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Orthopaedics > Back And Neck > Flashcards

Back And Neck Flashcards

1
Q

What is Marie strumpell’s disease?

A

Also called ankylosing spondylitis and bechterew’s disease. Inflammatory condition mainly affecting spine that causes progressive stiffness and pain. It’s part of the seronegative spondyloanthropathy group of conditions relating to the HLA B27 gene ( others are reactive and psoriatic anthritis)

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2
Q

What clin test perform for ankylosing spondylitis

A

Schober’s test

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3
Q

Clinical feature of cervical myelopathy

A

Increased LL reflexes, increased or decreased UL reflexes

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4
Q

What is Dennis 3 column classification

A

Used when assessing stability of thoracolumbrar fractures.
Ant column: ant longitudinal ligament + ant half vertebral body and disc
Middle: post half vertebral body and disc + post longitudinal ligament
Post: post elements (post lig complex, incl facet joint capsule, ligamentum flavum, interspinous + supraspinous ligs) and intervening vertebral arches.

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5
Q

AO classification of thoracolumbar fractures

A

Type A: compression injury
Type B: distraction injury
Type C: translation injury

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6
Q

XR feature of compression fractures

A

Ant vs post vertebral body height lat XR - loss height!

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7
Q

What is a burst fracture

A

Type of compression fracture of thoracolumbar spine. Compressive force act through ant + middle column vertebrae, resulting in retropulsion of bone into spinal canal. Vertebral body is crushed in all directions simultaneously (sudden axial loading force)
Unstable because involve 2 Dennis columns
Seen on X-ray as multiple fragments of the vertebral body.

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8
Q

2 XR features of burst fracture

A

1 retropulsion of post wall of vertebral body - fragments seen
2 wide interpedicular distance

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9
Q

What is a distraction injury of thoracolumbar spine

A

“Laceration” of vertebra caused by seatbelt injury eg.

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10
Q

XR feature distraction injury thoracolumbar spine

A

Wide space btwn spinous processes

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11
Q

Is # transv/spinous processes stable/unstable? 2 compl?

A

Stable

Look for kidney + ureter injury

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12
Q

Rx stable + unstable thoracolumbar #

A

Stable: bed rest + brace
Unstable: ORIF

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13
Q

Most common site thoracolumbar #

A

T11 - L2

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14
Q

Usual consequences of injury to C3 and above

A

Ventilator dependant/diaphragmatic pacemaker

Dependent for mobility, transfer and self-care. (Quadriplegia)

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15
Q

Consequences of C4 injury

A

Quadriplegia but still head and neck injury - may shrug shoulders

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16
Q

C5 injury consequences

A

Has head and neck control, shrug shoulders
Shoulder control.
Can bend elbows and supinate
Therefore can feed, groom, push manual chair on flat surfaces

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17
Q

C6 spinal cord lesion injury consequences

A

Wrist extension therefore can use tenodesis grasp, drive adapted car, push wheelchair

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18
Q

C7 - T1 quadriplegic injury expectations with rehab

A

Can straighten elbows-easier transfers

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19
Q

T2-T8 injury expectations with rehab

A

High paraplegia injury
N use head, neck, arms, hands.
Decreased use rib and chest muscles, poor trunk control.

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20
Q

Cauda equina lesions expectations with rehab

A

Walk with assistive devices eg AFO and crutches

Incontinent bladder and bowel (LMN) - self-catheterisation and colon lavage

21
Q

American spinal injury association (ASIA) impairment scale classification

A 
A= complete. No motor or sensory preserved in s4- s5
B= incomplete. Sensory but no motor k presented below near level (include s4- s5) = anterior cord syndrome
C= incomplete. Motor and sensory fx preserved below neuro level, more than half key muscles below level have power <3.
D = incomplete. Sensory and motor sparing.... Muscle power ≥3
E = normal.
22
Q

What expect from pt with ASIA B lesion

A

Anterior cord syndrome
Loss spasticity, hypersensitive, pain, motor fx dependent on level injury
Sensory maintained below lesion, not motor

23
Q

Presentation of pt with anterior spinal cord lesion

A

Sensory sparing spasms, loss muscle power, reduced pain and temperature below lesion
(Sensory spinothalamic , and motor.dorsal column spared)

24
Q

Presentation of pt with central spinal cord syndrome

A

Walk but poor arm function

Hands > affected legs

25
Q

Pt presentation with posterior cord syndrome

A

Walk but poor proprioception and balance

Dorsal column = fine touch, vibration, proprioception

26
Q

Pt presentation with Brown Sequard syndrome

A

Loss sensation contralat and mm strength ipsilat. Most walk.

27
Q

What is autonomic dysreflexia and where is lesion

A

Potentially life threatening imbalanced sympathetic discharge. Usually in patients with spinal cord lesion at at /above t6

28
Q

Symptoms autonomic dysreflexia (7)

A 
Headache pounding
Profuse sweating
Flushed
Goose bumps
Feeling of impending doom and anxiety
HIGH BLOOD PRESSURE
Overfull bladder/bowel
29
Q

How assess spinothalamic tract

A

Pain -pin prick

30
Q

How assess posterior columns of spinal cord

A

Fine touch and proprioception

31
Q

How assess corticospinal tract of spinal cord

A

Power muscles grading

32
Q

Spinal shock definition

A

Areflexia in initial period injury
Ends when bulbocavernosus reflex returns in supra-sacral lesions
Hypotensive and bradycardia

33
Q

How determine stability of Thoracolumbar spine.

