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EM Cervical > cervical disc disease > Flashcards

cervical disc disease Flashcards

1
Q

what is the outer 1/3 of the annulus fibrosis innervated by

A

sinuvertebral

vertebral

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2
Q

sinuvertebral arises from what?

vertebral arises from what?

A

sinuvertebral - ventral ramus - somatic root

vertebral - sympathetic chain - autonomic root

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3
Q

what 2 age peaks are prevalent in radiculopathy

A

20s - disc herniation

60s - DJD - spurs/protrusion

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4
Q

symptoms of a disc

A

referred pain
muscle spasm
myofascial pain
autonomic component

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5
Q

annulus is made of what

A

collagenous lamella

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6
Q

annulus collagen arranged how

A

35 degree angle from horizontal

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7
Q

annulus is more susecptible to injury with what movements

A

rotation and translation

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8
Q

annulus is what percent water

A

65

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9
Q

what kind of collagen is in annulus

A

1 and 2

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10
Q

what is seen near where the annulus attaches to the end plate

A

elastic fibers

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11
Q

lamellae are made up of what

inner and outer?

A

type 1 and 2 collagen

inner - type 2
outer - type 1

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12
Q

what are components of annulus

A

water 65
collagen 55
proteoglycans 20
elastic fibers at endplate

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13
Q

what is the major component of nucleus pulposus

A

water 80

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14
Q

what are the components of nucleus pulposus

A

water 80
proteoglycans 65
type 2 collagen 17
elastic fibers

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15
Q

what traps and holds water which gives the nucleus pulposus its strength and resiliency

A

proteoglycans aggrecan

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16
Q

cervical disc herniation of nucleus pulposus usually hits what root

A

the next numbered root

if herniation at c5-c6
c6 is affected

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17
Q

referred pain

c6-c7 disc is felt where?
c5-c6 disc is felt where?
c4-c5 disc is felt where?
c3-c4 disc is felt where?

A

c6-c7 - inferior angle of scap
c5-c6 - medial scap border
c4-c5 - scap spine and superior angle
c3-c4 - c7 sp and posterior border of trapezius

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18
Q

what is the most common cause of cervical radiculopathy

A

foraminal encroachment

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19
Q

herniation of nucleus pulposus in cervical spine percentage

A

20-25 percent

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20
Q

what is the most common NERVE ROOT LEVEL affected by radiculopathies

what is the most uncommon

A

c7

c5

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21
Q

the disc begins to degenerate in the __ decade of life

A

2nd

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22
Q

what causes degradation of the nucleus, which decreases rigidity

A

endplate cracks

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23
Q

buckling of the annulus leads to what

A

circumferential tears for in osterolateral annulus

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24
Q

circumferential tears will form ___ which will progress to what

A

radial tears

radial fissures

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25
Q

what pathology dscribes annular fissuring within the disc without external disc deformation

A

internal disc derangement

26
Q

internal disc derangement occurs when?

A

trauma
degradation
cervical flex and rotation injury
whiplash

27
Q

what serves as a major pain generator in herniation

A

outer annulus fibrosis

28
Q

degenerative disc disease may progress to what

A

internal disc derangement

29
Q

describe discogenic pain without nerve root involvement

A

vague, diffuse, distributed axially

30
Q

what irritates and alleviates discogenic pain

A

worse - increase in intradiscal pressure due to lifting or valsalva maneuver, vibration

better - lying supine to decrease intradiscal pressure

31
Q

discogenic pain that is referred from disc to upper limb usually is what

A

nondermatomal

32
Q

pain generators - different types

A

chemical - inflammation, neurogenic
ischemic
mechanical - pressure or stretch

33
Q

describe radicular pain

A

deep, dull, achy, sharp, burning, electric

34
Q

radicular pain that is referred from disc to upper limb usually is what

A

myotomal or dermatomal

35
Q

cervical radicular pain most commonly radiates where

A

interscapular region

but also can go to occiput, shoulder, arm

36
Q

what is present with radicular pain in regards to distal limbs and proximal limb

A

distal limb - numbness

proximal limb - weakness

37
Q

what are the two components of radicular pain

A

constant deep dull ache

sharp lacerating

theories - dural vs root
ischemia vs stretch
compression vs inflammation

38
Q

what is dynatome

A

area where pain is experienced with root pathology

39
Q

what is dermatome

A

area of sensory disturbance with root pathology

40
Q

radicular pain - decreased sensation to pain, touch, vibration may be present in the distal limb in what distribution

A

dermatome

41
Q

radicular pain - proximal limb weakness manifests when what is compromised

A

motor root

42
Q

patient with radicular pain experiences a decrease in what

A

range of motion

43
Q

what worsens a patient with radicular pain

A

neck extension and rotation

44
Q

what makes it better for the patient with radicular pain

A

neck flexion and abduction of affected limb (bakody)

45
Q

radicular pain may have diminished or absent reflexes where?

A

at the coresponding root level

46
Q

what signs suggest myelopathy and mandate evaluation

A

increased upper and lower limb reflexes

UMN signs

47
Q

what cervical roots are clinical most important to ambulatory practice

A

c5-t1

48
Q

c5-t1 exit where

A

at the same numbered disc

49
Q

which cord segments are difficult to test clinically

A

c1-c4

50
Q

bicpes reflex indicates integrity of what

A

c5 neurological level

51
Q

c5 root exits the c4-c5 ivf and is often hit by

A

c4 disc

52
Q

c5 neurological level found where
c6 neurological level found where
c7 neurological level found where
c8 neurological level found where

A

c5 - found at c4-c5
c6 - found at c5-c6
c7 - found at c6-c7
c8 - found at c7-t1

53
Q

c5 neuro level

A

motor - deltoid and biceps
biceps c5-c6

reflex - biceps and inverted radial reflex

sensation - superior lateral aspect of arm/shoulder

54
Q

c6 neuro level

A

motor - wrist extensors

reflex - brachioradialis

sensation - tips of thumb, index, and long finger

55
Q

pain is more ___ and paresthesia is more ___

A

pain is proximal

paresthesia is distal

56
Q

c7 neuro level

A

motor - wrist flexion

reflex - triceps

sensation - posterior aspect of arm, poterolateral forearm, dorsum hand, ring finger, little finger

57
Q

c7 neuro dysfunction is associated with weakness of what

A

wrist flexors, triceps, pronators

58
Q

c8 neuro level

A

motor - finger flexion
reflex - none
sensation - medial forearm

59
Q

c8 neuro dysfunction is associated with weakness of what

A

interossei motor weakness

60
Q

t1 neuro dysfunction is associated with what

A

weak atrophy of intrinsic hand muscles

pain numbness tingling at or above elbow, may have horners syndrome from pregang fibers

61
Q

t1 neuro level

A

motor - interossei muscle
reflex - none
senstation - medial brachium

62
Q

why is MRI useful

A

great for imaging disc and relationship to thecal sac

EM Cervical (3 decks)

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