Case 11 Ankylosing Spondylitis
Case 11
Ankylosing
Spondylitis
Age
20 – 30 years
What
happened ? They have pain on back and other
joints
Other associated symptoms ? –
Morning stiffness , Swelling , Cant see straight , altered sensation on
Upper and Lower Extremities
Examination
Conscious
, ill looking , patient may be in distress due to pain
Pallor
+/-
Posture
– Question Mark ( bending forward )
HEENT
– No Uveitis , his gaze is downward only sees object 1 meter away
Chest
– Chest expansion Measurement
CVS
P/A
– tenderness at Symphysis pubis
MSK
Examination –
Describe
Whole body
Normal
Gait
Able
to squat
(
Check Ablity to tip toe and stand on heel on standing to know the neurological
involvement )
Upper
Extremity –Normal with No Any arthritis
Spine
- During examination check whole
spine as one single organ unlike description on text .
From
front
Head at centre , both shoulders at the same
level
Nipple at the same level , both
ASIS at the same level , both patella at
same level facing forward , alignment of leg and feet normal
From
sides,
Forward thrust of C-spine (neck translated anteriorly from
front
both the
elbows are straight , hands overlying overlying greater trochanter ,
knees straight , normal plantigrade feet
Posteriorly – Alignment of
vertebrae is normal
Overlying skin is normal on
examination from all sides
Absence of any swelling, tuft of
hair on back, dimpling
Temperature – Normal
Palpation – Superficially no any tenderness on C, T
and L-spine
Deep
–No any defect palpable
No
any superficial and deep bony tenderness
ROM –
C
– Spine
Flexion
/Extension / Rotation / Lateral Bending
Limited
flexion and extension , no lateral movement of head
T,L spine
Flexion
, Extension , Rotation , Lateral Bending ,
Schober.s test – Normal > 4 cm
Wall test – Unmasks kyphotic
distance
FABER Test +
Hip and Knees – Flexed
Neurology –
Higher mental Functions – Speech
, Memory and Gait
C 5 – T1 Upper Extremity
T1-L1 Trunk
L 3 – S 5 – Lower Extremity
Sensory examination
Motor examination – Bullk . Tone , Power
Reflexes – Superficial
Deep
Complications
Intubation
– Difficult
Cord
Injury during management of Cervical trauma
Potential
for massive epidural haemorrage owing to preexisting fusion of vcervical
vertebrae and secondary tearing of
epidural veins
Decreased
lung capacity
Ossified
ligaments – difficult epidural catheter and pain management
Investigations
Management
Medical
Surgical
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