Disorders Of Trunk And Spine/msk Infections *

Front 1

L4 responsibilities
(motor, reflex, dermatomal sensation)

Back 1

Motor: tibialis anterior
Reflex: knee jerk
Sensation: Medial aspect of calf/foot

Front 2

L5 responsibilities
(motor, reflex, dermatomal sensation)

Back 2

Motor: extensor hallicus longus
Reflex: none
Sensation: central forefoot

Front 3

S1 responsibilities
(motor, reflex, dermatomal sensation)

Back 3

Motor: peroneus longus and brevis
Reflex: ankle jerk
Sensation: lateral aspect of foot

Front 4

Signs/symptoms of cauda equina syndrome

Back 4

Urinary incontinence
Saddle anesthesia
Decreased anal sphincter tone
Bilateral lower extremity weakness
Progressive neurologic defects

Front 5

Define cauda equina syndrome

Back 5

A neurologic condition in which damage to the cauda equina causes acute loss of function of the lumbar plexus

Front 6

Anulus fibrosis and nucleus pulposus typically occur in which direction?

Back 6

Posterolaterally

Front 7

When ordering imaging studies of the back (s-rays) in which position should the patient be?

Back 7

Standing
AP and Lateral

Front 8

Define Osteoporosis

Back 8

Defined when there is abnormal bone remodeling and fragility

Front 9

Two types of osteoporosis

Back 9

Primary: postmenopausal or elderly people
Secondary: hormonal imbalance, malignancies, or GI problems

Front 10

Best diagnostic tool for osteoporosis

Back 10

Dexa scan

Front 11

Treatment for osteoporosis

Back 11

Prevention is key! (lifestyle and diet choices)
Meds: estrogen, calitonin, PT, bone building drugs such as "forted"

Front 12

Two types of Osteomyelitis

Back 12

Acute Hematogenous Osteomyelitis (kids MC)
Chronic Osteomyelitis (adults MC)

Front 13

Define Acute Hematogenous Osteomyelitis AHO

Back 13

Infection of the bone stemming from bacterimia. It is most often due to Staph aureus and is most commonly found in long bones of peds patients.

Patient may have recent Hx of puncture wound

Front 14

Which two bones does AHO effect most commonly

Back 14

Distal femur
Proximal tibia

Front 15

Which part of the long bone is most affected by AHO?
Epiphysis or metaphysis

Back 15

Metaphysis

Bacteria tend to lodge in an end artery in this area and multiply.

Front 16

Signs and symptoms of AHO

Back 16

Acute tenderness
Fever
Rapid pulse
Localized pain that may radiate to adj. joint
Decreased activity/ROM

Front 17

Lab/Diagnostic Findings in AHO

Back 17

Elevated WBC w/ Left shift, elevated ESR and CRP

Plain radiographs are often false negatives early on

Front 18

Treatment of AHO

Back 18

Emperical antibiotics (ciprofloxacin until culture returns with sensitivity of the bacterium)
Typically treated for 6 weeks

Drainage and debridment in serious cases

Front 19

Define Chronic Osteomyelitis

Back 19

Necrotic bone becomes walled off by a sheath or sac
Arises from acute but untreated AHO
The cavity contains pieces of dead bone, granulation tissue and bacteria

Front 20

What is a sequestrum

Back 20

Dead piece of walled off bone

Front 21

Treatment for Chronic Osteomyelitis

Back 21

Surgery
debridement and reconstruction #1
open drainage, sequestrectomy, amputation

Hyperbaric Oxygen following surgery for some canditates

Front 22

Define Septic Arthritis

Back 22

Inflammation of the joint due to bacteria
Hematogenous spread is the most common type

Front 23

Most common joint affected by septic arthritis

Back 23

Knee joint

Front 24

Most common bacterium causing septic arthritis

Back 24

Staph aureus

Front 25

Signs and symptoms of septic arthritis

Back 25

Swelling
Pain
Limited ROM in that joint
*typically only one joint*

Front 26

Best diagnostic tool for septic arthritis?
What does it look like?

Back 26

Arthrocentesis of joint fluid

Creamy-grayish color with turbidity
Less viscous, no stringing of the joint fluid
*(stringing is normal)*

Front 27

Is there more or less glucose in joint fluid when the joint goes septic?

Back 27

Much less!
<50% of what's in the blood

Front 28

Treatment of septic arthritis

Back 28

Rocephin shot in the buttock until culture comes back
ABX are usually given for 6 weeks (first by IV followed with PO)

Surgery: arthroscopic drainage and debridement

Front 29

Four main purposes for performing surgery in septic arthritis

Back 29

Decreases intraarticular pressure
Decreases bacterial count
Removes purulent discharge
Improves cartilage nutrition

Front 30

Define septic bursitis

Back 30

Inflammation or degeneration of a bursa due to infection

Front 31

Common causes for septic bursitis

Back 31

Direct puncture wound (superficial bursa)
Cellulitis spread (superficial bursa)
Hematogenous spread (deep bursa)

Front 32

Most common organism for septic bursitis

Back 32

Staph aureus

Front 33

Signs and symptoms of septic bursitis

Back 33

Pain
Swelling
WARMTH
TTP
Redness
Fever

Front 34

Treatment for septic bursitis

Back 34

Appropriate ABX with...
Adequate draining of infected bursal fluid

Dicloxacillin 500 mg QID
MRSA = clindamycin
**Bursal excision is a last resort**

Front 35

How does gangrene develop?

