Back Clinical Supplement Flashcards
Atlanto-Occiptal Articulation
Synovial condyloid
Atlanto-Axial articulation
2 Synovial plane/gliding
1 Synovial pivot
Zygapophyseal Joint Articulation
Facet joints
Plane/gliding
Intervertebral disc articulation
Secondary cartilaginous
Cervical Dislocation mechanism
Due to sloped facets, superior cervical segments can slide anteriorly and superiorly along inferior segments
Jefferson fracture
Trauma (usually from above) travels through skull and bursts the the arch of the atlas. Usually no spinal cord damage.
Bonk go to horny jail
Hangman Fracture
Hyperextension breaks pars articularis of axis bilaterally
Osteoporosis cause
Ca++ metabolism deficiency
Dowanger’s hump
Nana hump
Exaggerated kyphosis and decreased lordosis, makes you short
Dens Fracture consequences
Avascular necrosis of dens
Dens fragments lacerate cord
Transverse ligmanent of atlas rupture consequence
Compression of spinal cord by dens
Populations with lax transverse ligament of atlas
Marfans
Down syndrome
Spinal stenosis symptoms
Bilateral extremity pain or numbness
Incontinence
Spinal stenosis fix
Surgical laminectomy
Causes of spinal stenosis
Protruding intervertebral disc
Meningeoma
Bone changes
Ligament Hyperthropy (posterior longitudinal, ligamentum flavum)
Zygapophyseal joints
Congenital Scoliosis cause
Improperly formed vertebra (fused/hemi)
Myopathic Scoliosis
Muscle asymmetry (common in cerebral palsy)
Functional Scoliosis
Different leg lengths
Ankolysing Spondilitys
spondyLYTIS
Vertebral joint and ligament inflammation, causes calcification of annulus firbrosus
Ankolysing Spondylitis symptoms
Fusion of vertebral segments, pain, stifness
Epidural anesthesia site
Between lamina of L3-L4
Sacral hiatus
Spinal Anesthesia
Injection into subarachnoid space
Done by lumbar puncture
Uncovertebral Joints, Joints of Luschka
Plane synovial joints that develop in early adolescence
Develop between uncal/hook process of C3-C7
Intervertebral disc innervation
Ventral rami ———> Recurrent branch———> Sinuverterbral nerves ———> intervertebral disc
Zygapophyseal joint innervation
From dorsal rami. Overlaps and includes above joint as well
Disc herniation common location
Posterior lateral
Goes lateral to Posterior longitudinal ligament , annulus fibrosis is thinner here
Nerves affected due to disc herniation
Nerve exiting at level in cervical spine
Nerve level below in lumbar region
Common disc herniation sites
95% L4-L5
5% C5-C6, C6-C7, C7-T1
Central (midline) disc herniation consequences
Compress spinal cord (LL weakness, incontinence) or cauda equina
Schorl nodes
Intervertebral disc herniation
Nerve Root testing C5
Strength: Deltoid, Biceps brachii
MSR: Brachioradialis
Key Sensory Area: lateral shoulder and arm
Nerve Root testing C6
Strength: biceps brachii, wrist extension
MSR: brachioridialis
Key Sensory Area: lateral forearm and palm, 1st digit
Nerve Root Test C7
Strength: triceps brachii, wrist flex, finger extension
MSR: triceps brachii
Key Sensory Area: middle finger
Nerve Root test C8
Strength: finger flex
MSR: Triceps brachii
Key Sensory Area: Fifth digit, medial forearm
Nerve Root test T1
Strength: finger adduction/abduction
MSR: no
Key Sensory Area: medial arm
Nerve Root test L4
Strength: tibiales anterior, quadriceps
MSR: patellar tendon
Key Sensory Area: medial leg, medial aspect of foot
Nerve Root test L5
Strength: extensor hallucis longus, extensor digitorium longus, walk on heels
MSR: tibiales posterior
Key Sensory Area: dorsum of foot
Nerve root test S1
Strength: fabularis longus, walk on toes
MSR: calcaneal
Key Sensory Area: lateral aspect of foot
Provocative tests for disc herniations
UE: Spurling
LE: straight leg test
Radiculopathy
Injury or compression of spinal nerve root
