Trauma ortho 1 Flashcards by Jia Ying Tan

Name 5 categories of LBP causes

Spondylogenic - originating in the spine
Neurogenic
Viscerogenic
Vascular
Psychogenic

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Mechanical back pain is managed in ______.

Investigations:
should you offer lumbar spine x-ray?
When should you offer MRI?

Mechanical back pain is managed in primary health care
Investigation: lumbar spine x-ray should not be offered
Offer an MRI only if result likely to change management or sinister causes are suspected

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Mechanical back pain: first-line treatment approach (3)

Reassurance, explanation
NSAIDs (+PPI over 45)
Avoid bed rest, keep active, early return to work

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Mechanical back pain: second-line treatment approach

If fails to settle, physiotherapy

Alternative therapies e.g. facet joint injections, acupuncture

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Persistent mechanical back pain: third line treatment approach

Rehabilitation programmes

Pain clinics

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Prolapsed intervertebral disc
What can happen to the…
Annulus
Nucleus pulposus

Annulus can tear
Nucleus can prolapse
Resulting in cord/nerve root compression

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Prolapsed intervertebral disc

Which ligaments are involved

Anterior longitudinal ligament

Posterior long ligament

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Prolapsed intervertebral disc
Disc changes in normal aging - name 4
Physiological and on imaging

Decreased water content of discs
Disc space narrowing
Degenerative x-ray changes
Degenerative changes in facet joints

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Prolapsed intervertebral disc

What social factor can aggravate this?

Normal degenerative disc changes can be aggravated by smoking

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Prolapsed intervertebral disc

Pathological disc changes 6

Tearing of annulus fibrosis, prolapse of nucleus
Osteophytes causing nerve root compression
Central spinal stenosis
Abnormal movement - trauma
Spondylosis
Spondylolisthesis

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Nerve root pain

distribution of pain
progression/prognosis
2 modalities of treatment
when to refer

Distribution of pain - radicular, along nerve root
Prognosis: usually settles in 3 months
2 modalities of treatment:
- Physiotherapy
- Strong analgesia
Refer after 12 weeks and do MRI

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4 types of disc problems
Which one is the most common, asymptomatic?
Which one involves desiccated disc material free in canal?
Which one is caused by weakened but intact annulus?

Bulge - common, asymptomatic
Protrusion - weakened annulus but intact
Herniation - through annulus but still in continuity
Sequestration - desiccated disc material free in canal

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Cervical disc prolapse

Which nerve roots

C5-6

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Thoracic disc prolapse

Which nerve roots

T11-12

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Lumbar disc prolapse

Most common nerve root involvement

L4/5

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Lumbar disc prolapse

Which ligament weakening causes posterolateral lumbar disc prolapse?

PLL

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3 types of thoracic disc prolapse and herniations

Central
Posterolateral
Lateral

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Cauda Equina Syndrome (CES)
Name 6 causes
Which is the most common cause

Central lumbar herniated disc
Tumours
Trauma
Spinal stenosis
Epidural abscess
Iatrogenic

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Name 3 iatrogenic causes of CES

Spinal manipulation
Spinal epidural
Spinal surgery

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Name 4 clinical features of Cauda Equina Syndrome (CES)

Investigation of choice
If this is contraindicated, what investigative modalities are used? (2)

Injury or precipitating event
Location of symptoms
- Bilateral buttock and leg pain, varying dyasthesia and weakness
Bowel and bladder dysfunction
- urinary retention, incontinence
Saddle anaesthesia - loss of anal tone, loss of anal reflex

Investigation of choice - MRI
If contraindicated, use CT or pyelogram

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Cauda Equina Syndrome (CES)
Treatment
Prognosis after surgery

Treatment - surgery outcome good if surgery within 48 hours

Prognosis after surgery - third will not regain function of bladder/sensory/motor deficit

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Degenerative cervical spondylosis

Why might a patient lose consciousness in this situation

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Osteoarthritis

Vertebral artery passing through foramina transversarium may get occluded in cervical spondylosis

Degenerative cervical spondylosis
Name 5 clinical features excluding referred pain
What are the 3 areas of referred pain?
Complications [2]

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Cervical pain worsened by movement
Retro-orbital or temporal pain
Numbness, paresthesia of upper limbs
Limited ROM of cervical spine
Poorly localized tenderness
Referred pain
- occiput
- between shoulder blades
- upper limb

Complications include radiculopathy and myelopathy.

