Ankylosing Spondylitis Overview Quiz
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Questions and Answers

What is a primary characteristic of ankylosing spondylitis as seen on spinal X-rays?

  • Thickening of the vertebral discs
  • Increased curvature of the lumbar spine
  • Presence of osteophytes at the C7-T1 junction
  • Loss of anterior concavity of vertebral bodies (correct)

    • Which demographic is most affected by ankylosing spondylitis?

  • Women over 50 years old
  • Children under 10 years old
  • Elderly individuals above 70 years old
  • Men between 20 and 40 years old (correct)

    • What percentage of patients with ankylosing spondylitis present with axial symptoms?

  • 60%
  • 75%
  • 80% (correct)
  • 90%

    • What is the significance of the HLA-B27 gene in relation to ankylosing spondylitis?

    <p>There is a strong association, but it does not guarantee disease occurrence.</p> Signup and view all the answers

    Which of the following conditions is classified under the spondyloarthropathies related to inflammatory low back pain?

    <p>Reactive arthritis</p> Signup and view all the answers

    What is a common cause of patellar tendinopathy in athletes?

    <p>Incorrect training methods</p> Signup and view all the answers

    Which symptom is typically associated with patellar tendinopathy?

    <p>Pain at the tibial insertion of the tendon</p> Signup and view all the answers

    What does functional impotence usually lead to in cases of patellar tendinopathy?

    <p>Antalgic flexion position</p> Signup and view all the answers

    Which condition is NOT related to patellar tendinopathy?

    <p>Plantar fasciitis</p> Signup and view all the answers

    What is a common incident rate of iliotibial band syndrome among runners?

    <p>1.6% to 12%</p> Signup and view all the answers

    Which muscle contributes fibers to the iliotibial band?

    <p>Tensor fascia latae</p> Signup and view all the answers

    Which of the following activities is likely to trigger pain in individuals with iliotibial band syndrome?

    <p>Repetitive knee flexion and extension</p> Signup and view all the answers

    What is the primary factor involved in the development of patellofemoral pain syndrome in adolescents and young adults?

    <p>Muscle strength imbalance</p> Signup and view all the answers

    Which anatomical factor does NOT contribute to the alteration of patellar tracking?

    <p>Hip abductor strength</p> Signup and view all the answers

    What symptom is NOT commonly associated with patellofemoral pain syndrome?

    <p>Swelling of the knee joint</p> Signup and view all the answers

    In individuals over 40 years of age, what percentage is likely to present with osteoarthritis when experiencing patellofemoral pain?

    <p>70%</p> Signup and view all the answers

    What clinical action is NOT typically required for the diagnosis of patellofemoral pain syndrome?

    <p>MRI imaging</p> Signup and view all the answers

    Which of the following factors does NOT increase the likelihood of developing patellofemoral pain syndrome?

    <p>Regular warm-up exercises</p> Signup and view all the answers

    Which of the following describes the pain behavior pattern associated with patellofemoral pain syndrome?

    <p>Pain primarily occurs after periods of inactivity</p> Signup and view all the answers

    Which of the following conditions is patellofemoral pain syndrome often confused with?

    <p>Meniscus tear</p> Signup and view all the answers

    What biomechanical factor is associated with the alteration of patellar tracking?

    <p>Q angle</p> Signup and view all the answers

    What are the possible factors contributing to iliotibial band syndrome?

    <p>Excessive running</p> Signup and view all the answers

    Which anatomical location is the insertion point for the iliotibial band?

    <p>Gerdy's tubercle</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with iliotibial band syndrome?

    <p>Pain decreases after running</p> Signup and view all the answers

    What is a common event that triggers the pain of iliotibial band syndrome?

    <p>Pain after excessive downhill running</p> Signup and view all the answers

    Which condition can be confused with iliotibial band syndrome?

    <p>Patellofemoral tendinopathy</p> Signup and view all the answers

    What biomechanical factor may lead to iliotibial band syndrome?

    <p>Weak hip abductors</p> Signup and view all the answers

    In the context of patellofemoral pain syndrome, the Q angle is associated with which type of force?

    <p>Frontal plane lateralization forces</p> Signup and view all the answers

    What kind of modifications are listed as potential changes that can improve iliotibial band syndrome symptoms?

    <p>Use of ice and rest</p> Signup and view all the answers

    Which anatomical location is implicated in the friction causing iliotibial band syndrome?

