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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