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Clin Med MSK: > cervical spine disorders > Flashcards

cervical spine disorders Flashcards

1
Q

What are the key cervical nerve motor functions

A

C3, C4 and C5 keep the diaphram alive

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2
Q

C4 motor functions

A

scapular winging - serratus, shoulder shrug

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3
Q

C5 motor functions

A

shoulder abduction, wrist extension: biceps reflex

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4
Q

C6 motor functions

A
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5
Q

C7 motor functions

A
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6
Q

C8 motor functions

A
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7
Q

T1 motor functions

A
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8
Q

when is an MRI with contrast indicated

A

previous surgery
malignancy
infection

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9
Q

when may you need a CT

A

trauma or if they are unable to get and MRI

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10
Q

when might you get a CT myelogram

A

pacemaker and people who need contrast but cannot get an MRI

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11
Q

What are the surgical options for cervical spine

A

discectomy, laminotomy/foraminotomy
cervical fusion (anterior, posterior or both)

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12
Q

what patient have poor outcomes after cervical surgery?

A

nicotine users
uncontrolled DM
BMI >40
chronic narcotic use

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13
Q

What is another name for cervical strain

A

whiplash when associated with accelerated-deceleration injury (MVC)

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14
Q

what does nicotine impeed

A

bone healing

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15
Q

what are symptoms that may be associated with cervical strain

A

muscle spasms
headaches (occipital)
stiffness
dizziness/vertigo
blurred/double vision

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16
Q

What is the treatment of cervical strain

A

NSAIDs
+/- muscle relaxers
+/- soft cervical collar as needed for pain (long term use can exacerbate pain)

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17
Q

how long until MRI is indicated for cervical strain

A

> 6 weeks

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18
Q

what is the population affected by cervical DDD

A

aprox 90% of M>50 and F>60
result of normal degenerative process
chronic and progressive

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19
Q

what is the typical presentation of cervical DDD

A

headache
axial neck pain - may be exacerbated by posture, occupational stresses, activities
neck stiffness
+/- radicular complaints

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20
Q

What is possible for a physical exam finding with cervical DDD

A

+/- sensory motor deficits if associated with numbness, paresthesia and weakness

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21
Q

what is the first line for workup of cervical DDD

A

x-rays first line to assess for disc height loss, osteophytes, degenerative deformity

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22
Q

what disc is less commonly impacted and is a good comparison for normal disc height

A

C2 and C3

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23
Q

what can be present with advanced cervical DDD

A

dysphagia that is secondary to large ‘bone spurs’ (osteophytes)
DISH - ossification of ligaments in the spinal column

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24
Q

what is DISH

A

Diffuse Idiopathic Skeletal Hyperostosis

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25
Q

what is dysphasia

A

trouble swallowing

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26
Q

what is the treatment of Cervical DDD

A

osteophytectomy

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27
Q

What is cervical radiculopathy

A

nerve root ‘irritation’ originating in the cervical spine
pain radiating down the UE - dermatomal distribution

usually a symptom of some other cervical spine pathology

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28
Q

What is a cervical herniated disc

A

herniation of the nucleus pulposus (jelly donut)

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29
Q

What is the patient population for cervical herniated disc

A

F>M (60% female)
ages: 50-60 years old

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30
Q

what disc are most commonly involved in cervical disc herniation

A

C56 and C67

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31
Q

what is the presentation for cervical herniated discs

A

radicular pain (past the elbow)
numbness
paresthesias
weakness
neck pain

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32
Q

What special tests are used for cervical herniated discs

A

spurling
compression
distraction
Lhermitte sign

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33
Q

What is the spurling test

A

push down on the crown of the head while flexing laterally
(not forcing most lateral flexion - compressing the neutral foramen)
Pain in UE toward which the neck is flexed indicated nerve root compression

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34
Q

What is Lhermitte sign

A

flexion of the neck results in UE radicular pain

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35
Q

What is the test of choice for cervical herniated disc

A

MRI to look at the disc

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36
Q

what cervical patients suspected for herniated disc are not given the treatment buffet

A

those with large, symptomatic disc herniations

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37
Q

What is cervical spinal stenosis

A

narrowing of the spinal canal +/- foramen

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38
Q

what special tests are used for cervical spinal stenosis

A

spurlings
compression
distraction
lhermitte

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39
Q

What is cervical myelopathy

A

severe compression of the cervical spinal cord - thought to cause cord ischemia
most commonly secondary to cervical spinal stenosis

