Ankylosing spondylitis

Xue Yan Zhang

Definition:
Ankylosing spondylitis, known as axial spondyloarthritis, is an inflammatory
disease that, over time, can cause some of the bones in the spine, called
vertebrae, to fuse. This fusing makes the spine less flexible and can result in a
hunched posture. If ribs are affected, it can be difficult to breathe deeply.(1)
Symptom:


https://ghspineandlasercentre.com/journal/ankylosing-spondylitis-how-does-it-
progress

Case Study: Pt A, 32 years old, male.

Current Complaint: Left knee pain. pain worse at AM waking up, better with moving,
but worse at 4-5 pm daily. Fusing dull pain, stiffness to whole back, worse at T12
to L4 level. Not able to bend forward over 40 degrees. Love put cold patch on L
knee, hate warm drink. no cold hands and feet. deny knees give away when walking.

Hx: at age of 16, upper back ( T1-T7) pain. He lived in cold room in winter, and
parents divorced at that year. No treatment received. Last year, diagnosed with AS
when visiting Doctor for bilateral hip pain. current medication is TNF-a SQ.
monthly.

SSx:
-Observation: a stooped posture walking in. local knees have no swelling, bruising,
rashes.
-Palpitation with lateral L knee tenderness. -ROM:
AROM : Pain worse on knee flexion.Limited L knee flex and limited lumber. L knee
pain 6/10. PROM: increased pain with knee flexion 8/10, dec pain with knee
extension 4/10. increased pain with hip adduction (tenses ITB). RROM: decreased
strength of knee flexors & hip abductors.
-Neuromuscular: WNL . No radiation or referral pain. No numbness or tingling.

DDx:
1. Knee fracture(X-ray)
2. Meniscus tear(-) Apley
3. Biceps femoris tendinopathy (pain less on knee extension to R/O
hamstrings problem). (2)
4. LCL sprain
5. ITB syndrome (AS induced inflammation )

https://www.sciencedirect.com/science/article/pii/S187705681400334X

Special tests:
1. (+) Schober’s test
2. (+)Renne
3. (-) Apley compression/distraction test
4. X-ray to role out fracture
5. ultrasound for visualization of lig. Injuries to different LCL and ITB
Working diagnosis: ITB syndrome (AS induced inflammation )
Treatment:
- PRICE in acute stage
-Physical exercise: deep breathing & bridges. Avoid activities that may cause you
to feel pain and discomfort, for injury occurs if motion is forced. (3)
-TENS and Ultrasound
- Massage
-Acupuncture ( BL 11, GB 34, SP 10, ST35)
-Pain management:

Naproxen 500mg BID P.O.(4)

- Botanicals: Astragalus 20g, yam 10g, Guoqi berry 10g. Tea BID. nourishing liver
and kidney(5)

Fun Assignment (5%):

1‐2 minute lyrical video, song, poem, greeting card, board game, PowerPoint,
presentation that engages into artistic content and physmed or condition –
presented on 2nd last class
Dr. Nikita Vizniak | 6

Reference

1. Ankylosing spondylitis.(2023). retrieved from:

https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-
causes/syc-20354808
2. Hamstring Tendonitis(2022). retrieved from:
https://www.sportsinjuryclinic.net/sport-injuries/knee-pain/posterior-knee-pain/
biceps-femoris-tendinopathy

3. Exercise for Ankylosing Spondylitis: What You Need to Know.(Barbara, H.

2023). retrieved from: https://www.healthcentral.com/condition/ankylosing-
spondylitis/best-exercises-ankylosing-spondylitis
4. Treatment-Ankylosing spondylitis. (2023). retrieved from:
https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/
5. Li Jiren, a master of traditional Chinese medicine: classics on
differentiation and treatment of ankylosing spondylitis (2021). retrieved from:
http://szyyj.gd.gov.cn/zyyfw/dyjc/content/post_3579057.html