Degenerative cervical spondylosis
Investigation largely dependent on clinical or imaging
What can imaging show to confirm dx (2)

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Largely clinical diagnosis but x-ray can show osteophytes and narrowing disc space with
encroachment of intervertebral foramina

What will be an indication of MRI at early stage of investigation (4)

Neurological symptoms: Progressive myelopathy Radiculopathy Intractable pain

What is Lhermitte's sign

Neck flexion causing electric shock like sensation radiating down spine

``` Degenerative cervical spondylosis Treatment approaches (3) ```

Wait and see Avoid bed rest, keep active Physiotherapy - after 4-12 weeks of not resolving pain

Spinal stenosis/claudication | Presentation (4)

Bilateral - usually Sensory dyasthesiae Weakness - foot drop Takes several minutes to ease after stopping walking (mimicking claudication)

Spinal stenosis/claudication | Which factors improve/worsen symptoms

Worse walking down hills - extension | Better walking uphill, riding bicycle - flexion

Spinal stenosis/claudication - Lateral recess stenosis | Tx (4)

Non-operative measures Nerve root injection Epidural steroid injection Surgery

Spinal stenosis/claudication - Central stenosis | Tx (3)

Non-operative measures Epidural steroid injection Surgery

Spinal stenosis/claudication - foramina stenosis | Tx (4)

Non-operative measures Nerve root injection Epidural injection Surgery

Spondylosis definition (1)

defect of pars interarticularis

Spondylolisthesis definition (1)

anterior displacement of vertebral body

Spondylosis | 2 symptoms

1. LBP | 2. Radicular symptoms occasionally

Spondylosis Investigations - 4 Treatment - 3 modalities

``` X-rays CT MRI Bone scan Treatment - Non-operative measures - Injection therapy - Surgery ```

Spondylolisthesis | Wiltse Classification 5 categories

``` Congenital Isthmic Degenerative Traumatic Pathologic ```

``` Spondylolisthesis Surgical indications (2) ```

Indicated in persistent pain and/or nerve root entrapment

According to ASIA classification of SCI, which grade has completely no chance of recovery

ASIA Grade A

What fracture causes tetraplegia or quadriplegia

Cervical fracture

In tetraplegia/quadriplegia, respiratory failure is due to loss of innervation of what? What nerve is this and state nerve roots

In tetraplegia/quadriplegia, respiratory failure is due to loss of innervation of diaphragm Phrenic nerve C3-5

Paraplegia definition (1)

Partial or total loss of use of the lower limbs

What is spared in paraplegia

Arm function spared

What are 2 partial cord syndromes

Central cord syndrome | Anterior cord syndrome

Which patients and which type of injuries are typically affected in central cord syndrome

Elderly patients with arthritic neck with hyperextension injury (low velocity)

What injury can cause central cord syndrome

Hyperexentension injury

Clinical features of central cord syndrome | What is typically preserved? (2)

Weakness of arms > legs Dyasthesias Perianal sensation and lower extremity power preserved

``` Anterior cord syndrome Presentation What type of injury causes this (2) Damage to what causes this? What is preserved ```

Profound weakness Type of injury causing this - hyperextension injury, anterior compression fracture Damage to anterior spinal artery Fine touch and proprioception preservaed

Management of SCI

Prevent secondary insult/further damage | ABCD management

What is ABCD management

Airway and c-spine Breathing Circulation Disability - PR, peri-anal sensation

``` Spinal shock definition Clinical features (2) ```

Transient depression of cord function below level of injury lasting several hours-days after injury Clinical features Flaccid paralysis Areflexia

Neurogenic shock Cause (2) 3 clinical signs

``` 2 causes of neurogenic shock: - Injuries above T6 - Secondary to disruption of sympathetic outflow leading to loss of sympathetic tone 3 Clinical signs - Hypotension - Bradycardia - Hypothermia ```

How to differentiate radiculopathy and named nerve pathology like ulnar nerve palsy?

Radiculopthy follows a dermatomal distribution, unlike named nerve pathology. The pattern of sensory loss cannot be explained by a single named nerve.

Trauma ortho 1 Flashcards

Shoulder problems Elbow problems Spinal problems Back pain problems (53 cards)