13 Orthopedic-Neurologic Overlap

Question 1

Outer and inner layers of disc

Answer 1

Outer = annulus fibrosis
Inner = nucleus pulposis

Question 2

Spinal cord ends at…

Answer 2

L1-L2, conus medullaris

Question 3

Nerve roots exit where?

Answer 3

C1-C7- above vertebra
T1 down- below vertebra
C8 is between C7 and T1

Question 4

Spinal arthritis symptoms

Answer 4

Local or radicular pain
Muscle weakness
Numbness
Limited mobility
Headaches (cervical)
Loss of balance

Question 5

Radiculopathy symptoms

Answer 5

Pain
Numbness
Tingling
Weakness

Question 6

Kyphosis types

Answer 6

Round back
Hump back
Flat back
Dowager’s hump

Question 7

Causes of scoliosis

Answer 7

Structural- genetic, idiopathic, congenital

Non-structural- poor posture, hysteria, nerve root irritation, LLD, hip contracture

Question 8

Central vs lateral stenosis symptoms

Answer 8

Central- bilateral numbness, tingling, muscle weakness, UMN signs
Lateral- unilateral numbness, tingling, muscle weakness, LMN signs

Question 9

Spondylosis/spondylolisthesis

Answer 9

Defect in pars or arch of vertebra that may lead to slippage of body and compromise spinal cord or nerves

Question 10

Disc protrusion

Answer 10

Nucleus pulposus bulges into but does not rupture annulus fibrosis

Question 11

Disc prolapse

Answer 11

Nucleus pulposus reaches outermost layers of annulus fibrosis but is still contained

Question 12

Disc extrusion

Answer 12

Nucleus pulposus disrupts outermost layers of annulus fibrosis and emerges into epidural space

Question 13

Disc sequestration

Answer 13

Fragments of discal material break off into spinal canal

Question 14

L4-L5 disc herniation

Answer 14

Foot drop

Pain and numbness dorsal aspect of foot

Question 15

L5-S1 disc herniation

Answer 15

Pain and numbness posterior and lateral LE/foot

Weakness in plantarflexion

Question 16

Roots of brachial plexus

Answer 16

C5-T1
Dorsal scapular nerve from C5
Long thoracic nerve from C5-C7

Question 17

Trunks of brachial plexus

Answer 17

Upper = C5-6
Middle = C7
Lower = C8-T1
Suprascapular nerve and nerve to subclavius from upper trunk

Question 18

Divisions of brachial plexus

Answer 18

Each trunk has anterior and posterior divisions
Anterior = flexor muscles
Posterior = extensor muscles

Question 19

Cords of brachial plexus

Answer 19

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

Question 20

Branches of brachial plexus

Answer 20

Musculocutaneous nerve from lateral cord
Ulnar nerve from medial cord
Median nerve from lateral and medial cords
Axillary and radial nerves from posterior cord

Question 21

Erb palsy

Answer 21

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

Question 22

Klumpke palsy

Answer 22

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

Question 23

Burner syndrome

Answer 23

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

Question 24

Parsonage-Turner syndrome

Answer 24

Rapid onset of severe shoulder pain followed by atrophy of affected areas
Immune-mediated attack on brachial plexus
Suprascapular nerve most commonly involved

Question 25

Femoral nerve injury

Answer 25

Denervation of hip flexors and knee extensors

Rare- protected position

Question 26

Sciatic nerve injury

Answer 26

Depends on tibial or peroneal nerve affected

From acetabular fx, surgery, post-op hematoma, direct laceration, tension

Question 27

Common peroneal nerve injury

Answer 27

Foot drop, supination deformity, steppage gait

From tibial plateau fx, postero-lateral knee disclocation, osteotomies, compression

Question 28

Tibial nerve injury

Answer 28

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