📍PAIN SEVERITY (Numeric Rating Scale):
Mild pain: 1–3/10 — nagging, annoying, does not limit activity
Moderate pain: 4–6/10 — interferes with activity or concentration
Severe pain: 7–10/10 — disabling, limits daily function
🧠CERVICAL STENOSIS (C3–C7):
Normal diameter: 13–17 mm
Mild stenosis: 10–13 mm
Moderate stenosis: 7–9.9 mm
Severe stenosis: <7 mm
🦴THORACIC STENOSIS (T1–T12):
Normal diameter: 12–14 mm
Mild stenosis: 9–12 mm
Moderate stenosis: 6–8.9 mm
Severe stenosis: <6 mm
💪LUMBAR STENOSIS (L1–L5):
Normal diameter: 15–23 mm
Mild stenosis: 12–15 mm
Moderate stenosis: 10–11.9 mm
Severe stenosis: <10 mm
💿 Disc Bulge:
A broad, symmetric extension of the disc (≥25% of disc circumference) beyond the edges of the vertebral body. The annulus fibrosus remains intact. Often asymptomatic.
💥 Disc Herniation:
A focal protrusion of disc material (<25% of disc circumference), usually due to annular tear. It may compress nerve roots or the spinal cord. Two types:
Protrusion: Base wider than the dome (contained by annulus)
Extrusion: Dome wider than base (nucleus pulposus breaks through annulus)
🔩 Disc Extrusion (with/without sequestration):
Advanced form of herniation where nucleus material extends beyond the annulus, and may even separate (sequestration). Common cause of severe radiculopathy.
🧬 Degenerative Disc Disease (DDD):
Age-related or mechanical breakdown of disc structure leading to disc space narrowing, loss of hydration (T2 MRI signal), osteophytes, and possible pain. Not a “disease” per se — more a descriptive term.
🕳️ Disc Desiccation:
Loss of water content in the disc nucleus. Appears dark on T2-weighted MRI. Common with aging and DDD.
🔻Annular Tear (High-Intensity Zone):
Disruption of the annulus fibrosus fibers, often seen as a bright spot on T2 MRI. May cause back pain even in the absence of herniation.
⚙️ Facet Arthropathy:
Degenerative changes in the facet joints (zygapophyseal joints), often due to DDD. Leads to hypertrophy, inflammation, and contributes to foraminal narrowing and pain.
🧱 Schmorl’s Node:
Herniation of disc material vertically into the vertebral endplate. Usually incidental but may be seen in axial loading injuries.
Joint Pain (Arthralgia):
General term for pain localized to one or more joints, may or may not be due to inflammation.
Types of Joint Pain:
🧊 Non-inflammatory Arthralgia:
Pain without overt inflammation (e.g., osteoarthritis). Commonly worse with activity, improves with rest. No redness or warmth.
🔥 Inflammatory Arthralgia:
Associated with swelling, redness, warmth, and morning stiffness >30 minutes (e.g., rheumatoid arthritis, gout, lupus).
⚙️ Mechanical Joint Pain:
Due to structural degeneration (e.g., cartilage wear in osteoarthritis or meniscal tears). Typically unilateral and activity-related.
⚠️ Referred Joint Pain:
Pain perceived in a joint but originating elsewhere (e.g., hip pathology causing knee pain).
🦴 Synovitis:
Inflammation of the synovial membrane. May present as joint effusion, warmth, and stiffness.
Common Descriptive Signs in Joint Exam:
Crepitus: Grinding or crackling with motion (degeneration)
Effusion: Fluid accumulation in joint capsule
Instability: Suggests ligament or meniscal involvement
Deformity: Often chronic or traumatic origin
Pain Due to Injury:
Pain resulting from tissue trauma (muscles, ligaments, bones, joints, discs, or nerves). Usually acute, can become chronic.
🦵 Soft Tissue Injuries:
Strain: Injury to muscle or tendon
Sprain: Injury to ligament
Contusion: Bruise, often with localized swelling and tenderness
Tendonitis: Inflammation due to overuse or microtrauma
🦴 Bony and Articular Injuries:
Fracture: Disruption of bone cortex
Subluxation: Partial joint dislocation
Dislocation: Complete loss of joint congruency
Bone bruise (Marrow Edema): Seen on MRI, often after trauma
Chondral injury: Damage to cartilage, may cause catching or locking
🔌 Nerve-Related Injury Pain:
Neuropraxia: Temporary conduction block
Radiculopathy: Nerve root compression (e.g., disc herniation)
Paresthesia: Tingling/numbness
Hyperalgesia: Heightened pain response from minor stimuli
⚠️ Acute vs. Chronic Injury Pain:
Acute: Sudden onset, tissue-based, often resolves with healing (days to weeks)
Chronic: >3 months, may involve central sensitization, nerve changes, or unresolved inflammation
🔹 Mild Arthritis
Cartilage loss: Minimal
Joint space narrowing: Mild or early, often focal
Osteophytes (bone spurs): Small, marginal
Symptoms: Occasional stiffness or pain with overuse
Function: No limitation in daily activities; pain managed with NSAIDs or activity modification
Radiographs (Kellgren-Lawrence Grade 1–2): Slight narrowing, possible small osteophytes, no deformity
🔸 Moderate Arthritis
Cartilage loss: Moderate thinning
Joint space narrowing: Moderate, more diffuse
Osteophytes: More prominent
Subchondral sclerosis/cysts: May be visible
Symptoms: Daily pain, morning stiffness <30 min, activity worsens pain
Function: Limitations in strenuous activity; some compensation in gait or posture
Radiographs (KL Grade 2–3): Moderate joint space loss, multiple osteophytes, early deformity
🔴 Severe Arthritis
Cartilage loss: Near-total or complete
Joint space narrowing: Severe to bone-on-bone
Osteophytes: Large, irregular
Subchondral changes: Sclerosis, cysts, bone marrow edema
Deformity: Visible joint misalignment or instability
Symptoms: Constant pain, night pain, limited ROM, stiffness, swelling
Function: Significant disability; difficulty with ADLs; often surgical candidate
Radiographs (KL Grade 4): Bone-on-bone contact, large osteophytes, marked deformity
Grade 0 – Normal
No joint space narrowing or osteophytes.
🟢 No radiographic evidence of arthritis.
Grade 1 – Doubtful
Possible small osteophytes, no joint space narrowing.
🟡 May be asymptomatic or have mild symptoms.
→ Considered "mild" arthritis if symptoms are present.
Grade 2 – Mild
Definite osteophytes, possible joint space narrowing.
🟡 Pain with activity, occasional stiffness, minimal functional loss.
→ Early mild arthritis.
Grade 3 – Moderate
Moderate joint space narrowing, multiple osteophytes, possible sclerosis or deformity.
🟠 Daily pain, limited ROM, joint swelling or crepitus.
→ Moderate arthritis.
Grade 4 – Severe
Marked joint space loss, large osteophytes, severe sclerosis, bone-on-bone changes.
🔴 Constant pain, disability, deformity, surgical candidate.
→ Severe arthritis.