Sunday, January 4, 2009
Siesta
Hello all! Will be taking a break from Cuccurullo for the rest of January in order to study for SAE's. I'll be back in February with Rheumatology.
Nonorganic back pain
What are Waddell's signs?
Answers:
3 or more Waddell's signs are cause for suspicion. DO ReST:
1. Distraction: Normal seated straight leg raise.
2. Overreaction: exaggerated reaction to exam.
3. Regionalization: Motor/sensory abnormalities without an anatomic basis.
4. Simulation: Pain axial load on skull.
5. Tenderness: Exaggerated sensitivity or dramatic pain with light touch.
Answers:
3 or more Waddell's signs are cause for suspicion. DO ReST:
1. Distraction: Normal seated straight leg raise.
2. Overreaction: exaggerated reaction to exam.
3. Regionalization: Motor/sensory abnormalities without an anatomic basis.
4. Simulation: Pain axial load on skull.
5. Tenderness: Exaggerated sensitivity or dramatic pain with light touch.
Infection of the spine
*1. What are risk factors for vertebral body osteomyelitis and discitis?
*2. What are the most common infectious agents?
3. What diagnostic studies are used for spine infection?
4. What is the treatment of spine infection?
Answers:
1. Age, diabetes, immunodeficiency, penetrating trauma, GU procedures, invasive spinal procedures, intravenous drug abuse (incr cervical risk), TB (thoracolumbar jxn).
2. Staph aureus (most common), pseudomonas (IV drugs), TB (Pott's disease).
3. By 2 wks, X-ray shows disc space narrowing and blurred endplates. MRI most sensitive: T1 hypointensity, T2 hyperintensity, gadolineum enhancing. Leukocytosis, increased ESR, CRP, positive bone bx.
4. Conservative care icludes spinal immobilization and antibiotics with early ambulation. Surgical care includes decompression or fusion.
*2. What are the most common infectious agents?
3. What diagnostic studies are used for spine infection?
4. What is the treatment of spine infection?
Answers:
1. Age, diabetes, immunodeficiency, penetrating trauma, GU procedures, invasive spinal procedures, intravenous drug abuse (incr cervical risk), TB (thoracolumbar jxn).
2. Staph aureus (most common), pseudomonas (IV drugs), TB (Pott's disease).
3. By 2 wks, X-ray shows disc space narrowing and blurred endplates. MRI most sensitive: T1 hypointensity, T2 hyperintensity, gadolineum enhancing. Leukocytosis, increased ESR, CRP, positive bone bx.
4. Conservative care icludes spinal immobilization and antibiotics with early ambulation. Surgical care includes decompression or fusion.
Thursday, January 1, 2009
Soft tissue spine disorders
1. What is the presentation of lumbosacral strain?
2. What are causes of lumbosacral strain?
3. What is myofascial pain syndrome?
4. How does myofascial pain present?
5. What is the treatment of myofascial pain?
Answers:
1. Muscle ache with spasm and guarding, can occur up to 24-48 hours after injury. Normal neuro exam.
2. Overuse, excessive eccentric contraction, accel-decel injuries, acute trauma.
3. Regional pain with local muscle tenderness and trigger points.
4. Muscle tenderness, trigger points, paresthesias, poor sleep, fatigue, normal neuro exam.
5. Correction of underlying causes, analgesics, tricyclics, rehab focusing on flexibility, strengthening and aerobic exercises. Trigger point injections. Psych counseling.
2. What are causes of lumbosacral strain?
3. What is myofascial pain syndrome?
4. How does myofascial pain present?
5. What is the treatment of myofascial pain?
Answers:
1. Muscle ache with spasm and guarding, can occur up to 24-48 hours after injury. Normal neuro exam.
2. Overuse, excessive eccentric contraction, accel-decel injuries, acute trauma.
3. Regional pain with local muscle tenderness and trigger points.
4. Muscle tenderness, trigger points, paresthesias, poor sleep, fatigue, normal neuro exam.
5. Correction of underlying causes, analgesics, tricyclics, rehab focusing on flexibility, strengthening and aerobic exercises. Trigger point injections. Psych counseling.
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