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40
Q

what is ischemia

A

lack of blood flow

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41
Q

what are the symptoms of myelopathy

A

progressive symptoms:
cervical radiculopathy, UE weakness, LE weakness/gait disturbances
BALANCE CHANGING(walking like they are drunk)

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42
Q

What is present on the physical exam for cervical myelopathy

A

varying degrees of sensory motor dysfunctions
fatiguability
balance changes
upper motor neuron symptoms

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43
Q

What is rhomberg test

A

patient stands with eyes closed and arms out in front, + if losses balance

44
Q

What is Hoffman’s test

A

extend the MCP joint and stabilize the PIP of the middle finger. force the DIP into flexion (flick the tip of the finger), + spontaneous flexion of fingers, particularly the thumb and first finger

45
Q

What special tests would be positive with cervical myelopathy

A

hoffmans and babinski’s test

46
Q

What is myelomalacia on an MRI indicative of

A

cervical myelopathy - evidence of long standing trouble

47
Q

What is the treatment for cervical myelopathy

A

Recommend surgical decompression to preserve remaining function

may have some neurologic improvement but dont typically return to baseline

48
Q

What is kyphosis

A

exaggerated thoracic curvature
commonly referred to as “round back” or “hunchback”

49
Q

what are the causes of kyphosis

A

congenital
postural
scheuermann’s kyphosis
hyperkyphosis (osteoporosis, age related degeneration)

50
Q

What is scheurmann’s deformity

A

juvenile structural deformity - sharp and angular curvature, rigid deformity doesn’t correct with posture/laying supine
M>F primarily age 13-16
likely a hereditary component

51
Q

what is the clinical presentation of kyphosis

A

back pain
stiffness
visible deformity (cosmesis)

52
Q

what is seen onthe physical exam for kyphosis

A

often normal except for deformity

can progress to include:
LE weakness/numbness/tingling
sensory changes in the trunk
difficulty breathing

53
Q

when is an MRI indicated for kyphosis

A

if neurologic symptoms present

54
Q

what is the treatment for postural kyphosis

A

treatment is observation, PT and NSAID as needed if pain

55
Q

what is treatment for congenital kyphosis

A

typically` early surgical statement - spinal fusion

56
Q

What is the treatment for scheurermann’s kyphosis

A

bracing if skeletally immature and 50-75 degrees
spinal fusion if >75 degrees or fail conservative management

57
Q

What is the treatment for osteoporosis related kyphosis

A

symptomatic treatment vs spinal fusion depending on pt reference and impact on ADLs

58
Q

What is thoracic outlet syndrome

A

compression of brachial plexus and/or subclavian vessels between neck and the shoulder - neurovascular disorder

likely anatomic predisposition with superimposed injury to that region (acute or chonic)

59
Q

what is the typical patient population

A

usually thin females with long necks
F>M
peak onset 20-60 years old

60
Q

what are the possible neurologic presentations of thoracic outlet syndrome

A

variable:
UE pain, non radicular with numbness/paresthesias/weakness
UE heaviness worse with overhead activities
nighttime symptoms (decreased pressure on brachial plexus, sensory return = pain)

61
Q

What are the vascular symptoms of thoracic outlet syndrome

A

variable:
UE heaviness
cyanosis
swelling
deep pain in UE
Raynauds (primarily in hands associated with pain, numbness; worse in the cold)

62
Q

what may you seen on a thoracic outlet syndrome phsyical exam

A

UE changes (cyanosis, edema, pallor)
Hair and nail changes
muscle atrophy
+/- tenderness to palpation over the supraclavicular area
+/- masses in the supraclavicular area
reduced skin temperature

63
Q

What special tests are used for thoracic outlet syndrome

A

Adson test
supraclavicular pressure test

64
Q

What are beneficial imaging for TOS

A

Xray, CT, EMG/NCS, vascular studies to identify underling anatomic cause

65
Q

What is the treatment for TOS

A

non operative vs operative
- activity modification, pain control, PT, TENS, nerve block (anterior scalene)
- thoracic outlet decompression (failed 6 months conservative tx, progressive neurologic sx, worsening atrophy), vascular interventions (primary vascular etiology)

66
Q

What is torticollis

A

one of the ‘packaging deformities’
most cases are congenital
contracture of the SCM muscle (head rotates away from affected side and tilts toward affected side- palpable mass)
typically not painful
often associated with other MSK disorders

67
Q

What imaging is useful for torticollis

A

used to rule out other conditions
-xrays if no mass
US if mass present
CT to rule out atlantoaxial rotary subluxation

68
Q

what is the treatment of torticollis

A

passive stretching (opposite of deformity)
surgical release of SCM (failure of 1 year of stretching or significant deformity)

