Answer 35

if there are no localising near signs- analgesics and NSAI agents, use of soft collar and physic. Usual for recurrent attacks to occur. If nerve root entrapment is confirmed- surgical fusion of the vertebrae and decompression of the nerve root may be necessary

Question 36

cervical disc disease- clinical presentation

Answer 36

lower discs more likely to cause the problem. Symptoms of pain, referred pain sufferers tend to have no pre history of neck trouble. Following disc prolapse- neck muscles may be in spasm and the movement of the neck is severely restricted

Question 37

management of cervical disc disease

Answer 37

most recover with resting, gentle traction and wearing a supporting collar. Surgery and fusion of affected vertebrae may be necessary if localising signs are marked or symptoms don’t regress