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Musculoskeletal Block > Back and Neck Pain > Flashcards

Back and Neck Pain Flashcards

1
Q

L4 Neurologic Level

A

Tibialis Anterior
Patellar Reflex
Sensation on medial part of leg and big toe

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2
Q

L5 Neurologic Level

A

Extensor Hallicis Longus
No Reflex
Sensation on middle aspect of leg toes 2-4

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3
Q

S1 Neurologic Level

A

Fibularis Longus and Brevis
Achilles Reflex
Sensation on lateral aspect of leg and little toe

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4
Q

FABER test

A

FABER: for Flexion, ABduction, and External Rotation is performed to evaluate pathology of the hip joint or the sacroiliac joint. The test is performed by having the tested leg flexed, abducted, and externally rotated.

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5
Q

Babinski Test

A

Babinski test is only for pediatric patients, this would be abnormal in adults – elicits flexion of all toes (normal), but positive test is extension of toes

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6
Q

Straight Leg Lift Test vs. Reverse Straight Leg Test

A

Straight Leg test: lift leg, and abnormal/positive test will cause pain indicative of a sciatic nerve compression

Reverse: Femoral nerve stretch test

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7
Q

Spurling’s Test

A

Spurling test: compress foramen and reproduce arm pain, which shows signs of radiculopathy in cervical spine

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8
Q

Muscle Testing: C5-T1

A 
C5-deltoid
C5-biceps
C6-radial wrist extensors
C7-triceps
C7-flexor carpi radialis (FCR)
C8-flexor digitorum sublimus (FDS) to ring finger
T1-first dorsal interosseous
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9
Q

Hoffman Reflex

A

w/ pt’s hand relaxed, flick the long fingernail & look for index finger & thumb flexion
Sign of long-tract spinal cord involvement

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10
Q

Quick Exam

A 
Look at posture/general appearance
Crouched/hunched over,      neck ROM?
Do they appear to be in legitimate pain
Palpate neck/back
Check motion
Flex/ext/sidebend/rotate etc

Check active/passive ROM of all large joints
Check muscle strength
Check reflexes
Check neurovascular status

Provocative tests
Straight leg raise, femoral nerve stretch, Spurling’s etc
Waddall signs- are they really in pain or not?

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11
Q

Cervical Radiculopathy: Relief

A

Pain relieved by placing hands on head

Opens neural foramen

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12
Q

Cervical Radiculopathy: Tests

A

Physical exam
Assess alignment
ROM
Motor & sensory exam
R/O shoulder pathology, vascular disturbances & peripheral nerve entrapment
Signs of UMN involvement suggest spinal cord compression

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13
Q

Cervical Spondylosis

A

Degenerative disk disease (DDD) of the cervical spine
Produced by ingrowth of bony spurs, buckling or protrusion of the ligamentum flavum &/or HNP
Result in narrowing of the neural foramen & stenosis of cervical spinal canal
Can cause neck pain, radiculopathy &/or myelopathy

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14
Q

Cervical Spondylosis: Symptoms

A

Most common is limited mobility of the cervical spine & chronic neck pain that worsens with upright activity

Radicular symptoms & pain may occur in the UE’s w/ lateral recess stenosis & nerve root entrapment

Many asymptomatic patients will show these changes

Narrowing of the spinal canal & resultant myelopathy are more common in older men

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15
Q

Myelopathy vs. Radiculopathy

A

Radiculopathy is compression on the nerve root(s)

Myelopathy is compression on the cord
Trunk or leg dysfunction
Gait disturbances
Bowel or bladder changes
Signs of UMN involvement
more common with stenosis
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16
Q

Cervical Spondylosis: PE

A

Assess neck ROM
Check motor & sensory distributions of UE/LE
Assess gait & bowel/bladder function

Hoffman reflex, clonus, Babinski
+ in patients with myelopathy
These are your UMN signs

Radiculopathy has same findings as HNP
Abnormal reflexes & motor/sensory dysfunction

17
Q

Cervical Strain Clinical Symptoms

A

Cervical pain may follow an incident of trauma or may be spontaneous in onset

Nonradicular, nonfocal neck pain, noted anywhere from the base of the skull to the cervicothoracic junction, is most common

SCM &/or trapezius pain is also common

Pain often worse w/ motion & may be accompanied by paraspinal spasm

Occipital headaches common
Pain following trauma lasts longer

18
Q

Cervical Strain PE

A

Areas of tenderness in paraspinous muscles, trapezii, SCM ,spinous processes, interspinous ligaments &/or medial border of scapula
Limited ROM is common
Pain noted in extremes of motion
Neuro exam is normal

19
Q

Cervical Strain Dx Tests

A

AP, lateral & open mouth xrays necessary w/ hx of trauma, neuro deficits or elderly