69
Q

what are the most common mechanisms for cervical fractures

A

result of a trauma
MVC
Fall
sports-related injuries
violence

70
Q

what is the approach to a spine trauma patient

A

always be immobilized until cleared
treatment of life-threatening injuries ALWAYS trumps immobilization

71
Q

what is being assessed for on the initial surgery for the exam of spine trauma

A

gross motor/sensory deficits
tenderness - especially midline (spinous process)
step-offs
palpable fluid collections/hematoma
bruising or abrasions/wounds

72
Q

what is the later testing done in spinal injuries

A

still in the ED - neurologic exam - including perineal sensation and anal sphincter tone for SCI

73
Q

what is the tertiary survey for spine traumas and when do they occur

A

within 24 hours of admit, again when awake/alert if not done during initial tertiary survey - neurologic exam

74
Q

What does NEXUS stand for

A

national emergency x-radiography utilization study

75
Q

when do c-spine patients not need x-rays

A

answer yes to all of the following:
Alert and stable
no focal neurologic deficits
no altered level of consciousness
not intoxicated
no midline spinal tenderness
no distracting injuries

76
Q

what are the two c-spine clearance rules

A

NEXUS and Canadian C-spine Rules

77
Q

What is the treatment for stable fractures

A

conservative management, usually with a brace for immobilization

78
Q

what is the treatment for unstable fractures

A

ORIF, usually a fusion procedure

79
Q

what medication do spinal cord injury patients get

A

steroids that are started immediately, thought to be neuroprotective
but not strongly supported in the literature, but widely used

80
Q

what is the MOA for TP and SP fractures

A

flexion injury (whiplash)

81
Q

how are TP and SP fractures treated

A

like a “bad sprain”

Treat conservatively: Rest, ice, NSAIDs, activity modification
soft cervical collar as needed for comfort
+/- follow-up

82
Q

What is a Clay Shoveler’s fracture

A

C7 spinous process fracture

83
Q

what is a occipital condyle fracture

A

compression into C1 or extreme rotation
for the most part these are stable (expect occipitoatlantal dislocation)
usually associated with head trauma
look for co-occuring C1 (atlas) fracture

84
Q

what type of occipital fracture is almost always fatal

A

occipitoatlantal dislocation

85
Q

what is the treatment for occipital condyle fractures

A

almost always rigid cervical collar (miami J)

86
Q

What is the MOI for a C1 fracture

A

compression - force through the occipital condyles

87
Q

what are the fracture classification pattern

A

levine classification - 5 types

88
Q

What is Jefferson Fracture

A

C1 - burst fracture of C1 - comminuted atlas fracture
see widening of lateral masses on odontoid view
usually UNSTABLE - halo or operative fixation

89
Q

what cervical fracture is unstable

A

jefferson fracture

90
Q

what is the treatment of a jefferson fracture

A

Halo or operative fixation

91
Q

what is the MOI for an odontoid/dens fracture

A

C2
high energy injuries - MVCs or falls

92
Q

what imaging is used to see odontoid/dens fractures

A

CT or odontoid views

93
Q

what is the treatment for odontoid/dens fractures

A

most are non-operative or at least get trail of non-op tx
high rate of non-union for type 2-3 fractures - may still heal with a relatively stable fibrous union and dont require surgery

94
Q

What is Hangman’s fracture

A

traumatic spondylolisthesis of C2 - C2 pars interarticularis fracture

95
Q

what is the mechanism of hangmans fracture

A

high energy injuries - MVCs or falls
hyperextension and distraction

96
Q

how is a type 1 hangmans fracture treated

A

non-operative with cervical collar

97
Q

how is a type 3 hangmans fracture treated

A

operative fixation

98
Q

What is a teardrop fracture

A

fracture of the anteriorinferior vertebral body

99
Q

what is the MOI for teardrop fractures

A

compression and flexion or extension - associated with ligamentous injury

100
Q

how are teardrop fractures usually treated

A

usually non-op with cervical collar

101
Q

what is a burst fracture

A

fractures through both superior and inferior endplates

102
Q

what is the MOI for burst fractures

A

axial compression - fragments may displace into canal -> spinal cord injury

103
Q

what is the typical treatment for burst fractures

A

generally require surgery due to instability

104
Q

what is a facet fracture

A

often associated with facet subluxation/dislocation

105
Q

what is the MOI for facet fractures

A

flexion distraction - often associated with SCI

106
Q

what is the treatment for facet fractures

A

usually unstable and require surgery

Clin Med MSK: (14 decks)

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