Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone. Um, we'll start shortly but would someone mind just letting me know in the chat if you can see and hear me? Ok, perfect. Thank you, Anna. Um, what I'll do is I'll just share the powerpoint and if you could just say yes and the chat again, if you can see it. Ok. So I have to switch windows. So this is what it should be like. So you just put yes, if you can see that now, I'll just go back to the main page. Perfect. Thank you so much, Anna. Um Right. So it's six o'clock. So we'll get started. So I'll head back to the, the powerpoint. Um, so I'm Hannah, I'm an F two, currently working on geriatrics. Um I have an interest in orthopedics and I'm one of the orthopedic leads at mind the bleep. Um So today we're gonna be learning all about the spine and conditions affecting the spine. So some of the MLA content that will be covered is back pain, bone pain, metastatic disease and pathological fractures. Um And really what we're gonna focus mainly on are are the back problems that are the ones you don't want to miss and the, the key red flag things that you're looking for when you see someone with back pain. Um So we'll go through a little bit about all of all of those um conditions and then we've got three cases at the end to go through. Um And I'll ask for your interaction with those about what you would do in that situation. So firstly, we've just got some very brief anatomy of the spine, just, just to kind of give context to what we'll talk about. So, obviously, the spine is split into the cervical spine, thoracic spine, lumbar spine, and then the sacrum down at the bottom. Um So you can see they're all, they're different spinal levels and then you've got intervertebral discs between some of these vertebrae um that act as kind of cushioning between, between the bones. So, looking more closely at the anatomy of the actual vertebrae themselves, you've got the main body of, of the vertebrae, which is the big round bit. And then in the middle, you've got the spinal canal or the vertebral foramen, which is where the spinal cord runs through. So that's really important is what we're, we'll be learning about today. Um And then you've got the spinus process, which is the sticky bit out in the middle. Um And then two bits sticking out on either side as well. So that's your kind of basic anatomy of the vertebra we won't go into too much detail. Um and then you have your spinal nerves that come out the sides. So where the spinal cord goes through the middle, then they come out the sides. So that's just a very quick overview of the anatomy. So, what I'm gonna be talking about is the, the key things with back pain. So when you have somebody coming with back pain in the vast majority of cases, it's going to be something very simple and, and really like a musculoskeletal issue that they've had some kind of injury and pulled a muscle in the back that's causing them pain, potentially limiting activity. Um So for the most part with people with back pain, you're not going to do all of these investigations that that will cover. Um But what I wanted to highlight were the key conditions that you don't wanna miss and how you can direct your history with anyone with back pain to make sure you don't miss those key things. So one of the things that's really important not to miss is bone cancer. And you're particularly cautious about this in people less than 18, presenting with bone pain or over 50 because these are, are the most common times that people might get a bone cancer. So with this type of pain, it might have a gradual onset rather than an acute onset that's happened when somebody has had some kind of injury or strain through the back. Um, it doesn't improve when they're at rest and they might have night pain as well. So these are key things that you want to ask about. They might also have thoracic pain. So the upper spine is affected. Most people presenting with musculoskeletal back pain, it will be the lower back that's affected. So if it's the upper back, that's, that's a red flag to think this might be something more serious. They can have spinal tenderness at a localized point. So it might be over one of the vertebrae. That is the one that's affected and they will have no improvement with physio. So that would suggest that it's not a muscle issue that that can be improved with physio. They could have other red flag symptoms such as weight loss that makes you think cancer. Um and they might even have a history of having a cancer. So, in particular, you're thinking about the ones that metastasize to bone. So lung gi prostate renal and thyroid, those are the key ones that, that you'll be thinking this could be a metastasis to bone. Some people could have a spinal fracture and this could either be just a simple spinal fracture on its own or a pathological fracture caused by a a bone cancer. So I'll come on to that next. But just for a simple spinal fracture, you might have a history of trauma. So in a young person, this could be a severe trauma. So something like a car crash, that's caused that fracture. But in an older person, it could be a much more minor trauma. So just a fall from standing could result in a fracture because they're more at risk for because of things like osteoporosis. They might be on long term steroids or they might be over 70. So those things make you more concerned about a potential spinal fracture. Even with a minor trauma, you might see cuts or bruises around the spine on, on the skin. So that suggests that there is an injury. Um and there might be tender over a vertebral body, then you've got a pathological fracture. So in these fractures, usually there'll be a his no history of trauma, they may have a history of a cancer. So just like we said with, with bone cancer, they may have a history of one of those cancers. But if you suspect a pathological fracture, so you have somebody with a, a fracture to one of the vertebrae, but no history of any cancer, then you probably want to investigate and think is there a cancer that that's resulted in this? So, in this situation, you're gonna wanna take an extensive history, particularly thinking about those types of cancer that metastasize to bone um to see if they have any other symptoms and think about other tests you can do so a PSA in men because prostate is very common to, to go to bone or a CT chest Abels to look for any other organ disease, you can treat a pathological fracture with calcium and Vitamin D if, if they're deficient and also you can use bisphosphonates because sometimes people might have a high calcium because of the fracture. Um and bisphosphonates help with bringing the calcium level down, but also um help with the pain. Um And you also should in these situations, get a neurosurgical opinion to see if there is any surgical intervention to treat the fractures. Um Or if they have any advice on things like using braces and how that person should mobilize. If there's any limits on that and weight bearing, in particular, if it's a cervical fracture, that's um you really want to get that advice to, to see what they think about that neck and if it needs to be stabilized in a brace and all of those kinds of things, so, neurosurgery should be consulted on any fracture. But the most important is is when it's that upper cervical spine area. So coming, I'll just have a quick pause and have a look at the um the chat and just check, has anyone got any questions at this point about those things before we move on to a couple of other things? Ok. I'm gonna take that as a no, because nothing's come through, but I will check back in a bit anyway. So heading back over to the powerpoint. So, um let's think about called a requi so obviously with back pain you always hear that, what you really wanna make sure it's not is, is called a quina syndrome. So, the cor equina is a group of nerves that sit at the bottom of the spinal cord. So the spinal cord runs down to between the L1 and L2 vertebrae and then it finishes in the middle there and then the quarter equina starts in, in that same middle bit between L1 and L2 and runs down. So that group of nerves um innovates the pelvis in the lower limbs and that's sensory and motor innervation and it also innervates the bowel and the bladder. So these are key things to know when you're thinking of your history and in your examination, what signs are you looking for based on what the quina innovates. So, cord Aquinas syndrome happens when the, the nerves of the cord equina are compressed. This could be caused by a herniated disc trauma, a fracture.