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Orthopedics II - Cervical > Cervical Pain - Instability > Flashcards

Cervical Pain - Instability Flashcards

1
Q

What are the 7 serious conditions that you must screen out for patients with cervical pain?

A 
fracture
instability
vascular insufficiency
neoplasm
CNS degenerative disease
CVA
cord compression/ Myelopathy
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2
Q

True/False. If someone loses consciousness due to a head injury, you should always assume the presence of a cervical fracture until excluded by CT scan or MRI

A

True

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3
Q

What are the 3 parts of the Canadian C-Spine rules?

A
  1. Is there a high risk factor present mandating radiography?
  2. Is there a low risk factor that prevents safe assessment of ROM?
  3. Is the patient able to rotate neck 45 degrees in both directions?
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4
Q

What are the 3 high risk factors from the Canadian C-Spine rules that could warrant radiography?

A
  1. Age > 65
  2. Dangerous mechanism
  3. paraesthesias in extremities (>1 extremity)
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5
Q

What are the 3 dangerous mechanisms that we talked about in class as being high risk factors?

A
  1. fall >1m, or 5 stairs
  2. MVA > 100km/hr (62mph), rollover or ejection
  3. bicycle accident
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6
Q

What are the 5 low risk factors that prevent safe assessment of ROM in the Canadian C-Spine rules?

A
  1. not a simple rear-end MVA
  2. unable to sit in ER
  3. not ambulatory since injury
  4. immediate onset of pain
  5. presence of mid-line pain
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7
Q

What is the sensitivity and specificity of the Canadian C-spine rules?

A

Sensitivity: 99.4%
Specificity: 45.1%

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8
Q

What are the X-ray views commonly used for assessment of C1-C2?

A

Lateral
AP
Odontoid (open mouth)

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9
Q

What are the 2 types of C1 Atlas fractures and what kind of force can cause the injury?

A
  1. Neural Arch Fractures: Hyperextension - post. ring of C1 is jammed between C2 and occiput.
  2. Burst Fracture: Axial compression.
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10
Q

True/False: Odontoid fractures of C2 have a likely mechanism of excessive flexion and are highly fatal.

A

False. Odontoid fractures are highly fatal but likely result from excessive rotation.

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11
Q

What is the common treatment for anterior wedge fractures of C3-C7?

A

Collar for comfort

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12
Q

What will an X-ray of a hyperextension injury to C3-C7 show?

A

A gap

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13
Q

What ligament is torn during a flexion dislocation injury of C3-C7 with no fracture? What is the treatment for such an injury?

A

Posterior ligament is torn. Treated with fusion.

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14
Q

True/False: A flexion dislocation injury with or without a fracture is usually associated with cord damage.

A

False: Only a fracture dislocation is usually associated with cord damage.

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15
Q

What is the usual cause of upper cervical instability?

A

pathological changes to the ligamentous restraints that result in an increase in the atlas-dens-interval (ADI).

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16
Q

What is a too high ADI?

A

> 2-3 mm

17
Q

What is the ligament in the upper cervical spine that provides the most stability?

A

transverse ligament

18
Q

What is the most common cause of sudden death in RA pts?

A

cord compression

19
Q

What is the mortality rate within 12 months of those who develop cord compression?

A

50%

20
Q

What is Marfan’s syndrome? Signs/symptoms?

A

Genetic, soft tissue disease that results in c-spine instabilities, spondylo defects, and possible aortic aneurisms. Signs include the wrist sign (overlap thumb and little finger) and thumb sign (thumb in palm extends beyond wrist).

21
Q

What is Grisel’s syndrome and what ages does it effect?

A

Spontaneous A-A dislocation in ages 6-12.

22
Q

What are some signs and symptoms of Grisel’s syndrome? Treatment?

A

signs/symptoms: Upper respiratory tract infections, crhonic sore throats, spontaneous torticollis, cock robin head posture.
Treatment: Early: antibiotics, collar, rest. Late: fusion.

23
Q

What is a common upper cervical ailment seen in Down’s syndrome patients?

A

Odontoid hypoplasia (22% in kids, 15% in adults). Also have increased ADI.

24
Q

What is Ehlers Danlos Syndrome and what are 3 types of it we talked about in class?

A

A syndrome of not having enough collagen in the body, resulting in joint dislocations, + Beighton index, and a higher rate of atlanto-axial subluxation.
3 types: Classic, hypermobile, vascular.

25
Q

In summary, what are 9 possible causes of non-traumatic instability?

A
  1. Arthritis (RA, psoriatic, or ankylosing spondylitis)
  2. Marfan’s Syndrome
  3. Grisel’s Syndrome
  4. Down’s Syndrome
  5. Ehlers Danlos
  6. Corticosteroid use (prolonged)
  7. Osteoporosis
  8. Congenital abnormalities
  9. Chiari malformation, types I-IV
26
Q

The dens does not fully develop by what age?

A

12

27
Q

What is a Chiari malformation? What are symptoms of it? What is the progression rate (generally) of types I-IV?

A

Inferior displacement of cerebellum into foramen magnum.
Symptoms: UE weakness, headaches, ataxia, dysphagia and a bunch of other CEREBELLAR symptoms.
I: slow
II-IV: rapid

28
Q

What are the 5 cardinal signs of cervical instability?

A
  1. Perioral Anethesia/paresthesia
  2. Quadrilateral limb paresthesia
  3. Drop attacks
  4. Nystagmus
  5. Trauma
29
Q

What are 4 treatment principles for treating instability?

A
  1. surgical stabilization (cases which have neuro compromise)
  2. Exercise program (less severe cases)
  3. Isometrics to suboccipital muscles
  4. Avoid Flexion

Orthopedics II - Cervical (6 decks)

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