Rheumatology notes detailing rheumatological pathologies and conditions for medical school examinations. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary contents of this ...
Description
Often self-limiting but can be sign of sinister cause such as malignancy, infection or inflammatory disease. If presenting
with red-flag signs, further investigations are required
Back Pain in General
Presentation Investigations
- Spine: Assess Forward/Lateral Flexion; Extension - General: FBC; ESR; CRP
- NB: Schober’s test - Paget’s: U&E; ALP
- Sacrum: Assess sacroiliitis - Myeloma: Electrophoresis; Bence-Jones in urine
- Nerve: Limb sensation/power; Nerve root pain - X-ray: Bony abnormalities or fractures
- NB: Straight leg raise; Femoral stretch tests - MRI: Prolapse; Cord compression; Various lesions
Causes Management
- 15-30 YO: Prolapsed disc; Trauma; AS; Pregnancy - Neuro Sx: Urgent referral (see below)
- 30-50 YO: Prolapsed disc; Malignancy - Thoracic Pain: Urgent referral
- >50 YO: Paget’s disease; Myeloma; Spinal stenosis - Non-specific Sx: Paracetamol ± NSAIDs ± Codeine
- Rare: Cauda equina tumour; Psoas abscess; Pott’s - Alternative: Consider low dose neuropathic meds
Red Flag Symptoms Associated with Back Pain
Aged <20 YO or >55 YO Worse pain on being supine Thoracic back pain Sphincter disturbance
Acute onset in elderly people Fever + Night sweats + ↓ Weight Morning stiffness Current or recent infection
Constant / Progressive pain Hx of malignancy Bilateral or alternating leg pain Immunosuppression (e.g. steroid/HIV)
Nocturnal pain Abdominal mass Neurological disturbance (sciatica) Leg claudication
Neurological Emergencies
Description - Acute cord compression
- Acute cauda equina compression o Pain: Bilateral pain
o Pain: Alternating or bilateral root pain in legs o LMN: Occur at level of compression
o Sensation: Saddle anaesthesia (perianal) o UMN: Occur below level of compression
o Tone: Loss of anal tone on PR o Tone: Sphincter disturbance
o NB: Bladder ± Bowel incontinence
- Immediate urgency treatment
o Disc protrusions: Laminectomy
o Tumours: Radiotherapy
o Abscesses: Decompression
Nerve Root Lesions
Nerve root Pain Weakness Refex affected
L2 Across upper thigh Hip flexion and adduction Nil
Hip adduction
L3 Across lower thigh Knee jerk
Knee extension
Knee extension
L4 Across knee to medial malleolus Foot inversion Knee jerk
Dorsiflexion
Knee extension
L4 Across knee to medial malleolus Foot inversion Knee jerk
Dorsiflexion
Hip extenion and abduction
L5 Lateral shin to dorsum of foot and great toe Knee flexion Great toe jerk
Foot and great toe dorsiflexion
Knee flexion
S1 Posterior cald to lateral foot and little toe Foot and toe plantar flexion Ankle jerk
Foot eversion
, MRI showing disc herniation and spinal cord compression
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller sk25. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £6.49. You're not tied to anything after your purchase.