T7 Musculoskeletal Problems

• What is muscular dystrophy?

  Gradual loss of strength in muscles with increasing disability and deformity as a result of genetic disease.
• What is the most common form of muscular dystrophy?

  Duchenne muscular dystrophy.
• Between Becker and Duchenne MD, which is worse and occurs faster?

  Duchenne MD.
• What can be given for MD that can slow progression for up to 2 years?

  Corticosteroids: Deflazacort (Emflaza).
• What diagnostic measures the muscle serum enzymes for diagnosing MD?

  Creatine kinase.
• What disease modifying drug is used for MD?

  Eteplirsen (Exondys 51).
• Is there a cure for muscular dystrophy?

  No.
• What may be applied to a patient with MD to prevent spinal deformity or injury?

  Orthotic jacket.
• For patients with MD, should they avoid bed rest?

  Yes, limit sedentary periods and keep them active.
• Where is localized pain?

  Discomfort in a specific area.
• Where is diffuse pain?

  A larger area, deep tissue.
• Where is radicular pain?

  Irritation of the nerve root such as sciatica.
• What part of the spine bears the most body weight?

  Lumbar region.
• How long does acute low back pain last?

  4 weeks.
• What test is done to test for disc herniation when radicular pain occurs?

  Straight leg raise.
• When are MRI and CT scans done for acute low back pain?

  Only for trauma or suspected systemic disease.
• When do symptoms occur for acute low back pain?

  Within the first 24 hours.
• What can be given for severe acute low back pain?

  Corticosteroids, opioids.
• How long should bed rest be for acute low back pain?

  1 - 2 days but avoid prolonged bed rest.
• How long does it take for back pain to be considered chronic?

  Anything lasting longer than 3 months.
• What is spinal stenosis?

  Narrowing of the spinal canal.
• What are lumbar symptoms of spinal stenosis?

  Pain in low back radiating to butt and leg, pain increased with prolonged standing or walking, numbness, pain decreases when bending forward or sitting down.
• How is lumbar spinal stenosis treated?

  Similar to acute low back pain except you can give antidepressants like Duloxetine for pain and sleep problems, Gapapentin (Neurontin) to relieve leg symptoms.
• What are signs of cervical disc disease?

  Pain radiates to arms and hands, decreased reflexes and handgrip, may include shoulder pain and problems.
• What is cauda equina syndrome?

  Compression of multiple nerve roots causing severe back pain, progressive weakness, bowel and bladder incontinence or retention, saddle anesthesia.
• What can be done for cauda equina syndrome?

  Surgical decompression to prevent permanent paralysis.
• Which diagnostic helps find structural defects in vertebral discs?

  X-ray.
• What do the myelogram, MRI or CT scan do for vertebral disc disease?

  Helps localize the damaged site.
• What diagnostic is done if the other tests are inconclusive?

  Epidural venogram or discogram.
• What test is done to assess the severity of nerve irritation or rule out other conditions?

  EMG.
• What electrical therapy can be done for intervertebral disc disease?

  Transcutaneous electrical nerve stimulation (TENS).
• When is surgery needed for intervertebral disc disease?

  When conservative treatment fails, loss of bladder or bowel control, persistent neurological deficit.
• What minimally invasive procedures can be done for intervertebral disc disease?

  Intradiscal electrothermoplasty, radiofrequency discal nucleoplasty, interspinous process decompression.
• What is a laminectomy?

  Surgically excise protruding disc through part of the vertebra.
• What is a discectomy?

  Surgically decompress nerve root by removing damaged part.
• What should be done for a patient post spine surgery?

  • Pillows under thighs when supine
  • Pillows between legs when side-lying
  • Log roll to change position
• What do you monitor for after a spinal surgery?

  CSF leakage.
• What are signs of CSF leakage after a spinal surgery?

  Clear or slightly yellow drainage on dressing, fluid is positive for glucose.
• What do you do if a patient has a CSF leakage from their surgical site?

  Place them in a flat position.
• How often should you assess peripheral neurological status post spinal surgery?

  Every 2 - 4 hours during the first 48 hours.