W7 - MSK neurological Conditions Flashcards
(19 cards)
Name the 4 MSK neurological conditions
Cervical myelopathy
Cauda equina syndrome
Radiculopathy
Peripheral entrapment
Name the 2 spinal red flags
Myelopathy
Cauda equina syndrome
What is a myelopathy
Compression of the spinal cord in the central canal
Can be causes by central stenosis
Where does a myelopathy normally occurs
In the cervical spine
What causes a myelopathy
Central disc herniation
Age related changes (bony spurs & osteophytes)
Trauma/instability
Spondylolisthesis
Ligament thickening
Postoperative problems
Infections, tumours & cysts (rarely)
Signs & symptoms of a myelopathy
Gait disturbance (ataxia, falls, clumsiness & balance)
Changes in fine motor skills & coordination
Possible neck pain and/or bilateral symptoms (pain, weakness, pins & needles, paraesthesia or numbness)
Possible low back pain & symptoms in all 4 limbs
Hyper-reflexia
Bowel & bladder disturbances
Myelopathy risk factors
Older age= degenerative changes & stenosis
Phematoid arthritis & ankylosing spondylitis (systemic autoimmune)
Trauma & upper cervical instability
Management for a myelopathy
Conservative
Surgery = spinal fusion/stabilisation
What is cauda equina syndrome
Compression of the collection of nerves at the bottom of the spinal cord
Common causes of cauda equina syndrome
Herniation of lumbar disc (45%)
Stenosis
Tumour
Discitis
Trauma
Cauda equina management
Immediate surgery (spinal decompression) to prevent longstanding symptoms
Physio post surgery to return to normal function
MRI & bladder scanning within 48 hours
Signs & symptoms of a cauda equina syndrome
Retention of urine
Loss of anal tone
Saddle anaesthesia
Bilateral leg pain and/or numbness
Sexual dysfunction
What is a Radiculopathy
Change in the neurological functions from nerve root compression, irritation or sensitivity
Signs & symptoms of a Radiculopathy
Cervical arm symptoms
Lumbar leg symptoms
Pain in dermatomal distribution
Sensory sys proms (paraesthesia, anaesthesia, allodynia) in dermatome
Motor loss in relevant nerve roots (myotomes)
Reflex changes (reduced/hyporeflexia)
What is peripheral nerve entrapment/irritation
An area in the peripheral nerves in which the nerve becomes irritated
Where can a peripheral nerve entrapment be located
At an interface or area in which the nerve passes through a small anatomical space
Signs & symptoms of a peripheral nerve entrapment
Pain and/or sensory symptoms at the interface & distal to the are the nerve supplies
Depends which types of nerve it is (some are sensory, motor or both)
Management for peripheral neuropathies
Physio/non-invasive treatment first
Education, activity modification, ROM, strength & function
CTS = splinting
Oral medication has poor benefit
CSI can provide short term relief
Potential surgery
What scans are used to investigate a myelopathy, Radiculopathy & peripheral nerve entrapment
Myelopathy = full spine MEI
Radiculopathy = MRI in local region
Pheripheral nerve entrapment = EMG studies
