Ch 7 - SCI: Pain, Pressure Ulcer Flashcards
What is nociceptive pain?
From bone, ligaments, muscle, skin, other organ
What is neuropathic pain?
From peripheral or central neural tissue damage
What is the MC joint affected by pain in SCI?
Shoulder d/t WB and overuse syndromes
What are risk factors of shoulder pain in SCI?
– Tetraplegia > paraplegia
– ↑ with time from injury, older age
– Manual WC use and transfers; overuse; overhead activities; inflexibility; muscle imbalances
Which muscles should be stretched in SCI patients with shoulder pain?
Anterior shoulder, adductors, and external rotators
Which muscles should be strengthened in SCI patients with shoulder pain?
Posterior shoulder girdle muscles (rotator cuff, shoulder stabilizers [trapezius, rhomboids, levator scapulae, serratus anterior] and adductors
What is neuropathic pain in SCI correlated with?
Increasing age at injury
Peaks 30-39 age group and then again >age 50
What is the only medication approved for neuropathic pain in SCI?
Pregabalin
What percentage of patients develop UE compression neuropathies in SCI?
2/3 of patients
What are UE compression neuropathies in SCI correlated with?
Increases with the length of time from injury
MC median and ulnar neuropathies
What is the incidence of CTS in paraplegia?
21-65%
What is the most common cause of progressive myelopathy after a SCI?
Posttraumatic syringomyelia
What is the MC presenting symptom of posttraumatic syringomyelia?
Pain: Aching or burning, often worse with coughing, sneezing, straining, and usually in the sitting rather than in the supine position
What is the earliest sign of posttraumatic syringomyelia?
Ascending loss of DTRs
What is the gold standard for diagnosis of posttraumatic syringomyelia?
MRI with gadolinium
What are Charcot joints?
Destructive arthropathy due to impaired pain perception or position sense
What is Charcot spine?
Spinal trauma and analgesia below the level of injury makes SCI patients particularly prone to insensate joint destruction
What tendon transfer procedures can be done in C5 SCI?
– BR to ECRB: Restore wrist extension
– Deltoid to triceps: Provide elbow extension
What tendon transfer procedures can be done in C6 SCI?
– Moberg “key grip”: Restore lateral or “key” grip
– BR to FPL or finger flexors: Restore lateral pinch (FPL) or grasp (finger flexors)
– Posterior deltoid to triceps: Prior to hand reconstruction
– Rerouting of biceps brachii around radial neck: Correct supination contracture of forearm
What tendon transfer procedures can be done in C7 SCI?
– BR to FPL: Restore thumb flexion
– ECRL or FCU to the FDP: Restore finger flexion
What tendon transfer procedures can be done in C8 SCI?
Intrinsic minus or “claw hand” may be addressed with lumbrical bar, preventing hyperextension of MCPs to improve function
What is the incidence of concomitant TBI in those with a primary SCI?
24%-74%
What % of SCI patient experience depression?
20% to 45% within the first month
Describe the relationship between suicide and SCI.
SCI patients 5x the age-sex specific suicide rate in US
Leading cause of death in SCI in the youngest age groups, especially for persons with paraplegia, and incomplete injuries
Greatest risk 1-5 years post-injury
Where are the MC locations of pressure injuries in SCI?
Over bone prominences
First 2 years: sacrum> ischium>heels> trochanters
>2 years: ischial tuberosities
What is the MC locations of pressure injuries in SCI in <13 yo?
Occiput
What is the most important risk factors for developing pressure ulcers?
Persistent pressure and shear forces
What is the MOI of a pressure injury?
Local soft-tissue ischemia results due to prolonged pressure over bony prominences that exceed supracapillary pressure >70 mmHg
What tissue layer is most susceptible to pressure injury?
Muscles>skin
What does friction or shearing forces cause?
Removes corpus striatum of the skin
What are preventions of pressure injury?
- Dec duration of pressure forces → turned and positioned ~2 hours
- Pressure relief and repositioning should be done >2 minutes at a time, ~20 to 30 min when sitting
