Skeletal Pathologies

Question 1

Describe Scoliosis

Answer 1

Scoliosis describes a lateral S shape curve in the spine.

Generally the more pronounced the curve the more clinically relevant.

Question 2

Do people live with Scoliosis

Answer 2

People live with Scoliosis and are often asymptomatic

Question 3

How do we develop Scoliosis

Answer 3

We can be born with it, or it can develop throughout life (often adolescent onset)
It can develop from everyday imbalances i.e carrying a rucksack on one shoulder. It is also common in people with leg discrepancies.

Question 4

What does severe Scoliosis cause

Answer 4

It can cause spinal nerve compression

Question 5

Define Lordosis

Answer 5

Lordosis describes an increased concavity in the lumbar and cervical spine.

Question 6

What causes individuals to become Hyper-Lordotic

Answer 6

It may be genetics/ethnic cause i.e (Afro-Caribbean women) it can be secondary to other musculoskeletal changes. More common in Obese individuals. It is a normal adaption for pregnant women.

Question 7

What can a HyperLordotic posture cause

Answer 7

Muscular fatigue, it can also encourage the vertebral joints to move closer together causing inflammation

Question 8

Describe Kophosis and what can happen to an individual

Answer 8

A healthy spine will include a kyphosis in the thoracic spine, which is important as it helps distribute forces through the spine.

An individual can become Hyper-Kyphotic which causes an excessive curvature of the spine hunching forwards.

Question 9

What can cause a Hyper-kyphotic spine

Answer 9

Poor posture, occupation, stress. It can also be secondary to another disease such as Osteoporotic spinal fractures.

Question 10

What are the symptoms of a Hyper Lordotic spine

Answer 10

It can cause pain around the Scapular (shoulder blade) It can also cause irritation to the ribs and may interfere with breathing.

Question 11

Define Osteoporosis

Answer 11

Osteoporosis is described as chronic progressive thinning of the bones. (Porous bone)

Question 12

How is Osteoporosis characterised and what does it lead to?

Answer 12

Decreased bone mineral density (BMD). It leads to bone fragility and an increased risk of bone fracture.

Question 13

How do we diagnose Osteoporosis

Answer 13

By a Dual x-ray absorptiometry also known as a DXA Scan. A TScore of lower than -2.5 indicates Osteoporosis.

Question 14

What are the 6 main risk factors for Osteoporosis

Answer 14

1. Sedentary lifestyle
2. Genetics - Family history
3. Low Body weight
4. High Alcohol consumption and smoking
5. Toxins (heavy metals)
6. Endocrine pathologies e.g cushings syndrome, hyperthyroidism, hyperparathyroidism and inability to produce Oestrogen.

Question 15

Why is dairy not good for the body.

Answer 15

Although Dairy is an alkaline food when it enters the body it turns acidic and actually leaches calcium from our bones. It creates inflammation in the body and creates an acidic environment in the body.

Question 16

What are the signs and symptoms of Osteoporosis?

Answer 16

Osteoporosis is asymptomatic until the bone has reached critical thinness, whereby fractures will occur spontaneously with minor trauma. Commonly affecting the spine and hips.

Focal pain, and kyphotic posture with loss of height

Pain is aggravated by prolonged sitting, standing or bending.
It is relieved by laying on the side with hips and knees flexed.

Question 17

What is the Allopathic treatment for Osteoporosis?

Answer 17

Bisphosphonates (alendronic acid) and HRT

Question 18

What are the complications of taking Bisphosphonates

Answer 18

They can cause muscle and joint pain, fractures,oesophagitis and gastritis

Question 19

What are the natural treatments for Osteoporosis

Answer 19

To follow a healthy alkaline diet and no caffeine/alcohol. Increase calcium, magnesium, Vitamin D3 and K2. Encourage weight baring exercise, hormone balancing herbs and avoiding toxins

Question 20

Define Osteomalacia and Rickets

Answer 20

Inadequate mineralisation of the bone matrix in spongy and compact bone. Characterised by decalcification and hence softening of the bone.

Question 21

What is the Allopathic treatment for Osteoporosis?

Answer 21

Bisphosphonates (alendronic acid)

Question 22

What is the difference between Osteomalacia and Rickets

Answer 22

Rickets is in children prior to the closure of the epiphyseal plate under 18 years of age.
Osteomalacia is found in adults

Question 23

What are the causes of Osteomalacia or Rickets

Answer 23

Insufficient sunlight
Insufficient vitamin D
Secondary deficiency - Malabsorption disorders
Reduced receptor sites for vitamin D in tissues.

Question 24

What are the signs of Osteomalacia and Rickets

Answer 24

Deformed bones (bowed legs) and possible fractures
Severe back pain and muscle weakness
In Rickets: Delayed closure of the frontanelles and skull softening

Question 25

What does Myelo indicate

Answer 25

marrow

Question 26

Define Osteomyelitis and how does it present?