Back 35

Blood supply is cut off to the affected body part as a result of various processes such as infection, vascular disease, or trauma.

Front 36

Define dry gangrene

Back 36

Reduction of blood flow through the arteries (vasculitis)

Gradual and slow

Front 37

Define wet gangrene

Back 37

Develops as a complication of an untreated wound. Swelling due to infection stops blood flow and WBCs cannot reach the affected part of the body.

Front 38

Define gas gangrene

Back 38

Type of wet gangrene caused by Clostridia.
Produces a poisonous toxin and gas.

Front 39

Signs and symptoms of gangrene

Back 39

Area turns blue or black
Pain in a localizes area that is severe
Pus or blood draining from wound
Foul smelling odor discharges from wound

Front 40

Clinical presentation of of dry gangrene

Back 40

Dry and numb
Red to brown to black discoloration

Front 41

Clinical presentation of wet gangrene

Back 41

Swollen, decays, foul smelling, oozing, black
Extremely painful
Fever is present

Front 42

Clinical presentation of gas gangrene

Back 42

Swollen with red/brown bloody discharge
Crackling sensatin when the area is pressed
Extremely painful
Pt has fever, increased HR, rapid breathing
**can be life threatening**

Front 43

Treatment of gangrene

Back 43

IV antibiotic and surgery are primary treatments

Dry: anticoagulants, pain relief, amputation
Wet: ABX, Surgical debridement, amputation, IV fluids
Gas: hyperbaric oxygen chamber may be helpful

Front 44

Ankylosing spondylitis - definition

Back 44

* chronic inflammatory disease of the joints of the axial skeleton, manifested by pain and progressive stiffening of the spine

Front 45

Ankylosing spondylitis - epidemiology

Back 45

* onset usually in late teens/20's
* M>F (symptoms more prominent in men)

Front 46

Ankylosing spondylitis - presentation/PE

Back 46

* Onset is usually gradual, intermittent bouts of back pain that may radiate into the buttocks.
* Px worse in morning, stiff for hours which improves with activity
* decreased ROM
* Chest expansion may be limited.

Front 47

Ankylosing spondylitis - Less common S/S

Back 47

- 25-50% peripheral arthritis
- 25% anterior uveitis

Front 48

Ankylosing spondylitis - Dx/Labs

Back 48

* Radiographic changes in sacroiliac joints

* (-) Rheumatoid factor and anti-CCP antibodies

* (+) HLB

Front 49

Ankylosing spondylitis - Tx

Back 49

* NSAIDs
* TNF inhibitors

* Corticosteroids have a minimal impact, and may worsen osteopenia

Front 50

Radiculopathy - general definition

Back 50

* set of conditions in which one or more nerves is affected and does not work properly (a neuropathy)

* can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

Front 51

Cervical radiculopathy - Essentials of Dx

Back 51

* Poor posture is often a factor
* Degenerative disk disease is typical underlying cause
* Symptoms can be referred to the shoulder, arm or upper back
* Px is worse with back extension and relieved by sitting

Front 52

MC cause of neck Px in older pt's?

Back 52

Mechanical degeneration of disks, facet joints, and ligaments

Front 53

Common cause of acute Px in Cervical radiculopathy?

Back 53

- Whiplash

Front 54

Thoracic outlet syndrome in relation to Cervical radiculopathy?

Back 54

TOS is a mechanical compression of the brachial plexus and neurovascular structures causing Cervical radiculopathy

Front 55

Cervical radiculopathy - S/S

Back 55

* Positive Spurling test (rotating and extension of neck) towards affected side.

* Axial load reproduces Px (+ for root compression)

* Dermatoms may be affected: ulnar n. (5th digit, C8-T1), median n. (thumb, C6-8), axillary n. (deltoid, C5-6), spinal accessory (above C4, traps and sternomastoid)

Front 56

Cervical radiculopathy - Dermatomes that may be affected.

Back 56

1) ulnar n. (5th digit, C8-T1)
2) median n. (thumb, C6-8)
3) axillary n. (deltoid, C5-6)
4) spinal accessory (above C4, traps and sternomastoid)
5) lateral side of forearm: C5-6
6) medial side of forearm: C8-T1

Front 57

Cervical radiculopathy - Tx

Back 57

* PT is effective
* Chiropractic
* NSAIDs (Opiods for severe Px)
* Neuropathic medication for radicular symptoms
* Oral steroids (short course)
* Surgery is last resort

Front 58

Coccydynia - definition

Back 58

* pain in the coccyx or tailbone area, usually brought on by sitting too abruptly.

