Inflammatory, Autoimmune, Infectious Diseases (Part 2) | Lower Back Pain | Spine Expert in Colorado

Inflammatory, Autoimmune, Infectious Diseases (Part 2) |  Lower Back Pain | Spine Expert in Colorado

parkinson’s disease occurs in elderly it is noted to be one percent in
population over the age of sixty it’s associated with tremor muscle rigidity bradykinesia and akinesia difficulty
with muscle motion akinesia is the loss of normal automatic motion such as eye blinking swallowing so patients can drool and have a
decreased arms swing when walking many patients will have a pil rolling
maneuver at rest motor strength will be normal even
though the motion is slow and seventy five percent of patients may
have unilateral symptoms there is rest tremor present that is a pill
rolling but the voice tremor typically does not
occur and there is a typical gait called a festianation gait the patient tends to take short steps
with the upper body traveling faster than the lower body and a walk will typically turn into a
run in advanced diseases charcot marie tooth disease is an
inherited disease of peripheral nerves there’s actually a number of different
types it’s also called peroneal muscle atrophy the myelin sheath and the nerve itself
are both affected and it’s both motor and sensory the hallmark of this disease is a cavovarus foot a fancy way of
saying a very high arch turned in foot with arched toes the picture on the side
is significant for this some individuals have a quote stork leg
appearance unquote where they have lower leg muscle atrophy but the upper muscles in the thighs are
still intact ten percent of patients with
charcot marie tooth will have a spinal deformity and intrinsic
muscles of the hand can also be involved lyme disease lyme disease is in infectious
neurologic diesease caused by the bite of the deer tick this deer tick will carry the bacteria borrelia burgdorferi which is a
spirochete the onset from the tick bite is about three to thirty two days and eighty percent of patients will
experience a rash called in erythema migrans what they’ll see is a small central erythematuous macula or papule that spreads into a larger red ring with central clearing called the target lesion seen on the lady
on the right the symptoms will initially be headaches fever chills myalgias and fatigue fifteen percent of these patients
will develop frank nerve abnormalities such as meningitis encephalitis cranial neuritis such as bell’s palsy plexitis or momoneuritis multiplex individual
nerves which all become involved in months to years later the patient can develop chronic nerve
manifestations which include mood memory sleep patterns spinal and even radicular
pain and eight percent will develop cardiac
manifestations the treatment is doxycyclin and erythromycin if caught early guillain barre syndrome is called ascending paralysis it’s an autoimmune disorder associated with myelin destruction onset can be days or weeks after a viral
prodrome it starts always in the foot it works
up the leg and then ascends up the spine the ascent can take two to three weeks but some aggressive cases have noted to
see three to four hours of ascent the mildest form of guillain barre is simple
fatigue and typically won’t be recognized when the ascent goes to the diaphragm life-support it’s necessary and the affestc typically disappear within months but fifteen percent of patients can have
lasting impairment herpes zoster as most people know herpes zoster or
shingles is the varicella virus or the
chicken pox virus if a patient hasn’t had chicken pox they won’t develop herpes zoster the virus typically lies dormant in the
spinal dorsal root ganglion and for some reason a unknown
stressor will activate the virus the symptoms are unilateral pain down the dermatome of the nerve and two to three days later a rash will develop these are small reddish fluid filled blisters called vesicles the rash increases from onset for
three days and then dries up and small scars can permanently form there is a very painful condition that can occur to an injured nerve called post-herpetic neuralgia which is painful scarring of a nerve and a permanent painful condition if steroids are given during the
beginning of the attack this will typically prevent nerves
scarring parsonage turner syndrome is a brachial plexopathy an involvement of the lower motor
neurons of the brachial plexus it will be an onset somewhat similar to
a herniated disc in the neck it’s one sided unilateral shoulder
pain which is severe and crescendos in a day or two it’s associated with
significant weakness of the shoulder and the upper extremities the paralysis can last months to a year and typically there’s full recovery in
about seventy five percent but this is prolonged males are noted to be much more common
than females at 2:1 to 4:1 the diagnosis is made by exclusion and
an EMG as this is a plexopathy an EMG should not show any involvement
of the pair of vertebral muscles autoimmune vertebral involvement or spondyloarthropathies most of these disorders start with the sacroiliac joint
involvement except for rheumatoid arthritis and
lupus most are unilateral SI involvement
except ankylosing spondylitis which is typically bilateral involvement stiffness in the morning that gets
better with motion is a typical indicator of the autoimmune vertebral involvement fatigue is also very common the types of spondyloarthropathies are rheumatoid arthritis psoriatic
arthritis ulcerative colitis crohns reiter’s syndrome ankylosing spondylitis and lupus DISH is diffuse idiopathic skeletal hyperostosis or forestier’s
disease this is a typically non painful disease and associated with diabetes ten percent of patients with diabetes will have this disease it’s characterized by these non marginal very large osteophytes
sites where the spine starts becoming stiff and the spine can eventually fuse
together unilateral SI involvement as noted
before are typically the seronegative
spondyloarthropathies seronegative because the serum is
negative there is no HLA B27 here and again noted ulcerative colitis and
crohn’s psoratic arthritis reiter’s
syndrome but not ankylosing spondylitis as there
is bilateral involvement in this CT scan we can see the right
SI joined is not involved and the left SI joint is fused indicating a unilateral SI involvement or seronegative spondyloarthropathies seronegative spondyloarthropathies develop non marginal syndesmophytes
these are spurs that join the vertebra together that are not right on the margin they
actually swing out here marginal syndesmophytes that go right edge to edge are typical of
ankylosing spondylitis and again these diseases have
sacroiliac involvement fatigue and lethargy and typically not common HLA B27
but they can have that this is compared to
ankylosing spondylitis the prototype for these diseases it first starts with bilateral joint
sacroiliac involvement the incidence is considered to be one in
a thousand in patients there’s periods of remission and
aggravation it’s typical to have back pain that
wakes the patient up at night morning stiffness it is relieved with
exercise anterior uveitis and unlike the others marginal
syndesmophytes it’s typically called a bamboo spine in
ninety five percent of patients are positive for HLA B27 it’s also a typical to have a kyphosis
and as we can see this patient’s bent forward with a few
spine and we look at the brow chin angle ankylosing spondylitis starts on x-rays with an initial squaring of the vertebra as you can see here the vertebra should
typically be cut but they start to square and marginal
syndesmopkytes are the most common findings physical exam findings and ankylosing spondylitis will first be noted with chest excursion if you measure inspiration and
exploration of the chest they will be much more limited than
normal reduction or absence of normal lumbar
range of motion can also be associated with this

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