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Orthopedics II - Cervical > Cervical Pain - Vascular Insufficiency, Cancer, and Degenerative Disease of the CNS, etc. to Page 11. > Flashcards

Cervical Pain - Vascular Insufficiency, Cancer, and Degenerative Disease of the CNS, etc. to Page 11. Flashcards

1
Q

What are two parts of CAD?

A

VAI/VBI and ICA

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2
Q

What is a common injury mechanism of the pars prevertebralis?

A

compromised by fascia around the scalenes associated with TOS and scalene muscle spsm following trauma such as whiplash.

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3
Q

What is the only real way that the Pars transversaria can be compromised?

A

Osteophytic encroachment.

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4
Q

How can the Pars Axo-atlantis be compromised?

A

Contralateral rotation causing bleeding, platelet formation and possible embolus.

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5
Q

The Pars Subarachnoidealis can be compromised from what action?

A

Suboccipital extension can impinge the artery between the occiput and C1.

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6
Q

What are kind of cervical manipulation is usually associated with vertebral artery trauma? What are the reported incidences of this happening?

A

Rotational. Between 1 in 20,000 and 5 in 10,000,000 cervical manipulations result in serious vertebrobasilar complications causing stroke.

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7
Q

What are the 8 main symptoms and signs of vertebrobasilar insufficiency?

A 
5 D's:
Dizziness
Diplopia
Drop Attacks
Dysarthria
Dysphagia
3 N's
Nausea
Numbness
Nystagmus
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8
Q

What are the 8 main signs/symptoms of ICA Dysfunction?

A 
TIA
Horner's Syndrom
Pulsitile tinnitus
Cranial Nerve Palsy (VI)
Scalp tenderness
Neck swelling
Orbital pain
CVA
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9
Q

What are the 7 major arterial risk factors?

A 
BP >140/90
Hypercholesterol/lipidemia
Diabetes
Family Hx of MI, TIA, CVA, PVD, angina
BMI > 30 (In other word: obesity)
Recent or repeated injury
Upper C-spine instability
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10
Q

What are the 3 main types of things that cause dizziness?

A
  1. Inner Ear (Menieres, infection, trauma, vestibulotoxic drugs, BPPV)
  2. Central (VAI, tumors, cervical proprioceptor dysfunction, and SCM, demyelinating disease)
  3. Systemic (drugs(anticonvulsants, antihypertensives, hypnotics, alcohol, tranquilizers), hypotension, hypothyroidism, dehydration).
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11
Q

What are 4 things to ask about when VBI is suspected?

A
  1. hx of trauma
  2. cardiovascular hx
  3. type of dizziness
  4. positional symptoms (eg. at hairdresser)
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12
Q

What are some risk factors and symptoms associated with an intracranial tumor?

A
  1. Age: 45 to 55
  2. Headache (1/3 of patients) that is retro-orbital, worse in AM, and worse with exercise or bending forward.
  3. Visual blind spots
  4. Lethargy and mental clouding
  5. Cranial nerve VI issues
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13
Q

What are some important things you may find in a history for someone with a suspected tumor?

A
  1. Age over 50
  2. previous hx of cancer
  3. constant pain
  4. night pain
  5. headache
  6. Recent unexplained weight loss
  7. visual changes
  8. lethargy
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14
Q

3 types of tests for brain tumors?

A
  1. Cranial nerve
  2. UMN signs
  3. Imaging
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15
Q

What are the most common types of intraspinal tumors?

A

Intradural-extramedullary such as Schwannomas and Menigiomas.

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16
Q

What is a pancoast tumor and where can it cause pain? What is it commonly misdiagnosed as?

A

It is an apical lung cancer that may be asymptomatic until it impinges the brachial plexus from C8-T1. It can cause pain in the shoulder and/or ulnar distribution. It is commonly misdiagnosed as OA

17
Q

What is Horner’s syndrome?

A

An interruption of the occulosympathetic nerve supply resulting in enophthalmos, ptosis, and miosis.

18
Q

What is MS according to the notes?

A

Viral induced autoimmune disease of the CNS resulting in edema, inflammation and demyelinization. No unique clinical test to dx it. Must know from hx.

19
Q

What is ALS? What tracts does it affect? What is symptoms/signs of it?

A

A progressive motor neuron disease of unknown cause that results in degeneration & scarring of the motor neurons in the lateral aspect on the spinal cord, brain stem and cerebral cortex.
Tracts: corticospinal & corticobulbar tracts from cerebral cortex down to synapse with LMN.
Signs: Asymmetrical weakness (no pain), fasciculation, UMN signs.

20
Q

What is the primary age for strokes?

A

> 65

21
Q

What level of the spine is affected most often by cervical spondylitic myelopathy?

A

C6

22
Q

What are the pathomechanics of Cervical spondylitic myelopathy?

A

Narrow spinal canal
C6 level affected
Usually it is the posterior part of the cord under greatest stress.
Hypertrophy of the ligamentum flavum - compresses cord in extension.

23
Q

What are the 2 body systems that are affected by cervical spondylitic myelopathy and give details, fool.

A

Vascular: anterior spinal artery can be compressed causing cord ischemia
Nerve: demyelization (Schwann cells sensitive).

24
Q

True/False: CSM is the 2nd most common cause of spinal cord dysfunction in patients over 55.

A

False: It’s the MOST common cause.

25
Q

What are some signs/symptoms of CSM?

A

Weakness & loss of dexterity in UE
Unsteadiness causing broad based gait
Hoffman’s sign
diminished reflexes AT level of lesion and hyper-reflexia BELOW level of lesion.
Any spinothalamic tract issues: pain and temp changes on opposite side
Any dorsal nerve root issues: proprioception, balance, and vibratory sense.

26
Q

Treatment of CSM?

A

Milder cases: cervical spine traction & manipulation of thoracic spine
Severe cases: decompression surgery

27
Q

What are the 3 MANDATORY QUESTIONS that you have to know for the cervical spine. C’mon, spit em out, already!

A
  1. Any dizziness (vertigo), drop attacks, or blackouts?
  2. Any hx of RA (or other inflammatory arthritis)?
  3. Any neurological symptoms in the legs (and pain, numbness, tingling, spasticity, difficulty walking)?
28
Q

What are signs/symptoms of Meningitis?

A
  1. Headache, stiff and painful neck
  2. fever
  3. Kernig’s sign (flexed hip, straightened knee causing pain
  4. Brudzinski’s sign (flexed neck causes hip and knee flexion)
  5. Neuro changes if undetected (Cranial nerves and seizures/coma).

Orthopedics II - Cervical (6 decks)

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