Front 59

Coccydynia - Causes

Back 59

#1 sudden impact due to fall
#2 coccydynia caused by childbirth pressure in women.

Front 60

Coccydynia - Less Common Causes

Back 60

* partial dislocation of the sacrococcygeal synchondrosis that can possibly result in abnormal movement of the coccyx from excessive sitting, and repetitive trauma of the surrounding ligaments and muscles, resulting in inflammation of tissues and pain.

Front 61

Coccydynia - S/S and PE

Back 61

* Px will sitting, MOI, TTP

* simple test: injection of local anesthetic into the area. If the Px relates to the coccyx, should produce immediate relief

* Image if above test postive

Front 62

Coccydynia - Tx

Back 62

* NSAIDS
* Cushion
* stool softeners
* nerve block
* rare surgery

Front 63

Costochondritis - definition

Back 63

* a benign and often temporary inflammation of the costal cartilage

Front 64

Costochondritis - Etiology

Back 64

* often self-limited, it can be a recurring condition that can appear to have little or no signs of onset. MC in 20-40 y/o, F>M

* symptoms can be similar to the chest pain associated with a heart attack.

* often idopathic, but may result from: trauma, ankylosing spondylitis, RA, OA, infection of the joint, or a tumor

Front 65

Costochondritis - S/S

Back 65

* Pain or TTP usually occurs on the sides of the sternum, affects multiple ribs, and is often worsened with coughing, deep breathing, or physical activity.

* Possible swelling at tender areas w/ reproducible Px

* MC in 3-6th ribs

Front 66

Costochondritis - Tx

Back 66

* PT
* NSAIDs
* Opiods if Px severe
* Rest

Front 67

Spondylolysis - definition

Back 67

* a defect in the pars interarticularis of the vertebral arch. (the bony mass between the facet joints, anterior to the lamina and posterior to the pedicle)

* the pars interarticularis is detached/fractured and there is a separation of the joints

* has various sub-types

Front 68

Spondylolysis - general

Back 68

* majority of cases occur in L5,

* but may also occur in the other lumbar vertebrae, as well as in the thoracic vertebrae.

* common in young athletes via repetitive trauma, M>F

Front 69

Spondylolysis - S/S & PE

Back 69

* reduced ROM
* nuero Px below injury
* Px may be above injury via muscular groups)

Front 70

Types of spondylosis:

Back 70

1) Spinal Stenosis- spinal canal becomes narrow and cord can become pinched

2) Cauda equina syndrome- a syndrome where the nerves at the bottom of the spinal cord are compressed by an intervertebral disc or mass

3) Radiculopathy- a condition where one or more spinal nerves are compressed.

4) Cervical Myelopathy- spinal canal narrows to the point that causes spinal cord injury.

Front 71

Spondylolysis may progress to what?

Back 71

Spondylolisthesis

Front 72

Spondylolysis - Tx

Back 72

* PT (strengthen core muscles)
* protect joint (limit movement) w/ brace
* NSAIDs, Px management
* Surgery

Front 73

Spondylolisthesis - definition

Back 73

anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below

* aka "step-off"

Front 74

MC reason for spondylolisthesis?

Back 74

* Spondylolysis (a defect or fracture of the pars interarticularis of the vertebral arch, not to be confused with a herniated disc).

* Causes isc

Front 75

Spondylolisthesis is officially categorized into five different types?

Back 75

1) Dysplastic: rare malformation disease
2) Isthmic: MC Form (spondylolytic spondylolisthesis; slip or fracture of the intravertebral joint)
3) Degenerative: arthritis
4) Traumatic: rare
5) Pathologic: Paget's, TB, tumor

Front 76

Paget's disease of bone

Back 76

* chronic disorder that can result in enlarged and misshapen bones. Paget's is caused by the excessive breakdown and formation of bone, followed by disorganized bone remodeling

* bone to weaken, resulting in pain, misshapen bones, fractures, and arthritis in the joints near the affected bones. Often Paget's disease is localized to only a few bones in the body. The pelvis, femur, and lower lumbar vertebrate are the most commonly affected bones.

Front 77

Spondylolisthesis - S/S

Back 77

* stiffening of the back and a tightening of the hamstrings
* gait change
* semi-kyphotic posture and waddle
* low back Px, w/ intermittent shooting pain from the buttocks to the posterior thigh
* sitting and attempting to stand are painful

Front 78

Spondylolisthesis - Tx of low grade isthmic spondylolisthesis (<50% slip)

Back 78

* Conservative Tx:

activity modification, NSAIDs, oral/inj steroids, Px management, PT

- Surgery is last resort (after 6wks, and often as late as 6-12 months)

Front 79

Spondylolisthesis - Tx of high grade isthmic spondylolisthesis (>50% slip)

Back 79

* Surgery