    <p>Lateral femoral condyle</p> Signup and view all the answers

    Study Notes

    Pelvis

    • Conditions related to the pelvis include ankylosing spondylitis, coccygodynia, meralgia paresthetica, and pubalgia.

    C/O-Medical records

    • This section outlines the crucial steps in medical record management, from patient initial complaint (C/O) through to final plan (Rx1).

    Ankylosing spondylitis

    • Characterised as a chronic form of arthritis, often affecting the spine (spondyloarthropathy).
    • Bamboo-shaped spine is a common feature, often with inflammation, leading to spinal fusion, and a stooped posture.
    • 80% of patients experience axial symptoms.
    • Typically affecting the lumbopelvic spine.

    Spondyloarthropathies classification

    • Seronegative arthritis / peripheral spondyloarthritis is associated with Crohn's disease or ulcerative colitis, characterized by: peripheral, symmetrical, and bilateral involvement of joints like knees, ankles, elbows, and wrists.
    • Enteropathic arthritis/spondyloarthritis progress independently of the primary intestinal disease. Predisposition is shown to HLA-B27 but less than in ankylosing spondylitis.
    • Differentiated spondyloarthritis : Includes peripheral arthritis, sacroiliitis, and enthesitis with inflammatory low back pain. Diagnostic classification is often unclear or cannot be definitively established with imaging tests alone.
    • Reactive arthritis / Polyarticular. Asymmetric, commonly affecting feet and peripheral joints, mostly characterized by pain in the hindfoot.

    AS incidence

    • Lumbopelvic joint is frequently affected, as well as the lumbar vertebrae.
    • Areas where ligaments and tendons attach to bones, especially in the spine.
    • Cartilage between the sternum and ribs can also be impacted.
    • Hip and shoulder joints can also be affected.

    Coccygodynia

    • Defined as pain in or around the tailbone (coccyx).
    • Often with undefined spreading of pain.
    • Higher frequency in women (5:1).

    Coccygodynia: Involved factors

    • Traumatic origin – local trauma.
    • Prolonged sitting, especially on hard surfaces.
    • Other factors: arthritis, childbirth.
    • Obesity listed as a risk factor.

    TP pelvic floor

    • This section describes tenderness spots in the pelvis and their locations.

    Coccygodynia: 24-hour behavior

    • Pain while sitting worsens with leaning backward.
    • Pain during bowel movements or sexual intercourse.
    • Pain can be reduced with particular cushions.

    Coccygodynia: Current and past history

    • To reduce symptoms: leaning forward when sitting, and using pressure-reducing cushions (sometimes wedge-shaped).
    • Applying heat or ice.
    • Medication.
    • Symptoms can resolve in weeks with rest.
    • Prolonged sitting should be avoided.

    Coccygodynia: Special questions

    • Trauma in area (direct or indirect) should be investigated.
    • Bowel or urination problems, or any sexual difficulties should be explored..
    • If using cushions to reduce symptoms, continuing that practise is recommended.
    • Upright sitting should be maintained to avoid recurrence of symptoms.

    Meralgia paresthetica

    • Mononeuropathy (sensory-only) of the femorocutaneous nerve.
    • Often caused by injury or entrapment, mainly at the inguinal level.
    • The condition is more common in people aged between 30 and 40, without a gender bias.
    • Incidence rate of 4.3 per 10,000 people in a given region.

    Meralgia paresthetica: Factors Involved

    • Idiopathic.
    • Mechanical causes – conditions that increase abdominal pressure, situations where the nerve is compressed.
    • Metabolic factors –type 2 diabetes, alcoholism.
    • Iatrogenic causes– during hip, lumbar spine, abdominal, obstetric, gynaecological surgery.

    Meralgia paresthetica: Past and Present Background

    • Obesity.
    • Pregnancy.
    • Tight fitting clothing.
    • Surgery

    Meralgia paresthetica: Special questions

    • Differential diagnosis includes: metastasis at the iliac crest, lumbar disc herniation, avulsion fracture, chronic appendicitis, spinal surgery and diabetes.
    • Differentiate from trochanteritis.

    Meralgia paresthetica: Prognosis

    • 62% of cases resolve spontaneously.
    • Conservative measures are effective for 90% of cases.
    • 73% of infiltration cases improve completely; relapse rate is 7%.
    • Cases caused by compression, posture adjustment, or tissue retraction have quicker recovery times than direct injury.

