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Injuries and medical problems in sport > Spine problems > Flashcards

Spine problems Flashcards

1
Q

Disc problems overview

A
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2
Q

List the pain-producing structures in the back

A
  • nucleus polposus
  • annulus fibrosus
  • facet joints
  • ligaments
  • muscles
  • nerve (mechanical and chemical irritation)
  • synovium (facet joint capsule)
  • meninges
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3
Q

Back pain Sx red flags

A
  • FLAWS
  • Sx for cauda equina
  • Morning stiffness
  • Uncontrolled pain
  • Thoracic pain
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4
Q

What serious conditions can lead to back pain?

A
  • Cauda Equina
  • Pathological fracture
  • Cancer
  • Infection (TB)
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5
Q

Sx for cauda equina

A
  • Saddle anaesthesia
  • Disturbed gait
  • Progressive neuro, bladder/bowel/sexual dysfunction
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6
Q

Back pain PMHx/SHx red flags

A
  • <20 or >50
  • Hx IVDU
  • Hx cancer
  • Immunosupression
  • TB contacts
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7
Q

Yellow flags back pain- Psychosocial factors for poor prognosis

A
  • Depression, social withdrawal
  • Fear avoidance
  • reduced activity
  • expectation that passive not active treatment will be useful
  • social/financial problems
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8
Q

Function vertebrae

A
  • protect cord and nerves
  • posture and locomotion
  • supports bodyweight above pelvis
  • partly rigid axis for head to pivot on
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9
Q

Label the vertebra

A

Lumbar vertebra

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10
Q

What are the basic steps to spine examination?

A

1) Obs + inspection inc gait
2) Neurology inc slump or SLR
3) palpate muscles and SP/SIJ
4) assess movement different levels- ROM
5) Special tests

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11
Q

Pharmacological Mx back pain principles

A
  • NSAIDs - ibuprofen/naproxen
  • Spasms- short course diazepam
  • Codeine + paracetamol (SE advice)
  • Sciatic pain- neuropathic meds eg amitriptyline
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12
Q

Impact of smoking on back pain

A
  • strong Ax with LBP and sciatica

- poorer surgical outcomes

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13
Q

Conservative Mx back pain

A

Exercises and daily activity
• Heat
• + Psychological support (complex protracted cases)

Movement is an essential component of Mx-

  • changes pressure distribution in joints/muscles/nerves
  • keeps muscles and ligaments strong
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14
Q

Mx neuropathic pain

A

1) Neuropathic meds:
- amitriptyline, duloxetine, gabapentin, pregabalin
- Tramadol- acute ‘rescue therapy’
- capsaicin cream localised

2) Nerve root blocks
3) Decompression surgery

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15
Q

Causes of cord compressions

A
  • Tumour/lesions (primary/secondary)
  • Trauma
  • Spinal stenosis (eg by spondylolisthesis- vertebral compression fracture)
  • inflam/infection (pagets, TB)
  • disc herniation
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16
Q

Where can cord compression occur?

A

Anywhere- cord, conus medullaris, cauda

C4/5/6- v flexible so most vulnerable

Acute cord compression higher than conus/cauda

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17
Q

Sx of acute cord compression

A
  • UMN SIGNS
  • back pain>leg
  • signs of infection/cancer

occurs above conus/cauda

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18
Q

Symptoms cauda equina/conus medullaris syndrome

A
  • saddle anaesthaesia/parasthesia
  • LBP, unilateral/bilateral radicular pain
  • bladder/bowel/sexual dysfunction
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19
Q

Signs cauda equina/conus medullaris syndrome

A
  • perianal/perineal sensory loss
  • loss of sphincter tone
  • severe/progressive neuro deficit, mostly LMN but can be mixed UMN/LMN
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20
Q

Mx cauda equina

A
  • Imaging ED- MRI goldstandard

- urgent ortho spinal referral for decompression

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21
Q

conus medullaris vs cauda equina syndrome

A

conus medullaris:

  • less common + severe
  • bilat + symmetric
  • fasciculations
  • knee reflex still present
  • early, marked bladder/rectal/sexual Sx
  • more sudden onset
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22
Q

neurogenic bowel or bladder questions to ask

A 
Can you feel it filling? 
Urge? 
Make it in time? 
Flow problems? 
Incontinence?
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23
Q

non- spinal lower back pain ddx

A

Retroperitoneal structures e.g.

