Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
This is a chronic inflammatory disease that presents with progressive spine stiffness. It is most often seen in young adults with an onset of 20-30 y.o., inflammation around enthesis causing fibrous or bony bridging of joints is seen. It responds to NSAIDS.
|
Ankylosing Spondylitis
|
|
|
This occurs at the intervertebral disc margins. The apophyseal joint capsue insertion on the bone is affected, as well as teh ligamentous insertions on the spine.
|
Ankylosing Spondylitis
|
|
|
What are the primary sites of disease in ankylosing spondylitis?
|
Sacroiliac Joints
Apophyseal Joints |
|
|
Many patients with ankylosing spondylitis are positive for this genetic marker?
|
HLA-B27
|
|
|
What are two major signs of ankylosing spondylitis?
|
Pain radiates to gluteal region and proximal posterior thigh.
Morning back stiffness that improves with activity, sometimes this pain will disrupt sleep. |
|
|
This is the most frequent extraarticular manifestation of ankylosing spondylitis?
|
Acute Anterior Uveitis
|
|
|
How does acute anterior uveitis, associated with ankylosing spondylitis, present?
|
Severe eye pain, redness, photophobia, blurry vision, increased lacrimation. Immediate referral to ophthomologist is required.
|
|
|
What is a physical exam test that can be used to diagnose ankylosing spondylitis?
|
Schober's Test
|
|
|
What physical exam findings will you have with ankylosing spondylitis?
|
Pain with palpation of the following:
SI joint Spinal/paraspinal region Ischial tuberosities Iliac crests Costovertebral/Costochondral junctions Achilles tendon/Plantar fascia Reduced lateral flexion, extension, and rotation of the back. |
|
|
What is the most prevalent sign of ankylosing spondylitis on X-Ray?
|
Bamboo Spine appearance
|
|
|
What is the TX for ankylosing spondylitis?
|
NSAIDS - start with period NSAID use but may need to progress to continual therapy.
Replace NSAIDs with COX-2 Inhibitor (celecoxib) if NSAID unsuccessful |
|
|
This is a narrowing of the spinal canal, compressing the nerve roots. Primarily effects the lumbar region but can effect any region of the spinal column. Effects mostly older people. Is characterized by back pain and "neurogenic claudication".
|
Spinal Stenosis
|
|
|
There are two types of Lumbar Spinal Stenosis, what are they?
|
Acquired
Congenital |
|
|
This is the most common type of lumbar spinal stenosis, it is caused by degenerative disease, trauma, post-spine surgery, metabolic or endocrine disorders, Paget's disease.
|
Acquired Lumbar Spinal Stenosis
|
|
|
This is lumbar spinal stenosis that presents at an early age (30-40 y.o.) and is caused by achondroplasia or is idiopathic.
|
Congenital Lumbar Spinal Stenosis
|
|
|
The signs and symptoms of this are as follows:
Neurogenic Claudication Aching pain originating in the low back, that radiates to the buttocks and upper legs. It worsens with walking and standing. Relief with sitting, lying or bending forward. |
Lumbar Spinal Stenosis
|
|
|
With this you can see leg neuropathy such as numbness, parasthesias, weakness, "spaghetti legs", wide gate "walking like a drunk soldier".
|
Lumbar Spinal Stenosis
|
|
|
What imaging studies are used for diagnosing Lumbar Spinal Stenosis?
|
MRI
CT Myelography good alternative in patients unable to have MRI |
|
|
What are the non surgical TX for spinal stenosis?
|
Physical Therapy
Weight Loss NSAIDS Epidural Injections |
|
|
What are the surgical options for lumbar spinal stenosis?
|
Laminectomy - Removal of lamina and spinous process adjacent to impinged nerve.
Laminotomy - Only a portion of the lamina is removed. |
|
|
The key characteristics are that it produces a siciatic type pain, there are clear physical exam findings that suggest disc impingement on nerve roots. Most common site for this is at L4-L5 or L5-S1.
|
Herniated Disc Disease
|
|
|
With this there is a degeneration of the outer layers of the intervertebral disc, weaking of the anulus fibrosus, and tearing and fissure formation of the anular layers.
|
Herniated Disc Disease
|
|
|
This usually has a distinct time of onset, ie it is not gradual. There is a sharp, burning, stabbing pain that radiates down posterior or lateral aspect of the leg to below the knee. Often numbness and tingling. Pain worsens with sitting or bending, relief with standing or lying.
|
Herniated Disc Disease
|
|
|
This is what a person with herniated disc disease does when they are in pain and want to try to avoid impinging a nerve root.
|
Sciatic list
|
|
|
What are the physical exam findings with herniated disc disease?
|
Difficulty heel walking
Decreased SAR with great toe dorsiflexion Straight leg raise test - pt feels pain at less than 80 degrees of leg being raised, when foot is dorsiflexed there is more pain. |
|
|
What is the gold standard for imaging herniated disc disease?
|
MRI
|
|
|
What is the TX for herniated disc disease?
|
Conservative Therapy - Bed rest 2-7 days, exercise - strengthening of abdominal and back muscles, weight loss. Injections - lidocaine at trigger points or areas of localized pain.
|
|
|
This results from a compression of cauda equina nerve roots by a lesion:
Traumatic Injury Lumbar disc herniation Abscess Spinal epidural hematoma Tumor Late stage ankylosing spondylitis Presenting symptoms: Non specific back pain Urine or stool incontinence Saddle paresthesia |
Cauda Equina Syndrome
|
|
|
What are the exam findings associated with cauda equina syndrome?
|
Pain with palpation of the lower back
Diminished or absent DTRs Loss of light touch in perineum Poor anal sphincter tone |
|
|
What imaging is best to diagnose cauda equina syndrome?
|
CT scan
|
|
|
What is the best TX for cauda equina syndrome?
|
Emergency surgical removal of impinging lesion
Permanent nerve damage can ensue if not corrected surgically |
