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Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
Ankylosing spondylitis
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Ankylosing spondylitis

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ankylosing spondylitis taught in PMR

ankylosing spondylitis taught in PMR

Published in: Health & Medicine
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  • 1. Ankylosing Spondylitis[Marie - Strumpell Disease]Gopisankar.M.G.2008 MBBS
  • 2. Presenting complaint• Lower back pain and stiffness
  • 3. • History• Age  15 – 30 yrs.(second and third decade)• Sex  male (three times more)• Onset  gradual• Initially – only after a period of rest andimproves on movement• Pain  worse at n8/early morning awakeningfrom sleep –better after walking or doingexercise• +/- pain in heel , pubic symphysis ,manubriumsterni and costo sternal joints
  • 4. • +/- Radiation of pain to buttocks and posteriorthighs• Later stages *Kyphotic deformity of spine*Deformity of hip
  • 5. O/E• Stiff spine• Sacroiliac involvement• Extraarticular invovlment1.Ocular2.CVS3.Neurological4.Pulmonary5.systemic
  • 6. Investigations• Radiological• ESR elevated• Mild anemia• HLA B27
  • 7. Simple mechanical• Pain varies with physical activities (improved withrest)• 20 – 55 yrs.• Sudden onset precipitated by lifting or bending• Recurrent episodes• Pain limited to back or upper leg(lumbosacral)• Does not radiate beyond knee• No clear cut nerve root distribution• No systemic features• Asymmetric local paraspinal muscle spasm,tenderness,painful restriction of some but not allmovements• Manual workers , heavy lifting ,twisting• Good prognosis ( 90% recovery in 6 weeks )
  • 8. Non mechanical-red flags• Age <20 >55• Character  constant , progressive pain ,unreleived by rest• Location  thoracic pain• Past medical history of carcinoma,TB , HIV ,systemic corticosteroid use• Constitutional  systemic upset ,sweats ,weight loss• Major trauma
  • 9. Spinal root pain /radical pain• Unilateral leg pain worse than low back pain• Pain radiates beyond knee• Paraesthesia in the same distribution• Nerve irritation signs (painfull and reducedSLR)• Motor ,sensory and reflex signs• Reasonable prognosis
  • 10. Cauda equina syndrome• Difficulty in micturition• Loss of anal sphincter control or fecalincontinence• Saddle anaesthesia• Gait distuirbance• Pain , numbness or weakness affecting one orboth legs
  • 11. Other specific causes• Spondylolysis• Spondylolisthesis• Spinal stenosis• Prolapsed IV disc• Arachnoiditis• Scheuermann’s disease• Vertebral facture
  • 12. Stiffness• TB spine• Fluorosis

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