| Category: | Books | | Genre: | Health, Mind & Body | | Author: | nota nota huda (12 Jan 09 ortho lect) |
pain (commonest)
1. spondylogenic
2. neurogenic
3. viscerogenic
4. vascular
5. psychogenic
spine: mechancal vs neurological
mechanical: bone fracture (often require stabilisation)
neurological: (central/ radicular)
pain pattern
1. low back pain (spasm, discogenic, referred pain)
2. radicular pain (intra/ extraspinal)
3. neurogenic claudication
4. tumor- nite pain
5. infection
6. rheumatological (arthritis-morning stiffness, generalised)
7. Intra abd- AAA, ulcer dz, biliary, pancreatitis, thoracic radicular pain
commonest can be treat,
1. spinal stenosis: narrowing of spinal cord.
Ix: MRI,
spinal end L1/L2 so never UMNL of lesion below L11/L2
increasing leg pain with walking relieved by rest (claudication)
often assc w numbness, tingling heaviness, buttock pain, must sit down for few mins, easier uphill compare to downhill, can ride bicycle wont pain.
PE: no findings
Dx: from hx
2. Spondylolisthesis
Tx: stabilization
young, trauma, back pain, ank spon
3. Disc prolapse
radicular pain- nerve root entrapment
dermatomal distribution
impulse + valsava +ve
assoc w numbness
L4, L5, S1
Check the pt S1 nerve root (power, reflex, sensation)
nerve root tension sign - straight leg testing
ankle reflex
plantar flexion- stand + walk on toe / push up 10x against wall
sensation
Check pt L5 nerve root
straight leg raise
x reflex
abductor muscle
stand one leg
eversion
walk on heel
Check L4 nerve root
reflex: knee
nerve tension: femoral stretch
pain: trouble getting onto chair? climbing stairs? knee jerk?)
Diagnostic
injection
1. LA giving temporary relief of injected joint @ nerve root- aim is dx
2. most pt w symptomatic prolapsed disc will required sx
cauda equina
central compression of all nerves root below the level of compression
Hx: saddle? urinary retention, fecal incntinence, leg signs dependant on level / S1 often involved. maybe very little pain
Tx: decompression
hyperreflexia, clonus of ankle/knee, upgoing plantar response
if compress cord- pain is not the feature, ataxic gait (broadbase gait)
extraspinal of sciatica
osteochondroma: nightpain- woke up from sleep (how many times per nite n how long remain awake)
spinal infection
Tx: decompression +Abx
trauma
tx: stabilisation
spinal tumors: mets from breast, lung, thyroid, prostate, renal, MM. primary tumor very rare
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