Assess soft tissues
Assess normal lordotic curve

Look for degenerative changes w/ pain, look for instability
Flex/ext films by specialist

20
Q

Fx of C-Spine

A

Result from high energy trauma
Beware in unconscious or intoxicated patients- cause of most missed c-spine fxs

Severe neck pain, paraspinous muscle spasm &/or point tenderness
Radicular pain suggests nerve root impingement
Global motor/sensory deficits suggest spinal cord injury
The absence of pain does not “clear” the patient or eliminate the possibility of cervical spine injury

21
Q

Fx of C-Spine: PE

A

Inspect for swelling & contusions
Palpate for tenderness & paraspinal spasm
Look for step-offs: suggest PLL injury…instability
Assess motor/sensory function
Perianal sensation, sphincter tone & bulbocavernosus reflex

22
Q

Fx of C-Spine: Dx Imaging

A

AP, lateral & open mouth view
Most important is cross-table lateral view
CT- most commonly missed injuries at top & bottom of c-spine
Flex/ext views to assess stability

23
Q

Fx of C-Spine: Tx

A

Immobilize immediately via c-collar and backboard: suspect injury until proven otherwise

Stable injuries can be treated with collar/immobilization
Unstable injuries require surgical stabilization

24
Q

Cauda Equina Syndrome: Symptoms

A

Onset can be immediate or progress over hours/days
Radicular pain/numbness typically involves both legs
Typically more severe on one side
**Presence of perineal numbness in a saddle distribution is typical = incontinence
Pain diminishes as paralysis progresses

25
Q

Cauda Equina Syndrome: Dx Tests

A

MRI or CT myelogram mandatory if CES suspected
Plain films can identify structural causes
CBC, ESR, CRP can be used if infection is suspected

26
Q

Fx of T and L Spines

A

Moderate to severe back pain
Pain is exacerbated by motion
N/T, weakness, bowel or bladder dysfunction suggest nerve root injury

Burst fracture where piece comes out and compresses nerve
Posterior longitudinal ligament damage needs to be stabilized, or can cause kyphosis if untreated

27
Q

Acute LBP

A

*******Low back strain is an injury to the paravertebral muscles
Because of the deep location of the lumbar soft tissues, however, localizing an injury to a specific structure is difficult, if not impossible
In this area, regardless of which muscle or ligamentous structures have been injured the treatment protocols are identical

A hx of repeated lifting & twisting or operating vibrating equipment may be associated with LBP
***Factors associated with LBP include poor fitness, job dissatisfaction, smoking & various psychosocial issues

28
Q

Acute LBP: PE

A

Diffuse tenderness in low back or SI region
ROM (flex) is limited/painful
***LE motor/sensory exam is normal

29
Q

Chronic LBP

A

Back pain of more than 3 mo duration
Affects pts from age 30-60
Symptoms recurrent & episodic

*****DDD common diagnosis: normal physiologic process of aging, and does not necessarily imply pain

30
Q

Chronic LBP: PE

A

L & SI tenderness is common
**Motor/sensory exam & DTR’s usually normal
Straight-leg raise can be +
**Waddell signs

31
Q

Lumbar Spinal Stenosis

A 
*******Narrowing of one or more levels of the lumbar spinal canal with subsequent compression of the nerve roots
Affects 30% of the population > 60 y/o
Not all will have symptoms
Degenerative in nature
Most common at L3-4, L4-5 & L2-3
32
Q

Metastatic Disease

A

Pain is the most common presenting symptom
***Pain is progressive & present at night
Can have compression fxs associated with nerve compression
Progression can be slow or fast depending on the type of tumor

33
Q

Spondylolisthesis (SPT): Degenerative

A

***Forward slippage of a lumbar vertebral body that is caused by degeneration & alterations in the facet joints in conjunction with degenerative changes in the disk

Most common in the 4th & 5th vertebral bodies
More common in women > 40 y/o
Retrolisthesis is posterior slippage 2nd to degenerative changes

34
Q

Spondylolisthesis (SPT): Isthmic

A

One vertebral body slips in relation to the one below
Usually L5 on S1 in kids
*****A defect at the junction of the lamina & pedicle (pars interarticularis) detaches the ant & mid columns from the posterior column

Most likely due to repetitive loading during adolescence, especially football and gymnastics

35
Q

Spondylolisthesis (SPT): Isthmic Symptoms and PE

A

May be symptomatic or asymptomatic
Can have radicular back pain that worsens with standing
*****Tight hamstrings
True nerve compression symptoms rare

**Diminished lumbar lordosis w/ flattening of the buttocks
If significant, can notice a step-off
**Hamstring spasm
Neuro deficits uncommon

Musculoskeletal Block (29 decks)

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