Spine.pptx and its functions with complete assesment
- 1. Management of spine related MSK disorders
- 4. Pathology of the Intervertebral Disc • Herniation: a general term used when there is any change in the shape of the annulus that causes it to bulge beyond its normal perimeter
- 5. Protrusion nuclear material is contained by the outer layers of the annulus and supporting ligamentous structures
- 6. •Prolapse: rupture of the nuclear material into the vertebral canal
- 7. Extrusion • Extension of nuclear material beyond the confines of the posterior longitudinal ligament or above and below the disc space, as detected on MRI , but still in contact with the disc
- 8. Free sequestration • the extruded nucleus has separated from the disc and moved away from the prolapsed area
- 11. Disc herniation, tissue fluid stasis, discogenic pain, and swelling from inflammation are conditions that may result from prolonged flexion postures, repetitive flexion microtrauma, or traumatic flexion injuries.
- 12. Tissue Fluid Stasis • During sustained end-range flexed postures in the spine, the discs, facet joints, and ligaments are placed under sustained loading. • The intra-discal pressure increases, and there is compression loading on the cartilage of the facets
- 13. • and a distractive tension on the posterior longitudinal ligament and posterior fibers of the annulus fibrosus. • Ligamentous creep and fluid transfer occur. • Sudden movement into extension does not allow for redistribution of the fluids and so increases the vulnerability of the distended tissue to injury and inflammation.
- 14. • Initially, symptoms may be exacerbated when attempting extension but then may be decreased when using carefully controlled extension motions. Several studies have documented that patients with a herniated nucleus pulposus (HNP) who have symptom reduction with an extension approach to treatment respond favorably to conservative nonsurgical treatment
- 15. Signs and symptoms of disc lesion Pain. Symptoms of pain arise from pressure of a swollen disc or swollen tissues against pain- sensitive structures (ligaments, dura mater, blood vessels around nerve roots) or from the chemical irritants of inflammation if there is herniated disc material
- 16. Neurological signs Pressure against SC or nerve roots specific myotome weaknesses and specific dermatome sensory changes Decrease SLR
- 17. Posterior or posterolateral protrusions are most common. With a small posterior or posterolateral lesion, there may be pressure against the posterior longitudinal ligament or against the dura mater or its extensions around the nerve roots. The patient may describe a severe midline backache or pain spreading across the back into the buttock and thigh.
- 18. A large posterior protrusion may cause spinal cord signs such as loss of bladder control and saddle anesthesia. If a large protrusion is untreated or undiagnosed in the cervical region, it may lead to cervical myelopathy The clinical syndrome that results from a disorder in the spinal cord that disrupts or interrupts the normal transmission of the neural signals is called a “myelopathy”
- 19. • The most common levels of protrusion are the segments between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and sacrum • Disc herniations in the thoracic spine are extremely rare (only 1 in 1000) d/t small disc to vertebrae ratio and osseous alignment.
- 20. Onset and Behavior of Symptoms from Disc Lesions Onset is usually between 20 and 55 years of age but most frequently from the mid-30s to 40s. Except in cases of trauma, symptomatic onset in the lumbar spine is Usually associated simply with bending, bending and lifting, Or attempting to stand up after having been in a prolonged recumbent, sitting, or forward-bent posture.
- 21. • The person may or may not have the sensation of something tearing. Although cervical disc lesions are not as prevalent, a prolonged flexed spinal position as in a forward head posture may lead to or exacerbate symptoms from a protrusion. Many patients have a predisposing history of a faulty flexion posture
- 22. Pain behavior Pain may increase gradually when the person is inactive, such as when sitting or after a night’s rest. The patient often describes increased pain when attempting to get out of bed in the morning or when first standing up. Symptoms are usually aggravated with activities that increase the intradiscal pressure, such as sitting, forward bending, coughing, straining, or when attempting to stand after being in a flexed position. Usually, symptoms are lessened when walking except when the bulge is large or the nuclear material has prolapsed and moved beyond the confines of the annulus
- 23. • The patient may have a decrease in or loss of lumbar lordosis and may have some lateral shifting of the spinal column. ■ Forward bending is limited. When repeating the forwardbending test, the symptoms increase or peripheralize. • Peripheralization means the symptoms are experienced farther down the leg.
- 24. Backward bending is limited; when repeating the backwardbending test, the pain lessens or centralizes. Centralization means that the symptoms recede up the leg or become localized to the back. If the protrusion cannot be mechanically reduced, backward bending peripheralizes or increases the symptoms. ■ If there is a lateral shift of the spinal column, backward bending increases the pain. If the lateral shift is first corrected, repeated backward bending lessens or centralizes the pain
- 25. • Pain between 30° and 60° of straight-leg raising is considered positive for interference of dural mobility but not pathognomonic for a disc protrusion
- 26. Spondylosis /Osteoarthritis/ Degenerative Joint Disease Osteoarthritis involves degeneration of the IV disc as well as the facet joints. Usually, there is a history of faulty posture, Prolonged immobilization after injury, or severe Or repetitive trauma
- 27. Rheumatoid Arthritis Symptoms of rheumatoid arthritis (RA) can affect any of the synovial joints of the spine and ribs. There is pain and swelling RA in the cervical spine presents special problems. There are neurological symptoms wherever degenerative change or swelling impinges against neurological tissue. There is increased fragility of tissues affected by RA, such as osteoporosis with cyst formation, erosion of bone, and instabilities from ligamentous necrosis. Most common of the serious lesions are atlantoaxial subluxation and C4–5 and C5–6 vertebral dislocations
- 28. Inappropriate movements of the spine in patients with RA, such as performing cervical manipulation, could be life-threatening or extremely debilitating because of the potential to cause damage to the cervical cord or vertebral artery
- 30. Ankylosing Spondylitis (AS) AS is a rheumatic disease characterized by chronic inflammation of the ligaments in the lumbar and spinal areas. The inflamed cartilage/boney junction will fuse in approximately 20% of the population This pathology appears to begin in the lumbar spine and progress cephalad. The sacroiliac joints are affected nearly 100% of the time, followed by the neck (75%), lumbosacral area (50%), and hips and heels (30%).
- 31. There is a gradual loss of motion and the person will Complain of general stiffness. The patient may initially Complain of bilateral pain in his or her sacroiliac joints, thoracic spine, or shoulders. The person will wake up early with pain and stiffness and have difficulty standing up straight. ■ In advanced cases, radiographs will reveal a “bamboo” spine.
- 32. Scheuermann’s Disease Scheuermann’s disease is a rare congenital and/or degenerative weakening of the vertebral endplates, typically seen at T10–L2. The nucleus pulposus can protrude vertically into the vertebral end-plate, which can lead to a boney necrosis or Schmorl’s nodes. (chamo-rs) Scheuermann’s disease may also be caused by insufficient blood supply to the growing bone. This pathology is usually seen in the second decade of life and may be diagnosed as “growing pains.”
Editor's Notes
- #14: Creep: time dependant elongation.