  • AAA
  • renal pyelonephritis/calculus
24
Q

cancer/infection Sx back pain

A
  • night pain
  • systemic Sx
  • thoracic Sx
  • inc age
  • Hx ca
  • recent infection eg UTI, surgical procedure
  • Fever/septic
  • Postural deformity
  • point tenderness
  • +/- neurology
25
Sx pathological fracture
- severe pain- rest and night - RF- osteoporosis, AN, cancer - sport- rowing, synchronised swimmer (pars/sacral resp) Need high index of suspicion
26
Mx pathological fracture
- analgesia - surgery - unstable, deformity, Rx pain - vertebroplasty/fusion
27
Inflammatory back pain Sx
- morning stiffness - Insidious onset then chronic - young, female - Hx/FHx AI disease - sacroilitis common initial pres
28
Signs inflammatory back pain
- Pain on SIJ palpation | - FABER test- leg flexed, abducted and externally rotated
29
Ix inflam back pain
- bloods- CCP, RF, ANA | - MRI/xray
30
Where does mechanical back pain most commonly occur?
- lumbar - may or may not involve nerve root - diskogenic/facet joint pain
31
Symptoms acute spinal cord compression/discogenic back pain
- unilateral, leg pain radiating below knee (L5) - leg Sx > back Sx - parasthesia, weakness - cough/sneeze/heavy lift inc. pain - worse on FLEXION
32
Clinical features acute spinal cord compression/diskogenic back pain
- loss of reflexes in nerve root distribution - list to contralateral side from pain - straight leg raise <30 deg, positive slump test - acute muscle spasm on palpation
33
Mx acute spinal cord compression/diskogenic back pain
- analgesia - weak opiod short course - Benzo - physio - surgical decompression
34
Facet joint pain is usually caused by what condition
degenerative arthropathy
35
Sx facet joint pain
- chronic - older - aggravated by EXTENSION and LATERAL FLEXION - +/- nerve root Sx - decreased ROM - tender on palpation
36
Ix facet joint pain
- MRI gold standard - CT - Bone
37
Mx facet joint pain
- as for arthritis and chronic LBP | - facet joint injection (diagnostic and therapeutic)
38
Types of spondylolisthesis/spondylolysis
Type 1: dysplastic/congenital Type 2: pars defect (lytic i.e. stress fracture, acute fracture) Type 3: degenerative Type 4: traumatic Type 5: pathological 2/2 bone disease eg osteogenesis imperfecta, pagets
39
Who is affected by stress fracture of pars interarticularis?
- Young athletes - hyperextension + rotation - fast bowlers, gymnasts
40
Sx stress fracture of pars interarticularis
Unilateral LBP - pain aggravated with extension - may have single episode precipitated pain - may be aSx if stress - excessive lumbar lordosis + HS tightening - unilat tenderness on palpation
41
Ix for stress fracture pars interarticularis
- oblique- scotty dog - SPECT bone scan - MRI less sensitive
42
Most common site for spondylolisthesis
L4/5
43
What is spondylolithesis and what is required for it to occur?
Slipped vertebra | requires bilateral pars defect
44
Sx spondylolisthesis
- LBP +/- leg pain - +/- claudication if central stenosis - palpable dip - compensatory muscle spasms in HS - decreased ROM - lordosis
45
Ix for spondylolisthesis
Lateral XR- grade slippage
46
Mx spondylolithesis
- relative rest - analgesia - PT - avoid contact sport - if progresses (rare)- surgery
47
signs and symptoms lumbar spinal stenosis
- elderly (affects 11% population) - LBP - Parasthesia and pain on prolonged standing/walking - neuro exam- plantars and Hoffmans, Romberg
48
Most common primary malignancies that metastasise to the spine
thyroid, lung, breast, renal, and prostate | haematological malignancies eg myeloma
49
Lumbar spinal stenosis causes
1. ligamentum flavum hypertrophy 2. facet degeneration- osteophyte formation 3. disc herniation
50
Mx lumbar spinal stenosis
Conservative = analgesia, exercises to improve spine mobilisation. Degenerative condition- aim to stabilise rather than cure If severe and Rx to conservative Mx - surgical decompression =/- fusion
51
Torticollis
'cricked neck' pain and difficulty turning head C4-7 Can be apophyseal or diskogenic
52
Burners and stingers
traction injury to brachial plexus contact sport burning/stinging sensation down arm
53
scheuermann's disease
excessive thoracic kyphosis, most commonly adolescent males
54
causes of thoracic back pain
- scheuermann's disease - costovertebral and costotransverse joint disorders (inflam arthritidies or mechanical) - other: chest, cardiac, oesophagus
55
if no neuro red flags Mx back pain
- tell to move - reassure - analgesia with NSAIDs - PT - no imaging
56
criteria for learning disability paralympics
IQ below 70-75 Intellectual disability must have been observed in developmental period (0-18 yrs.) Must be receiving 2 out of - Special education - Special accommodation - Special employment - Special protection - Respite care - Financial support
57
Lesion above T6 max HR
Cannot go above 120-130 because no sympathetic drive to the heart

Injuries and medical problems in sport (17 decks)

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