    Pubalgia

    • This is not a specific diagnosis. It is a generic term used to describe groin pain.
    • Different etiologies are involved, including sports hernia, sportsman’s hernia, sportsman’s groin, Gilmore’s groin, athletic pubalgia, and core muscle injury.
    • Different aspects of groin pain should be considered as a differential diagnosis.

    Pubalgia: Factors involved

    • Young males, and particularly males involved in sports.
    • About 58% of cases are related to soccer.
    • Includes sports-related overload.
    • Repetitive movements.
    • Postural imbalances.
    • Muscular imbalances.
    • Dysplasia or micro-traumatisms.
    • About 70% of cases involve adductor muscles.

    Pubalgia: Body chart

    • Localised to the pubic region.

    Pubalgia: 24h behavior

    • Localized pain; worse with palpation; Possible irradiation.
    • Symptoms increase after exercise.
    • Symptoms do not worsen with increased intra-abdominal pressure.
    • Improves with ice, rest and NSAIDs.
    • Symptoms may recur.

    Pubalgia: History

    • Insidious onset.
    • Pain improvement with rest and non-steroidal anti-inflammatory drugs (NSAIDs).
    • Possible fissure, or gracile disinsertion.
    • Chronic phase: constant pain and limitations.
    • Joint overuse may cause micro-traumas.
    • Swelling caused by oedema and muscular contractions.

    Pubalgia: Special Questions

    • Lumbar: radiculopathy, canal stenosis, disc herniation.
    • Hip pathology.
    • Inguinal hernia.
    • Muscle rupture.
    • Urinary tract infections.
    • Adductor tendinopathy.

    Knee: Clinical processes

    • Osteoarthritis.
    • Patellar tendinopathy.
    • Iliotibial band syndrome.
    • Patellofemoral pain syndrome.

    Knee Osteoarthritis

    • A degenerative joint condition characterized by progressive loss of cartilage and marginal bone hypertrophy.
    • Changes within the synovial membrane occur.
    • Worldwide incidence is estimated to be 240 per 100,000 persons per year.
    • OA frequently affects the knee joint and is the most common cause of disability in individuals over 65 years of age (up to 10% of affected individuals).
    • It does not affect the entire knee, but typically one or two of the knee compartments.

    Knee OA diagnostic criteria

    • Criteria are based on clinical records, laboratory testing, and imaging evaluation.
    • Clinical records include data such as: pain (gonalgia), age (>50), stiffness (<50 minutes), crepitus, tenderness of the bone; no temperature increases, but bone volume increase is seen.
    • Laboratory testing includes: VHS (<40 mm/h), rheumatoid factor (<1:40).
    • Imaging evaluation includes osteophytes (bony outgrowths)

    Knee OA Classification

    • Primary (or idiopathic): 70% of cases in the world.
    • Secondary – related to past injuries, inflammations, etc.

    Knee OA: factors involved

    • Age (around 50 years old).
    • Sex (female).
    • Genetic component is less prominent than other factors.
    • Weight alterations.
    • Systemic factors (metabolic syndrome).
    • Physical activity – is not considered a direct risk factor for developing this condition..
    • Symptoms do not always correlate with radiological alterations in 50% of individuals.

    Knee OA: 24-hour behavior

    • Typical initial symptoms include mild pain following strenuous activity.
    • Pain which worsens when walking up or down stairs or ramps, or during squatting.
    • Over time in advanced cases there can be stiffness, instability and swelling (due to effusion) resulting in limited mobility and even deformity.

    Knee OS: Actual and past history

    • Previous joint injuries (especially those occurring 10-15 years ago)
    • Meniscus problems, ACL tears.
    • Weight alterations, overuse, local trauma, infections, metabolic disorders

    Knee OA: Special questions

    • Consider differential diagnoses of other rheumatic or musculoskeletal conditions, including: osteoarthritis (osteoarthrosis, rheumatoid arthritis, fibromyalgia, gout, lupus, psoriatic arthritis, Reiter’s disease, Sjogren's disease).

