OrthoExam - PARTA:SPINALORTHOPAEDICS...

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PART A:  SPINAL ORTHOPAEDICS Section 1: Answer all questions Short answer questions Total 15 marks   1. Using signs and symptoms only, differentiate between the following:   a) a) Reflex Sympathetic Dystrophy of the right arm and C6,7 intervertebral disc syndrome (2 marks)  -cervical disc-more common in older people. -local neck pain with sharp raiation to arm unilaterally in dermatome pattern. -must shake arm to dec symptome. -sleep often disturbed by night pain. -dec ROM towards lesion side and may reproduce symptoms. -neuro changes detected. -mm weakness may be before onset of pain. -RSD. -persistent swelling and stiffness. -skin discolouration. -local temp changes, initially hot then cold. -symptoms occur distal to the site of trauma.  b) b) Cluster Headaches and Common Migraine (2 marks)  -cluster-vascular origin may be triggered by alcohol or tobacco. -severe unilateral temporal/peri orbital pain-nostril blocks and eye waters. -often wake patient at night. -short duration. -incapacitatingly painful and occur in a series over a period of weeks or months then remit spontaneously. - will not lie quietly but paces agitatedly with pain . -common migraine. -sharp pain throbbing severe. -unilateral-hemi cranium. -peri-ocular. -nausea, extremely light / sound sensitive. -exercise aggravates. -disabling, infrequent and short. c) c )  Scapulo-costal Syndrome and T3,4 facet capsule strain (2 marks)   -facet capsule-unilateral pain most common. -paindull and difficult to localize. -pain may refer non dermatomal. -subjecting sensory and motor changes may ve present. -pain does not change by traction or changed in posture. -local tenderness on palpation.
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-associated headache. -minor dec in ROM -scapulo costal syndrome. -pain around the tip of the scapula. -weak levator scapula or rhomboid. -no neuro changes. -trigger points at attachment of rhomboid and levator scap. d) d) Sub-dural Haematoma and Classic migraine (2 marks)   -classic migraine-sharp , throbbing, severe pain. -unilateral  hemi cranium and periocular. -prodroma may include visual field defects, hyper acusis, mood changes. -numbness/paraesthesia, nausea, extremely light and sound sensitive. -exercise aggravates. -disabling and infrequent and short. -sub-dural haematoma-usually elderly and children and often following trauma. -venous haemorrhage from a clot, which absorbs CFS osmotically. -symptoms occur over weeks or months progressively. -unilateral headache and developing contralateral hemiplegia with associated confusion and progressive loss of  consciousness.
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