Answer 26

A bacterial infection of the bone marrow resulting in necrosis and hence bone weakness. It presents as severe bone pain which is often worse at night, with swelling, redness and warmth.

Question 27

What are the causes of Osteomyelitis

Answer 27

Bacterial infection Staphylococcus aureus through the blood supply or post fracture. Immunosuppression, Diabetes, HIV and drug users

Question 28

Define Ankylosing Spondylitis

Answer 28

Systemic autoimmune disease that is associated with the spine and sacroilliac joints. Often leading to spinal fusion (ankylosis) and stiffness

Question 29

What is gene is normally present in Ankylosing Spondylitis patients and what percentage

Answer 29

HBA - B27 gene is found in 95% of AS patients.

Question 30

What is the age of onset for AS and is there a particular gender it is more common in.

Answer 30

Generally between 15- 30 years of age and more common in men.

Question 31

What other diseases are linked with AS

Answer 31

Inflammatory bowel diseases (leaky gut) as well as urogenital or intestinal infections such as salmonella and shigella which cross reacts with HLA - B27

Question 32

What are the signs and symptoms of Ankylosing Spondylitis

Answer 32

typically begins with sacroiliac and lower lumber spine pain, before progressing up the spine. Worsening morning stiffness Lower back symptoms that often improve with activity. The lumber lordosis flattens and patients often become kyphotic Hip and heel (achilles) pain are common 20% suffer acute iritis - (HLA -B27 diseases) Systemic symptoms: Fever fatigue and malaise

Question 32

How do we diagnose Ankylosing Spondylitis

Answer 32

Blood tests - elevated inflammation markers CRP/ESR HLA - B27 positive Xrays and MRI - identifies classic bamboo spine.

Question 33

What is the Allopathic treatment for Ankylosing Spondylitis

Answer 33

Surgery, anti inflammatories including steroids and non steroidal

Question 34

Define Gout

Answer 34

Gout is a type of monoarthritis (mono = one . Artho = joint) characterised by uric acid crystal deposition in the synovial joints

Question 35

Indicate what happens pathologically in the joint of a patient suffering with gout

Answer 35

Uric acid crystal deposition

Question 36

compare the distribution of joint symptoms seen in Rheumatoid Arthritis and Osteoarthritis

Answer 36

Osteoarthritis: unilateral or weight baring joints RA: bilateral or widespread/smaller joints

Question 37

What is Uric Acid

Answer 37

. Breakdown of purines produces Uric acid. By product from metabolism of proteins

Question 38

Explain Hyperuricaemia

Answer 38

Elevated blood uric acid levels due to overproduction or underexcretion

Question 39

What happens in Gout

Answer 39

Excess uric acid forms in solid crystals (monosodium urate) on cartilage surfaces. This causes white blood cells to infiltrate activating an acute inflammatory response.

Question 40

What are the causes of Gout

Answer 40

Increase intake of purine rich food. Alcohol especially red wine which accelerates the breakdown of purines. Red meat, organ meat shellfish Dehydration, kidney disease medications, obesity excessive alcohol consumption hypertension and diabetes

Question 41

How is Gout diagnosed

Answer 41

Blood serum for uric acid (not definitive as can fluctuate) can be useful to monitor treatment. Analysis of synovial fluid (needle aspiration)

Question 42

What are the signs and symptoms of Gout

Answer 42

Most often affects the big toe can affect the mid feet, ankles, knees elbows or hands. Usually monoarticular (one joint) Sudden onset of intensely painful, red, hot and swollen joints often lasting 12-24 hours shiny skin over the joing Urate crystals can deposit under the skin and produce Tophi.

Question 43

What is the allopathic treatment of Gout

Answer 43

Allopurinol - to prevent episodes Corticosteroid injections

Question 44

What are the adverse effects of corticosteroid injections

Answer 44

indigestion, rapid heartbeat, nausea insomnia, mood changes diabetes glucoma and osteoporosis

Question 45

What happens in a disc herniation

Answer 45

the Nucleus polposus of the intervertebral disc leaks out through the annulus fibrosus.

Question 46

What discs are affected in disc herniation

Answer 46

The discs with the highest fluid content most commonly lumbar spine L5/S1 then cervical spine. Usually between the ages of 30-40

Question 47

What are the complications of a disc herniation

Answer 47

It can compress spinal nerves

Question 48

What is the classic injury mechanism for a disc herniation

Answer 48

Combined lumbar spine flexion (bending) and rotation.

Question 49

What is the treatment for Disc Herniation

Answer 49

Manual therapy and exercise anti inflammatory nutrients and herbs

Question 50

Name and explain the 3 types of fractures

Answer 50

Complete - bone broken into 2 or more fragments. Can either be open (perforated skin) or closed (soft tissues not compromised) Incomplete - bone fractured but not into fragments Avulsion - tendon or ligament pulls off a piece of bone

Question 51

What are the following type of fractures a. linear b. transverse

Answer 51

a. along the bone length b. dissect across the bone