    Patellar tendinopathy

    • Overuse injury within the patella tendon, usually accompanied by pain, thickening, and reduced functioning.
    • Pain is frequently insidious at onset and is triggered by increased physical activity.
    • Pain becomes more persistent with increasing frequency and intensity of exercise.
    • Tendinosis is usually more common in impact athletes, with an incidence of 30-45% in this population.
    • However, non athletes can also be affected between 8% and 50% depending on working activity
    • Several classification methods are used to assess the severity of the injury.

    Patellar tendinopathy: Factors involved

    • Men aged 35 or older.
    • Biomechanical risk factors (including excessive foot pronation, high hip anteversion, increased Q-angle).
    • Previous tendon or knee injuries.
    • Genetic factors affecting tendon development and healing.
    • Incorrect training methods.
    • Environmental factors can contribute.

    Iliotibial band syndrome

    • Runners' knee syndrome.
    • Acute external knee pain, generally associated with repetitive knee flexion and extension.
    • Iliotibial band (ITB) friction against lateral femoral condyle a common source of pain.
    • An increased frequency exists in runners (1.6–12%) and cyclists (15–24%).
    • ITB is a source of up to 22% of lower limb related injuries.

    Iliotibial band syndrome: Factors involved

    • Narrow or wide iliotibial bands which results in friction with the lateral femoral condyle.
    • Iliotibial band compression on underlying adipose tissue.
    • Weak hip abductors (gluteus medius).
    • Poor foot biomechanics (resulting in dysmetria), excessive running and athletic endurance training.
    • Clothing can also be contributing factor.

    Patellofemoral pain syndrome

    • A common cause of dull pain around and front of the knee in the anterior aspect of the knee.
    • Patella tracking dysfunction can result in pain.
    • Patella never fully makes contact with the femur in all positions.
    • Cartilage degeneration and inflammation can result in secondary osteoarthritis.
    • There can be a biomechanical component which is dependent on issues with femoral anteversion, Q-angle, genu valgus/recurvatum or tibial varus/pronation of foot.
    • Possible muscular weakness in hip external abductors or knee extensors causes muscular problems that can create instability.
    • Occurs frequently in females between 40 and 50 years old.
    • The incidence is about 18% in men and sports men, and 33% in sportswomen.
    • 70% of those with patellofemoral pain over 40 years old have comorbid osteoarthritis.

    Patellofemoral pain syndrome: Factors involved

    • Age, particularly young adults and adolescents.
    • Gender, with females being more likely to be affected.
    • Overweight and obesity.
    • Reduced flexibility.
    • Lack of a good pre-exercise warm-up routine that prepares body for sports activity.
    • High level of sporting activity and/or training.

    Hip osteoarthritis (OA)

    • A degenerative joint disease of the hip joint where cartilage and subchondral bone degrades.
    • The hip and subchondral bone thicken, with development of osteophytes.
    • Chronic synovitis is commonly present.
    • The causes are often multifactorial: wear and tear arthritis, infection, crystal deposition, and/ or autoimmune disorders..
    • The condition is often found in individuals over 50 years old, with higher incidence in women and significant association with obesity.

    Hip OA: Factors involved

    • Advanced age – the likelihood of developing this condition increases in individuals 50 years or older.
    • Increasing prevalence with age into 75+ age category.
    • Female gender.
    • Obesity and other weight-related issues.
    • Genetic predisposition.
    • Previous joint injury/inflammation.
    • Repeated stress applied to the hip joint .
    • Muscle weakness.

    Hip abductor-rotator tendinosis

    • Pain in hip abductor-rotator tendons. Pain often felt around greater trochanter.
    • Pain may be felt during or after exercise, or even with prolonged periods of standing or sitting.

    Tendinosis or tendonitis?

    • Tendinosis – is a degenerative condition resulting from imbalance between tendon tissue damage and self-repair.
    • Resulting in compression, friction, and degeneration of the tendon structure.
    • Tendonitis – is a common overuse injury that involves inflammatory damage.
    • Both can occur simultaneously.

    Hip abductor-rotator tendinosis: Special questions

    • Localised trauma to the region
    • Sports practices, footwear.
    • Type of job performed.
    • Metabolic dysfunctions.
    • Physical conditions including past injuries are relevant..

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    Description

    Test your knowledge on the key characteristics and demographics of ankylosing spondylitis. This quiz covers spinal X-ray findings, the significance of the HLA-B27 gene, and axial symptoms related to this condition. Perfect for students and healthcare professionals alike!

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