Orthopaedics Unit 2 Flashcards Preview

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Flashcards in Orthopaedics Unit 2 Deck (38):
1

what is important to remember in the management of back ache

most back ache is self limiting

2

what is the group name for non-nervous tissue of the spine and what is the term for abnormalities in this area

spodylitides

spondylitis

3

what are the types of pain in spinal disorders

locally
- difficult to pin point back pain
- tends to be a general lumbar or dorsal pain

referred pain
- down buttock, thigh and leg
- rarely below mid-calf
- up shoulder and upper arm

along length of the nerve arising from affected nerve root
- disease of facet joints or discs may put pressure on nerve roots

4

what is the anatomy of nerve roots

nerve roots emerge from the vertebrae via the vertebral foramina

surrounded by facet joints behind and intervertebral disc in front

5

what is sciatica

compression of the sciatic nerve from the foramen in the lower lumbar region

6

Sx of sciatica

pain down the back of the leg into the foot

exacerbated by coughing

7

Sx of nerve root compression

loss of sensation
muscle weakness
tingling

8

what are the classification and causes of vertebral conditions

1. Related to spondylitides
a) aches and sprains
b) mechanical back pain
c) spondylolisthesis

2. Related to nervous tissue
a) disc prolapse
b) bony root entrapment

9

what is back sprain associated with

awkward twisting
poor lifting

10

what is a good lifting technique

Reducing the distance between the back and the weight results in less leverage and reduced spinal loading

11

how can you distinguish sprain from other types of back pain

there is no signs of nerve compression

12

Mx of back sprain

period of rest
gradual return to normal activities

NSAIDs
parcetamol

13

what is mechanical backache and causes of it

recurrent back sprains

spondylosis
primary OA

14

what is spondylosis

degeneration of the intervertebral disc leading to increased loading of the facet joints

which then develop secondary OA

15

Mx of mechanical backache

rest, physio, pain killers

16

what is spondyloisthesis

slippage of one vertebra relative to the one below

commonly seen in the lumbar spine.

17

what causes spondyloisthesis

bony abnormality which interferes with the stability of the facet joints and ligaments

congenital or acquired

18

what is thought to lead to acquired spondyloisthesis in adults

acute or fatigue fracture of the pars inter- articularis [small segment of bone that joins the facet joints in the back of the spine]

19

Sx and Ix of spondyloisthesis

low back pain
[similar to mechanical back pain]
no neuro Sx

x-ray

20

Mx of spondyloisthesis

spinal corset
- may relieve pain

physio, pain relief

fusion of 2 vertebrae
- if pain is severe

21

what is spondylolysis

defect or stress fracture in the pars interarticularis

w/out forward slipping of the vertebrae

22

where does the majority of spondylolysis cases occur

L5

23

Sx of disc prolapse

M > F
under 40 y/o

acute back and leg ache
-may describe a single event leading up to pain

pain down the back of the thigh and leg to the foot

24

how can you differentiate disc prolapse from referred back ache

referred pain usually goes no further than the knee or upper calf

25

what happens in disc prolapse

prolapse (extrusion) of the nucleus pulposus material through the annulus fibrosis

extrudes backwards and laterally impinging on the nerve root

26

what can happen if a disc prolapses posteriorly

impinges on the spinal cord or the cauda equina

27

what discs are most commonly affected in disc prolapse

discs between sacrum and the fifth lumbar vertebra

28

Mx of disc prolapse

ensure nerves supplying the bladder and bowel are not damaged
- cauda equina syndrome

analgesics
NSAIDs

they recover SPONTANEOUSLY as disc material is absorbed by cells released from bloodstream

if Sx persist, then surgical intervention is required to remove the material

29

Ix of disc prolapse

myelography
- injecting a radio-opaque material into the spinal fluid then taking an X-ray.
- image called a myelogram

30

clinical presentation of bony root entrapment a.k.a spinal claudication

M = F
over 40
Hx of mechanical back pain

develop new Sx of leg pain radiating to the foot, MADE WORSE BY EXERCISE

episodes are acute and recurrent

31

Mx of bony root entrapment

physio unlike to help

if pain is severe surgery may be necessary
- removal of bone to free trapped nerve roots
- may cause disturbance in spinal stability
- may need to fuse vertebrae

32

aetiology of bony root entrapment

bony overgrowth around the vertebral foramina where the nerve roots emerge

bony overgrowth secondary to degenerative changes in the adjacent facet joints i.e. primary OA or disc degeneration

33

why is the cervical spine prone to disease and injury

very mobile

34

what is Cervical Spondylosis

disc degeneration and joint disease

35

clinical presentation of Cervical Spondylosis

F > M
over 40 y/o

dull neck ache
referred to shoulders and upper arm
tingling in the arms

can progress and cause bony root entrapment or disc prolapse

36

Mx of Cervical Spondylosis

Analgesics
NSAID
soft collar
physio to relieve muscle spasm

37

clinical presentation of Cervical Disc Disease

pain
referred pain similar to Spondylosis

however, tend to have no Hx of neck trouble

38

Mx of Cervical Disc Disease

resting
gentle traction
support collar

potential fusion of affected vertebrae is localising signs are marked Sx do not regress