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SUMMARY Athletic activities commonly result in a variety of injuries. For providers who take care of athletes, a basic knowledge of both common injuries and treatment algorithms as well as various sport-specific injury patterns is necessary to provide optimal ...

Snowboarding and skiing Participants in both snowboarding and skiing have the full range of injuries associated with these high-speed sports. The rigid high boots used by skiers protect the ankle but increase the loads transmitted up the limb, risking fractur...

Tennis Tennis elbow or lateral epicondylitis is angiofibrous dysplasia of the common extensor origin. Treatment consists of brac ing, activity modification, injection (with some centres using platelet-rich plasma) and surgery if conservative measures fail. Pa...

Ankylosing spondylitis Should a patient with ankylosing spondylitis present following trauma, a high index of suspicion for occult fractures should be present. It is common for patients with ankylosing spondylitis to develop epidural haematomas with subtle neu...

Arnold–Chiari malformation Arnold–Chiari malformation occurs when the medulla oblongata and the cerebellar tonsils extend through the fora - men magnum into the cervical spinal canal, causing pressure on the lower medulla. Hydrocephalus and impaired neurolog -...

Bone densitometry Bone density and osteoporosis can be measured using dual energy x-ray absorptiometry (DEXA) of the hip, wrist and spine. Bone densitometry Bone density and osteoporosis can be measured using dual energy x-ray absorptiometry (DEXA) of the hi...

Bone scintigraphy Isotope bone scans are highly sensitive, but non-specific, tests that are useful for screening the skeletal system for metastatic disease, discitis or vertebral body osteomyelitis, or to assess the relative activity of bone lesions such as os...

CLINICAL ANATOMY The normal cervical lordosis measures between 35° and 45°. The normal lumbar lordosis is between 40° and 80° (mean 60°) and decreases with age. Most lumbar lordosis occurs between L4 and S1. The normal thoracic kyphosis is between 20° and 50° ...

Cauda equina syndrome CES is a very serious and urgent condition that arises from compression of the cauda equina nerve roots, which supply the perineum and genital regions and bladder, bowel and sexual function. The most frequent cause is a massive central l...

Cervical myelopathy Degenerative change in the cervical spine leading to spinal cord compression is the commonest cause of cervical myelop - athy in patients over 55 years of age. LMN changes occur at the level of the lesion, with atrophy of the upper extr...

Computed tomography This investigation is the best test for assessing bone anatomy . Three-dimensional reconstructions are often useful for the assessment of congenital spinal deformity . However, one should remember that a typical CT of the lumbar spine wil...

Congenital scoliosis This is caused by vertebral anomalies that produce a frontal plane growth asymmetry . The anomalies are present at birth, but the curvature may take years to be clinically evident. Close observation of spinal growth is required until skele...

Cost implications of modern spinal Cost implications of modern spinal Cost implications of modern spinal

DEGENERATIVE CONDITIONS OF THE SPINE Cervical radiculopathy Patients present with neck and arm pain (brachialgia), paraesthesia and motor weakness in the distribution of the compromised nerve root (radiculopathy). This may be caused by disc herniation or dege...

DEGENERATIVE CONDITIONS OF THE SPINE Cervical radiculopathy Patients present with neck and arm pain (brachialgia), paraesthesia and motor weakness in the distribution of the compromised nerve root (radiculopathy). This may be caused by disc herniation or dege...

DEVELOPMENTAL ABNORMALITIES Developmental abnormalities of the spine and spinal cord can be divided into primary bony disorders (e.g. congenital scoliosis, as discussed above) and primary neurological disor ders (e.g. spina bifida, Arnold–Chiari malformation a...

Discogenic low back pain Discogenic low back pain has been defined as a continuum of diagnostic categories (internal disc disruption, degenerative disc disease, segmental instability) reflecting various stages of degenerative pathology a ff ecting the interverte...

EPIDEMIOLOGY The lifetime prevalence of low back pain has been reported to be 60–80%. By contrast, the lifetime prevalence of true sciatica is 2–4%. It is generally accepted that 90% of acute low back pain episodes settle, allowing return to work within 6 we...