13 Orthopedic-Neurologic Overlap Flashcards
Outer and inner layers of disc
Outer = annulus fibrosis Inner = nucleus pulposis
Spinal cord ends at…
L1-L2, conus medullaris
Nerve roots exit where?
C1-C7- above vertebra
T1 down- below vertebra
C8 is between C7 and T1
Spinal arthritis symptoms
Local or radicular pain Muscle weakness Numbness Limited mobility Headaches (cervical) Loss of balance
Radiculopathy symptoms
Pain
Numbness
Tingling
Weakness
Kyphosis types
Round back
Hump back
Flat back
Dowager’s hump
Causes of scoliosis
Structural- genetic, idiopathic, congenital
Non-structural- poor posture, hysteria, nerve root irritation, LLD, hip contracture
Central vs lateral stenosis symptoms
Central- bilateral numbness, tingling, muscle weakness, UMN signs
Lateral- unilateral numbness, tingling, muscle weakness, LMN signs
Spondylosis/spondylolisthesis
Defect in pars or arch of vertebra that may lead to slippage of body and compromise spinal cord or nerves
Disc protrusion
Nucleus pulposus bulges into but does not rupture annulus fibrosis
Disc prolapse
Nucleus pulposus reaches outermost layers of annulus fibrosis but is still contained
Disc extrusion
Nucleus pulposus disrupts outermost layers of annulus fibrosis and emerges into epidural space
Disc sequestration
Fragments of discal material break off into spinal canal
L4-L5 disc herniation
Foot drop
Pain and numbness dorsal aspect of foot
L5-S1 disc herniation
Pain and numbness posterior and lateral LE/foot
Weakness in plantarflexion
Roots of brachial plexus
C5-T1
Dorsal scapular nerve from C5
Long thoracic nerve from C5-C7
Trunks of brachial plexus
Upper = C5-6
Middle = C7
Lower = C8-T1
Suprascapular nerve and nerve to subclavius from upper trunk
Divisions of brachial plexus
Each trunk has anterior and posterior divisions
Anterior = flexor muscles
Posterior = extensor muscles
Cords of brachial plexus
Lateral = anterior divisions of upper and middle trunk. Lateral pectoral nerve Medial = Anterior division of lower trunk. Medial pectoral nerve and 2 cutaneous nerves Posterior = Posterior divisions of 3 trunks. Upper and lower subscapular nerves, thoracodorsal nerves
Branches of brachial plexus
Musculocutaneous nerve from lateral cord
Ulnar nerve from medial cord
Median nerve from lateral and medial cords
Axillary and radial nerves from posterior cord
Erb palsy
Injury to C5-C6
Arm in extension and wrist fully flexed
Weak shoulder abduction, flexion, rotation; risk for dislocation
Sensory deficits posterior and lateral arm
Commonly occurs during birth
Klumpke palsy
Injury to C8-T1
Forearm supination and wrist and finger flexion (claw hand)
Weak hand intrinsics and sensory deficits to ulnar side of hand
Commonly occurs during birth
T1 may result in Horner’s syndrome
Burner syndrome
Stretch or compression of brachial plexus
Traction injury in young athletes or compression in older adults
Immediate severe, burning, prickling sensation followed by muscle weakness
Parsonage-Turner syndrome
Rapid onset of severe shoulder pain followed by atrophy of affected areas
Immune-mediated attack on brachial plexus
Suprascapular nerve most commonly involved
Femoral nerve injury
Denervation of hip flexors and knee extensors
Rare- protected position
Sciatic nerve injury
Depends on tibial or peroneal nerve affected
From acetabular fx, surgery, post-op hematoma, direct laceration, tension
Common peroneal nerve injury
Foot drop, supination deformity, steppage gait
From tibial plateau fx, postero-lateral knee disclocation, osteotomies, compression
Tibial nerve injury
Poor plantar sensation
Weak ankle plantarflexion (push-off in gait)
From distal femur, tibial, calcaneal fx, TKA, knee or ankle surgery, but rare due to protected position
