31 - Functional Spine Anatomy Flashcards
What are the components of a MSK spine exam?
- Inspection (observation)
- Palpation
- ROM
- Neuromusclar exam
- Special tests
- Examination of related areas (shoulder/cervical spine, Hip/lumbar spine)
What are the anterior bony landmarks/palpation spots of the cervical spine?
Hyoid bone: C3
Thyroid catrilage: C4-5
First cricoid ring: C6
Carotid tubercle: C6
What are the posterior bony landmarks/palpation spots of the cervical spine?
Occiput
Cervical spinous processes - C7 largest
Facet joints
How does the vertebral column structure confer function? How does this relate to injury?
The curve of the spine helps with movement.
More weight in the lumbar- can herniate
Cervical: increased mobility can cause problems
What are the components of a neuromusclar exam of the spine?
- Manual muscle testing
- Sensory testing
- Reflex testing
A 14 yo is diagnosed with flaccid paralysis to the right arm. There’s no pain, parethesis, or sensory loss. Lab results reveal polio virus infection. What is the target at which the polio virus aims to cause the pts symptoms?
The ventral horn of the spinal cord (just motor)
She is NOT having any sensory symptoms.
What type of innervation does each do: dorsal roots/doral horn, ventral roots/ventral horn, Ramis.
Dorsal roots, doral horn, DRG: all sensory
Ventral root or ventral horn: all motor
Ramis are MIXED nerves (a few exceptions) - motor and sensory
Defien myotome and dermatome?
Myotome: collection of muscle fibers innervated by the motor axons within each segmental nerve (root)
Dermatome: area of skin innervated by the sensory axons within each segmental nerve (root)
Describe the rash associated with herpes zoster (shingles)?
Acute neuralgia confined to the dermatome distribution of a specific spinal or cranial sensory nerve root.
Name the yellow labels?
What is the root level of the the thumb, long finger, and little finger?
C6 - thumb
C7 - long finger
C8 - little finger
What are the levels of manual muscle testing? Describe each?
- Normal strength: complete ROM against gravity with maximal resistance (examiner cannot overcome)
- Active movement against gravity and moderate resistance through full ROM (examiner can overcome)
- Active movement through full ROM against gravity (cannot do against resistance)
- Active movement through full RAM with gravity eliminated (can’t do full ROM against gravity)
- Flicker or trace of contraction, but no joint motion (no palpable muscle action)
- No contraction papated
Describe the numbers used to describe a neuromusclar exam?
0 - absent
1 - slight or less than normal (includes trace response or a response only brought out with reinforcement)
2 - lower half of normal range (low-normal)
3 - upper half of normal rane (high - normal)
4 - enhanced and more than normal (including clonus)
What is the Lhermitte’s sign?
Passive anterior cervical flexion elicits electric-like sensation down the spine or extremities.
Implies cervical spinal cord pathology.
What is a spurling neck compression test? What does it imply if positive?
Reproduction of radicular symptoms with cervical spinal extension, rotation, and lateral flexion.
Implies cervical nerve root pathology.
What is considered a positive test for a straight leg raising test (SLR or lasegue sign)?
Positive test is leg pain reprodued at 30-70 degree angle.
Implies lumbar nerve root pathology (L5 or S1)
What is the femoral nerve stretch test (upper lumbar disc)? What is considered a positive test and what does it imply?
Pt placed prone position while knee is flexed.
Positive test: reproduction of pts pain in anterior thigh
Implies upper lumber nerve root pathology (L2-L4)
What are signs of an UMN injury? What should this make you think?
Spasticity, hypertonicity, hyperreflexia, positive pathological reflexes, extensor plantar response.
THINK: spinal cord injury, brain injury/stroke, myelopathy, CNS lesion.
What are signs of an LMN injury? What should this make you think?
Flaccid weakness, loss of reflexes (hyporeflexia), muscle wasting and atrophy.
THINK: peripheral nerve entrapment, radiculopathy.
What are red flags to make you think of a patient having a malignancy?
History of cancer
Unexplained weight loss
What are red flags that make you think that someone has a spinal fracture?
- Major trauma
- Minor trauma or strenous lifting in an older/osteoporotic person
- Prolonged corticosteroid use
- Osteoporosis
- Advanced age >70yrs
What are red flags that make you think that someone has an infection?
- Constitutional symtpoms (fever, chills)
- Recent bacterial infections (UTI or skin infections, pneumonia)
- Immunosuppression
- IV drug use