PBL- Back Pain Leading To Chronic Incapacity Flashcards Preview

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Flashcards in PBL- Back Pain Leading To Chronic Incapacity Deck (75)
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1

What are the red flags of lower back pain?

Previous history of malignancy
Younger than 16, older than 50 with new pain
Weight loss
Prolonged steroid use
Recent serious illness
Recent significant infection

2

List some mechanical causes of lower back pain below.

Trauma
Muscular and ligament pain
Pustular back pain
Facts joint syndrome
Lumbar disk prolapse
Lumbar spondylosis

3

Describe the anatomy of an intervertebral disk.

Soft gelatinous centre called nucleus pulposus, encircled by a strong, ring-like collar of fibrocartilage called the annulus fibrosis.

4

What is the main function of an intervertebral disk?

Shock absorption

5

What happens in an intervertebral disk prolapse?

Nucleus pulposus is squeezed out of place and herniated through the annulus fibrosis

6

Name some reasons an IV disk would become damaged?

Trauma
Effects of aging
Degenerative disorders of the spine

7

Briefly describe pathology involved once an IV disk herniation has occurred?

Posterior protrusion of the nucleus pulposus towards the intervertebral foramen and its contained spinal root.
Annulus fibrosis becomes thin and poorly supported by posterior or anterior ligaments at this point

8

Which regions of the spine are most commonly involved in disk herniations?

Cervical and lumbar

9

Where are the signs and symptoms of a disk herniations seen?

Localised to the area of the body innervated by the affected spinal nerve roots- includes motor and sensory

10

If the nerve roots L4, L5, S1, S2 and S3 are damaged, what condition arises?

Sciatica

11

Describe where the pain is felt in sciatica?

Spreads down the back of the leg and over the sole of the foot

12

What are the most common sensory effects from spinal root compression?

Paraesthesia and numbness

13

What are the most common motor effects from spinal root compression?

Knee and ankle reflexes may be absent or diminished

14

What are the symptoms of severe spinal disease?

Pain worse at rest
Thoracic pain
Fever
General malaise
Urinary retention

15

What signs and symptoms of cord compression occur in severe spinal disease?

Back pain
Leg weakness
Limb numbers
Ataxia
Urinary retention
Hyperreflexia
Clonus

16

What signs and symptoms of cauda equina compression occur in severe spinal disease?

Bilateral leg pain
Back pain
Urinary retention
Perinatal sensory loss
Erectile dysfunction
Reduced anal tone

17

What are the layers of protection for the spinal cord?

Vertebrae
Vertebral ligaments
Fat and connective tissue in epidural space
Meninges
CSF

18

At what point do the spinal nerves stop being covered in meninges?

Once they exit the spinal column through the intervertebral foramen

19

What is the epineurium?

The outer covering of spinal and cranial nerves
- continuous with dura mater

20

Describe the connective tissues of the dura mater.

Thick, strong, dense and irregular

21

Describe the connective tissues of the arachnoid mater.

Thin, avascular with loosely arranged collagen and elastic fibres

22

Describe the connective tissues of the pia mater.

Thin and transparent
Bundles of collagen fibres and some elastic fibres
- adheres to surface of spinal cord and brain

23

Which meningeal layer contain blood vessels? (At least in the spine :/)

Pia mater and dura mater

24

What are denticulate ligaments?

Triangular shaped membranous extensions of the pia mater than suspend the spinal cord in the middle of the rural sheath

25

Where does the spinal cord arise and terminate in adults and babies?

Arises in the medulla oblongata
Terminates
- superior border of 2nd lumbar vertebrae in adults
- L3,4 in newborns

26

What is the superior enlargement of the spinal cord, and where does it span?

It's a cervical enlargement, that nerves to and from the upper limb arise from
Spans from C4 to T1

27

What is the inferior enlargement of the spinal cord, and where does it span?

It's a lumbar enlargement, that nerves to and from the lower limb arise from
Spans from T9 to T12

28

What is the conical structure that is the end of the spinal cord called?

Conus medullaris (between L1, 2)

29

What is the film terminale?

Extension of pia mater that extends from conus medullaris to the arachnoid and dura mater at the coccyx
- anchors spinal cord to coccyx

30

How many pairs of spinal nerves are there - and where do they all arise from?

31 pairs
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccyx