Back and Spinal Cord injury

Question 1

ASIA (American Spinal Injury Association) nerve root for elbow flexors?

Answer 1

C5

Question 2

ASIA nerve root for wrist extensors?

Answer 2

C6

Question 3

ASIA nerve root for elbow extensors?

Answer 3

C7

Question 4

ASIA nerve root for finger flexors?

Answer 4

C8

Question 5

ASIA nerve root for finger abductors?

Answer 5

T1

Question 6

why must CE syndrome be treated within 48hrs of onset of sphincter symptoms?

Answer 6

so as not to result in:
need for intermittent catheterisation
DRE- digital rectal evacuation
sexual dysfunction

*espec. important as syndrome occurs in young people- between 20 and 40 ish?, so would have to live with these symptoms for the rest of their lives.

Question 7

most common cause of CE syndrome?

Answer 7

IV disc herniation*

Question 8

hip flexion nerve roots?

Answer 8

L2, L3

Question 9

hip extension nerve roots?

Answer 9

L4, L5

Question 10

hip abduction nerve roots?

Answer 10

L5, S1

Question 11

hip adduction nerve roots?

Answer 11

L1-L4

Question 12

hip internal rotation nerve roots?

Answer 12

L1-L3

Question 13

hip external rotation nerve roots?

Answer 13

L5, S1

Question 14

knee extension nerve roots?

Answer 14

L3, L4

Question 15

knee flexion nerve roots?

Answer 15

L5, S1

Question 16

ankle dorsiflexion nerve roots?

Answer 16

L4, L5 (mainly L5*)

Question 17

ankle plantarflexion nerve roots?

Answer 17

S1, S2

Question 18

subtalar inversion nerve roots?

Answer 18

L4, L5

Question 19

subtalar eversion nerve roots?

Answer 19

L5, S1

Question 20

extension of big toe nerve root?

Answer 20

L5

Question 21

toe extensor nerve roots?

Answer 21

L5, S1

Question 22

toe long flexor nerve roots?

Answer 22

S1, S2

Question 23

what is a myelopathic gait?

Answer 23

broad base, and shuffle, with disruption in smooth, rhythmic function

Question 24

red flag symptoms in presentation of back pain?

Answer 24

age outside 18-55
non-mechanical- not relieved by rest
thoracic pain- thoracic spine less mobile in comparison to cervical and lumbar
night pain
systemic features- night sweats, weight loss
widespread neurology- symptoms cannot be related to just 1 nerve root
Ca history or infection
steroid/drug abuse- immunocompromised- infection risk
history of trauma

Question 25

characteristics of true SCIATICA?

Answer 25

pain below knees, intense, aggravated by coughing and straining
often in assoc. with numbness and paraesthesia

Question 26

characteristics of numbness or paraesthesia in spinal stenosis?

Answer 26

aggravated by standing upright or walking

relieved by bending forward or sitting down

Question 27

why should urethral discharge, diarrhoea and sore eyes be considered in a back disorder case?

Answer 27

features of Reiter’s disease= cause of ‘reactive’ spondylitis

Question 28

what name means vertebral displacement?

Answer 28

spondylolisthesis

Question 29

aetiology of ankylosing spondylitis?

Answer 29

genetic link
associated with HLA-B27 gene
gene also linked to reactive arthritis, some forms of psoriatic arthritis and enteropathic arthritis assoc. with UC and Crohn’s

Question 30

typical causes of back pain according to age?

Answer 30

15-30yrs= prolapsed disc, trauma, fractures, AS, spondylolisthesis, pregnancy
>30= prolapsed disc, cancer
>50= degenerative, OP, Paget's, malignancy, myeloma, lumbar artery atheroma

Question 31

definition of recurrent low back pain?

Answer 31

new episode of pain after a symptom free period of 6 months

Question 32

why must considerations be made to stiffness in presentation of back pain?

Answer 32

severe morning stiffness may indicate diagnosis of RA or AS

Question 33

indications of AS in relation to movement?

Answer 33

inactivity aggravates pain, exercise provides relief

Question 34

blood and urine tests in back pain?

Answer 34

FBC, ESR, CRP, urine analysis if cancer, infection or inflammation is suspected.
LFTs may be helpful. ALP can be elevated in metastatic disease and Paget’s disease of bone.
PSA will be raised particularly in carcinoma of the prostate.
Urinary hydroxyproline will be markedly elevated (with increased bone turnover) in Paget’s disease of bone.
Nephrolithiasis may produce red cells in the urine.

Question 35

what is the location of the SC on a lateral view plain X-ray of the vertebral column?

Answer 35

lies between the posterior and spinolaminar lines