A

Use Dennis classification. >2 columns affected-unstable.

34
Q

Complication autonomic dysreflexia

A

Intracranial haemorrhage

35
Q

Treat autonomic dysreflexia (5)

A
  1. Remove cause
  2. Sit pt up
  3. Nifedipine (CCB) or glyceryl trinitrate po
  4. If BP cont to rise, give IV phentolamine (alpha 1 and 2 antag)
  5. Rarely: spinal/epidural anaesthesia
36
Q

Identify pathology picture 37 in trauma section

A

Compression fracture

37
Q

Identify pathology picture 38 in trauma section

A

Compression #

38
Q

Name 10 red flags of back pain

A 
BACK PAIN
Bowel/bladder dysfunction
Anorexia /weight loss
Constitutional symptoms or malignancy; cancer history; hypercalcaemia
Khronic disease
Paraesthesias - especially saddle paraesthesia; pain at night or while sleep, at rest, morning stiffness; pyrexia
Age > 50 or <15
Iv drug use
Neuromotor deficits
39
Q

What is difference between unifacetal and bifacetal vertebral dislocation?

A

Unifacetal= 25% subluxation

Bifacetal =50% subluxation

40
Q

Clinical features Tb spine? ( 6 )

A

• Constitutional symptoms: chronic illness, malaise, night sweats, weight loss
• back pain: late signafter significant destruction and deformity
• kyphotic deformity; gibbus
• neurological deficits Due to
- mechanical pressure on cord by abscess, granulation tissue, tubercular debris, caseous tissue
- mechanical instability from subluxation or dislocation
- stenosis from ossification of ligamentum flavum adjacent to severe kyphosis

41
Q

Treatment Tb spine?

A
  • Ripe: riampicin, isoniazid, pyrazanamide, ethambutol 2 months, then ri 9 to 18 months.
  • spinal orthosis to prevent deformity
42
Q

What is a teardrop extension fracture?

A

Caused by forced extension of neck with resulting avulsion of anteroinferior corner vertebral body , fragment usually triangular like teardrop.

43
Q

Define spondylosis

A

Painful condition of spine from degeneration of the intervertebral discs.

44
Q

Name 8 clinical signs scoliosis

A

• Apparent curvature of spine when viewed from behind with patient erect , and in presence of curvature >10 degrees
• rib hump if thoracic curve, lumbar hump if lumbar curve on forward bending (Adam’s test )
• occiput not vertically over midline sacrum. Plumb line is used - pt erect, from occipital protuberance or from spinous process c7 or T1
• prominent scapulae, creased flank, asymmetric pelvis
. Associated posterior midline skin lesions in neuromuscular scoliosis: café-au-lait spots, dimples, neurofibromas, axillary freckling, hemangiomas, hair patches
. Apparent LLD
• primary curve where several vertebrae affected. Secondary curves above and below fixed 1° curves to try maintain normal position head and pelvis
• May have back pain, asymmetric shoulder height when bend forward, pes cavus or leg atrophy
(More common in females )

45
Q

Name radiological signs scoliosis

A

• Cobb angle >10: lines pwallel to upper border of upper vertebral body and lower border of lowest vertebra of curve, then erect perpendiculars from these lines to cross each other. Measure angle between perpendiculars (top angle)

46
Q

Name 5 causes scoliosis

A

•Idiopathic 90% (adolescent idiopathic scoliosis AIS)
• congenital: vertebrae fail to form or segment
• neuromuscular: umn or LMN lesion, myopathy (arthrogryposis, muscle dystrophy),cp
• postural: compensate for leg length discrepancy, muscle spasm, sciatica, inflammation
• osteochondrodystrophies, neoplastic, neurofibromatosis, Marfan’s
• trauma: #, sx, radiation
.

47
Q

Treatment scoliosis? (3)

A

Based on Cobb angle
• <25°: active surveillance
•>25° or progressive: bracing that halts or slows curve progression, but doesn’t reverse deformity
• >45°, cosmetically unacceptable or resp problems: spinal fusion

48
Q

Spine examination?

A

• ATLS, spine board log roll- clear Cspine

Look
• scars, posture (scoliosis), asymmetry shoulder girdle (scoliosis, arthritis, fractures, dislocation)
• pelvic tilt (scoliosis, LLD, hip abductor weakness)
• cervical lordosis (hyper = chronic degenerative joint disease), kyphosis thoraces (normal 20-45) hyper = Schuermann’s disease, lumbar lordosis (loss= sacroiliac joint disease eg ankylosing spondylitis)
•Spinal alignment, iliac crest alignment (lld, hip abductor weak), wasting paraspinal muscles, abnormal hair, bruising…
. Gait

Feel
• . spinous processes, sacroiliac joints, para vertebral joints
• paraspinal muscles

Move
• cervical: flexion 0- 80, extension 0- 50, lateral flexion 0- 45; rotation 0- 80.
• lumbar: flexion touch toes, extension lean back 10-20, lat flex
• thoracic: rotation

Special tests
• Schober’s test (ankylosing spondylitis)
• sciatic stretch test (straight leg raise)
• femoral nerve stretch test
• dermatomes key point /2
• myotome / 5 power

Orthopaedics (20 decks)

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