Sunday, 21 October 2007

Ankylosing spondylitis



Question mark posture

Protrudent abd

Loss of lumber lordosis

Restriction of the spinal movement in all directions

Heel-occipit-hip test is positive

Schober’s test is positive


Ask about Hx of:

Back pain which increase with rest or prolong immobility, and improve with exercise

Asymmetrical arthropathy

Heel pain (achellis tendonitis, planter faciitis)


Examine for:

Reduce Chest expansion and apical fibrosis

Eyes for iritis

Heart for AR


What are the clinical features?

Apical fibrosis

Anterior uvitis

Aortitis

Aortic regurg

Amyloidosis

Achellis tendonitis


What are the criteria for diagnosis?

Clinical: limited movement of the spine in the 3 planes

Pain in the lumber spine

Chest expansion <2.5

Radiological: uni/bilateral sacroilitis


What are the Ix?

ESR/CRP

X-ray of the spine: loss of lumber lordosis

Squiring of the vertebra

Bamboo spine (calcification of ligaments,

Fusion of the spinal facets,

Syndesmophytes)

X-ray sacroiliac joint


What are the lines of management?

Exercise

NSAID’s

Spinal surgery (vertebral wedge oesteotomy)





read more.

18 comments:

  1. in my exam,respiratory station,I was asked look at the patient then proceed to respiratory examination.
    patient had ankylosing spondylitis and the discussion was about causes of upper lobe fibrosis and how to investigate and manage this patient.

    ReplyDelete
  2. Schober's test:
    to assesses the amount of lumbar flexion.
    a mark is made at the level of the posterior iliac spine on the vertebral column, i.e. approximately at the level of L5. The examiner then places one finger 5cm below this mark and another finger at about 10cm above this mark.
    The patient is then instructed to touch his toes.
    If the increase in distance between the two fingers on the patients spine is less than 5cm then this is indicative of a limitation of lumbar flexion.

    ReplyDelete
  3. the A disease:
    artheritis
    atlanto-axial subluxation
    arachnoiditis
    apical fibrosis
    anterior uveitis
    aortitis
    aortic regurg
    AV block
    amyloidosis
    IgA nephropathy
    achilles tendinitis

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