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JCCC 2017 Issue 4

Table of Contents

Five Things to Know about Cauda Equina Syndrome

Teaser: 

Drew A. Bednar, MDCM, FRCS(C), FAAOS,

Clinical Professor of Orthopedic Surgery, Adult Spine Surgeon, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: Cauda Equina Syndrome (CES) is a rare progressive syndrome of pain and neurological deficits below the waist caused by massive central lumbar disc prolapse. The most common clinical presentation is highly variable with multifocal mixed polyradicular deficits. Loss of bladder and/or bowel control can be subtle and is frequently not the patient' chief complaint. These symptoms must be aggressively sought by the assessing physician. While delays of a few hours in the diagnosis and management may not be deleterious, definitive lumbar MRI imaging and (if positive) surgical care referral are emergent.
Key Words: Cauda Equina Syndrome; Presentation; Diagnosis; Outcome.

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www.cfpc.ca/Mainpro_M2

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The CES patient often presents with rapidly escalating, poorly controlled pain. There may be daily or even more frequent physician visits.
While standing, the CES patient commonly adopts a "sciatic scoliosis": forward bending at the waist and leaning to either side as they attempt to decompress themselves. They may limp or need walking aids. These features help distinguish them from drug-seekers or malingerers.
Since patients are distracted by extreme pain, they may not reliably volunteer a history of bladder/bowel disturbance.
Cauda Equina Syndrome is an acute or subacute pathology caused specifically by massive central prolapse of a lumbar disc. Decompensation lumbar spinal stenosis is not Cauda Equina Syndrome.
Cauda Equina Syndrome most commonly presents with complaints of back or leg pain. These differ from common sciatica in being rapidly progressive, difficult to control with analgesics and often associated with considerable locomotor impairment.
The neurological examination in Cauda Equina Syndrome most commonly finds a mixed pattern of incomplete polyradicular deficits in the distribution of multiple lumbar and sacral nerve roots involving either of the legs and/or the saddle (perineum). The classically described complete flaccidity with loss of all motor control from the waist down is extremely rare.
Patients presenting with CES will not commonly volunteer complaints of incontinence or urinary retention as they are often overwhelmed by the magnitude of their pain. The assessor must specifically ask about bowel/bladder function and when indicated, test these by bladder scanning or catheterizing and a digital rectal examination.
As a rapidly evolving syndrome of neurological deterioration, CES warrants emergent imaging investigation and referral. Although the literature is not precise on the critical time point, it is widely accepted that patients should receive surgical intervention within 24 to 48 hours.
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Related Terms: Back Health, cauda equina syndrome, presentation, diagnosis, outcome
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Movement as Medicine in Osteoarthritis

Teaser: 

Dr. Zahra Bardai MD CCFP (COE) MHSc FCFP,

Community Family Physician, Lecturer, University of Toronto, Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: Osteoarthritis is a prevalent health condition that affects millions of people worldwide. Increasingly, there has been a growing body of international recommendations emphasizing non-pharmacologic interventions using physical activity to modify joint mechanics. Discussion will focus on pathophysiology of joint mechanics as it relates to physical activity as well as the use of specific clinical strategies that can be incorporated into physical activity counseling in osteoarthritis management.
Key Words: Osteoarthritis, Physical Activity, Exercise Vital Sign, Exercise Prescription.
Osteoarthritis is a leading source of nonfatal health burden
Non-pharmacologic treatments of osteoarthritis focus on modifiable factors in joint mechanics
Osteoarthritis is a structural and functional failure of joints
Movement and physical activity have protective effects on osteoarthritic joints
The Exercise Vital Sign should become incorporated into assessments for preventative health and chronic disease including osteoarthritis.
The Exercise Prescription tool can help clinicians formally prescribe exercise as a treatment for their patients.
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Related Terms: Arthritis, Sports Medicine, osteoarthritis, physical activity, Exercise Vital Sign, Exercise Prescription

JCCC 2017 Issue 3

Table of Contents

Back Education: Does it Work for Patients?

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,

Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

CLINICAL TOOLS

Abstract: Back education or “Back Schools” are used both as a method of prevention and, in conjunction with traditional rehabilitation and exercise programs, as a component in treatment of recurrent or persistent low back pain. It is challenging to evaluate the effectiveness of this educational effort. Models have varied from brochures, booklets and simple office conversations to formal scheduled classes. Content has ranged from purely mechanical instruction to complex cognitive behavioural therapy. Essential to success is the ability to integrate the instructions into activities of daily living. The composition of those lessons remains the subject of continuing debate.
Key Words: Back School, education, body mechanics, prevention, pain management.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Back education programs do not reduce the frequency or severity of future back pain attacks.
The educational message should be consistent, frequent and stress self-management.
Group education is useful but the message must be tailored to the individual.
Information must be integrated into the patient's daily routine.
Back education should be part of rehabilitation and is probably most effective during the sub-acute phase of recovery when the pain is still present but not so distracting that it prevents learning.
Comprehensive back school includes spinal anatomy, instruction in proper body mechanics, individualized pain control techniques plus the recognition and treatment of pain disorder through cognitive behavioural therapy when required.
The back program should follow the precepts of adult education with frequent interaction, problem solving, practical applications and a focus on participation.
A successful back school educates the patient about the benign nature of back pain and provides the tools to transfer knowledge about back hygiene into practice in the patient's life.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Back School, education, body mechanics, prevention, pain management