Podcast
Questions and Answers
Pain made worse with coughing, straining, or ______
Pain made worse with coughing, straining, or ______
laughing
______ of the neck muscles
______ of the neck muscles
Spasm
X-ray to identify deformities and ______ of disk space
X-ray to identify deformities and ______ of disk space
narrowing
STERoid INJECTIONS helps control pain for several ______
STERoid INJECTIONS helps control pain for several ______
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______ TEST is performed to evaluate nerve function.
______ TEST is performed to evaluate nerve function.
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HERNIATED NUCLEUS PULPOSUS is also known as a ______ disk.
HERNIATED NUCLEUS PULPOSUS is also known as a ______ disk.
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HNP occurs when all or part of the soft center of a spinal disc is forced through a ______ part of the disc.
HNP occurs when all or part of the soft center of a spinal disc is forced through a ______ part of the disc.
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DISC DEGENERATION is a stage of HNP where chemical changes associated with aging causes disc to ______, but without a herniation.
DISC DEGENERATION is a stage of HNP where chemical changes associated with aging causes disc to ______, but without a herniation.
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In the stage of EXTRUSION, the gel-like nucleus pulposus breaks through the ______ wall but remains within the disc.
In the stage of EXTRUSION, the gel-like nucleus pulposus breaks through the ______ wall but remains within the disc.
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Pain radiating to the ______, upper arm, forearm, and rarely the hand, fingers or chest is a clinical manifestation of HNP.
Pain radiating to the ______, upper arm, forearm, and rarely the hand, fingers or chest is a clinical manifestation of HNP.
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Study Notes
Herniated Nucleus Pulposus (HNP)
- Also known as lumbar radiculopathy, cervical radiculopathy, herniated intervertebral disk, prolapsed intervertebral disk, slipped disk, or ruptured disk
- Occurs when all or part of the soft center of a spinal disc is forced through a weakened part of the disc, resulting in impingement on a nerve root
Stages of HNP
- Disc Degeneration: chemical changes associated with aging cause disc to weaken, but without a herniation
- Healthy Disc: well-hydrated nucleus with no bulging or loss in disc height and has an intact outer annulus
- Early Degeneration: early signs of degeneration, including fissures in the annulus, loss of hydration and disc height, resulting in bulging
- Advanced Degeneration: severe loss of hydration and disc height, resulting in bulging, bone spur formation, and spinal stenosis
- Prolapse: formation or position of the disc changes with some slight impingement into the spinal canal, also called a bulge or protrusion
- Extrusion: gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc
- Sequestration or Sequestered Disc: nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP)
Clinical Manifestations
- Arm muscle weakness
- Deep pain near or over the shoulder blades on the affected side
- Neck pain, especially in the back and sides
- Increased pain when bending the neck or turning head to the side
- Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers, or chest
- Pain made worse with coughing, straining, or laughing
- Spasm of the neck muscles
Diagnostic Exams
- Physical Examination: fever, vertebral tenderness, limited spinal mobility, and sciatica
- Straight Leg Raise Test: positive if pain in the sciatic distribution is reproduced between 30 degrees and 70 degrees passive flexion of the straight leg
- X-ray: to identify deformities and narrowing of disk space
- CT/MRI: to show spinal canal compression by the herniated disk
- Electromyography: measures muscle response to nervous stimulation
- Nerve Conduction Velocity Test: evaluates nerve function by testing the speed of impulses travel through a nerve
- Myelogram: determines the size and location of disk herniation using contrast dye
Medical and Surgical Management
- Medical Management:
- NSAIDs (Ibuprofen, Naproxen Na) to relieve pain and swelling
- Narcotics (Opioids) for severe pain
- Muscle Relaxants for back spasms
- Steroid Injections to control pain for several months and reduce swelling around the disk
- Surgical Management: not specified in the text
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Description
Test your knowledge on Herniated Nucleus Pulposus, a spinal condition also known as herniated intervertebral disk, slipped disk, or ruptured disk, and its stages.
