Quick revision Orthopedics

1. What 2 common syndromes are caused by intervertebral disc lesions?

Discogenic (sclerotome) back pain with and without neuro deficits

3. Give some terms which describe changes in the disc’s morphology

Bulge., herniation, protrusion, proplapse

3. What % of patients w/o back pain or sciatica have a disc herniation on a CT scan?

30+%

3. Name the 2 categories of intervertebral disc syndrome

With or without neuro deficits

3. Where is the lesion associated with sclerotome back pain?

In the annular fibers

8. What is “psuedoradicular pain” and what is a synonymous term?

Sclerotome pain (w/o neuro defs.)

8. Describe the mechanism of sclerotome referred pain.

Afferentation (dural irritation, ligamentous irr.)

8. What symptoms signs and deficits are absent in sclerotome pain syndrome?

Neurological

8. What may cause sciatica without neurological deficit?

Irritation of dura, ligaments (pll), annulus

8. What is another name for sciatica with neurological deficit?

Compressive radiculopathy

8. Describe the signs and symptoms associated with sciatica with neuro. Defs.

Dermatome, myotome, and reflex defs

15. What distinguishes between each category of discogenic back pain?

The nature of the pain and presence or absence of neuro signs

15. How is sclerotome pain described?

Deep, dull, achy

15. What is Minor’s sign?

Pushing up from a sitting position, need help getting up

15. How is discogenic leg pain described?

Achy, dull, deep, reproducible

15. What are at least 3 other synonyms sclerotome leg pain?

Somatic, psuedoradicular, referred

15. What would the SLR be when performed on patients with sclerotome leg pain?

Pain above 60°

15. Where might the SLR refer pain in patients with sclerotome pain?

Into the leg

15. Are there nerve tension signs in patients with sclerotome leg pain?

No

15. What are sensory, motor, and reflex test results in patients with sclerotome leg pain

Normal

15. In patients with sciatica, which pain is typically more severe back or leg?

Leg

15. How do patients describe the leg pain associated with sciatica?

Burning

15. When does the patient experience tingling or numbness?

With category II nerve compression

15. What may confirm that the positive SLR is the result of nerve root tension?

Pain at less than 60°, braggards

15. What describes the sensory, motor, and reflex findings of patients with sciatica w/o neuro def.

All normal

15. What are the signs associated with cauda equine syndromes?

Bilateral leg pain, autonomics deficits, loss of bladder and bowel control

15. What % of patients with sciatica demonstrate cauda equine syndrome?

Less than 1%

15. What sign is demonstrated in the sciatic patient by extending the seated patients knee?

Bechterew’s tripod sign

15. At what degree of SLR does nerve root tension produce pain?

Less than 60°

15. To where is the pain of upper lumbar nerve root irritation/compression referred?

Anterior thigh

15. On what is the diagnosis of IV disc syndrome based?

Clinical presentation, ortho, and neuro testing

Category: Orthopedics Notes