Annular Tears: Another Clinicians Nightmare
This week, David Fitzgerald has decided to talk about another issue considered to be one of the many clinicians’ nightmares: Annular tears.
As always, David has dissected the topic and given an outline of the condition, which you can read in this article. If you would like to know more about this problem, however, it is best to watch the video below and hear what David has to say for yourself.
So, what is an annular tear?
We are talking about a problem affecting the lower back; an annular tear is a form of disc injury that not many people of. We have talked about sciatica before and how it can be a pretty excruciating condition because of the disc bulging and putting pressure on the nerve. An annular tear, however, is a slightly different condition, despite the disc and same nerves are involved.
An annular tear can leave the patient’s back feeling vulnerable and it can be either a self-limiting condition that won’t progress or an early sign of something that will escalate to a condition causing more problems on the disc.
An annular tear can slip under the radar as patients usually assume that they’re suffering from a muscle strain. This is due to the fact that this particular condition causes pain and discomfort for a couple of days then settling down without causing great debilitation. However, when the patients go back to doing their ordinary activities (for instance sitting down, bending and twisting), the disc gets loaded again, causing discomfort and issues with weight-bearing.
When the disc suffers straining, the “casing” protecting the disc (known as annular fibrosis) can present some tears. This can happen when the disc is being strained.
This condition doesn’t look particularly dramatic on examination, it doesn’t make the disc bulge as the material inside it hasn’t actually pushed through to put a bugle on the nerve. It is however very important to recognise and it is possible for clinicians to do so through an MRI scan, which will show the presence of a tear. Once the condition has been recognised and the clinician has established the gravity of the situation, it is time for the patient to be informed of how long the rehabilitation period will take.
Rehabilitating after an annular tear
The healing process does not require complete rest, it is however important to give the disc enough time to heal properly so that the tears can be repaired. During the healing process, it is, in fact, possible for a patient to keep up with their ordinary activities, as long as they have established, together with their clinician, what level of weight-bearing their spine is at.
This is essential in order for the patient to avoid putting excessive load on the spine while the disc is trying to heal. An annular tear repairs no different than an ankle or ligament sprainunless there is major damage. This means that the tissue can repair successfully and return to normal in most cases.
Some people, however, might suffer from recurring setbacks during rehabilitation and it is crucial for clinicians to recur to scans when this happens. This is to avoid causing any further disruption to the disc by repeatedly putting a strain on it.
Annular tears do not commonly cause great pain, as patients very often only report a small amount of pain. Despite this, however, from a clinical point of view, an annular tear cannot be identified with any particular test and that is why it is the clinician’s job to analyse the patient’s symptoms and draw a conclusion.
Despite the trivial nature of its symptoms, annular tears are not to be underestimated and, as David explains in his video, if in doubt, it is better to get it checked in order to avoid putting excessive strain on the already damaged tissue.
Once again, David has decided to talk about one of the many clinician’s nightmares and, if you would like to know more about this condition, make sure you watch the full video above.