Ch8 8 Spinal Nerve Roots Flashcards
List the spinal nerve roots distribution
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal
Spinal cord ends at which level
L1-L2
What structure is formed at the end of spinal cord
cauda equina
Define: area of skin innervated by a single nerve
dermatome
Define: muscles innervated by a single nerve root
myotome
Sclerotogenous pain aka
referred pain
Def: Neuropathy
peripheral nerve disorder
Def: Radiculopathy
nerve root level disorder
Mononeuropathy distribution can be due to
Trauma
Local infection
Local Toxicity
Polyneuropathy distribution can be due to
Nutritional deficiency
Systemic infection
Autoimmunity
Systemic toxicity
What Causes radiculopathy?
- compressive, mechanical
- metabolic
- reflexive
- inflammatory
- infectious
Evaluation of radiculopathy steps
- muscle testing
- tendon reflexes
- dermatome sensory testing
- Valsalva and orthopedic testing
- nerve conduction (velocity testing)
- radiography
- MRI
Radiculopathy location
at the spine or lateral canal (in the IVF)
Radiculitis location
out side the lateral canal (but before the plexi)
Radiculopathy/Radiculitis symptoms
- Burning or tingling dermatomal pain
- Loss of reflexes
- Motor strength loss
Causes of Mechanical Injury
- disc lesion (MC C6 C7 L6 S1 nerve roots – C5, C6, L4, L5 discs)
- laceration
- neoplastic
- traction- whiplash injury
- degeneration - stenosis
Def: mild temporary interruption of nerve transmission
Neurapraxia
what results from injury or chronic compression?
Wallerian degeneration
Spondylosis is degenration due to
osteophytes, spinal stenosis
Spondylolysis is a
a Fracture/break in continuity
Spondylolisthesis is
displacement/shifted vertebra
Cervical stenosis signs & symptoms
LMNL and radicular signs in upper extremities
UMNL in lower extremities
Lumbar stenosis signs & symptoms
bilateral leg pain, and weakness with walking (LMNL sign)
what’s the difference between ALS vs Cervical stenosis:
cervical stenosis Pts still have sensory signs
leg pain or discomfort is called
Claudication
Neurological Claudication- gets worse and better with
position
Vascular Claudication- gets worse when
Pt walks more
Claudication testing
stationary bike test
if pain occurs after paddling, then it’s due to a vascular issue
how to test for Medial and Lateral Disc Bulge
Kemp test
(medial: away, Lateral: toward)
Central disc protrusion that affects multiple nerve roots bilaterally is called
Cauda Equina Syndrome
Cauda Equina Syndrome is caused by
- Central (median) disc lesion
- Canal stenosis
- Vertebral fracture
- Luxation
- tumor
Cauda Equina Syndrome management:
refer out immediately (medical emergency)
Cauda Equina Syndrome
Bilateral involvement of multiple levels (s1, s2, s3):
- urinary and fecal incontinence
- impotence
- loss of tendon reflexes
- muscle atrophy
- saddle anesthesia
- foot drop
- bilateral sciatica
vascular compromise to peripheral nerves is due to
Diabetic Neuropathy
Diabetic Neuropathy symptoms
Stocking glove sensory loss Charcot (neurogenic) joint Autonomic loss motor loss diabetic reinopathy
Def: Stocking glove sensory loss
- numbness
- pain, and paresthesia
- vibration loss
Autonomic loss includes
- hypo-tension
- arrhythmia
- alter bowl, bladder, and sexual function
Metal Toxicity symptoms
working around metal
- tingling in the extremities
- unsteady gait
- muscle tremor, pain, or tics
- headache
- general pain
- fatigue
Reflex Sympathetic Dystrophy Syndrome “RSDS”
must have 1 symptom from the 3 of the following
- sensory: hypersthesia or allodynia
- vasomotor: temperature or skin asymmetry
- pseudomotor: edema or symmetric sweating
- moto/trophic: weakness, dystonia, hair nail or skin changes
whats the difference between RSDS 2 types?
one include nerve injury, and the other doesn’t
RSDS Type 1
- complex regional pain syndrome
- less specific
- rapid severe swelling
- long term pain, along peripheral nerve fowwlowing minor injury (allodynia)
- sever sympathetic reaction
- includes regional osteoporosis
RSDS Type 2
- causalgia
- involves specific nerve damage
- begins with a nerve injury
- more specific
- follows the nerve distributions
Raynaud Disease is effect on peripheral vessels
causes peripheral vasospasm
Raynaud is associated with
migraines
Raynaud is more common with (which population)
women
Raynaud happens due to ____ exposure
cold
Raynaud color stages
white, blue, red
Raynaud can be diagnosed with _____ test
Allen’s
Guillian Barre Syndrome aka
Inflammatory polyneuropathy
acute idiopathic polyneuritis
Guillian Barre Syndrome characteristic
- post Epstein Barr infection
- PNS demyelination
- sensory loss
- weakness comes next LMNL signs
Guillian Barre Syndrome is more common in what ages
30-50
Guillian Barre Syndrome prognosis
90% self healing
Myasthenia Gravis is disorder of
neuromuscular junction
in Myasthenia Gravis, autoimmune attack
acetylcholine receptor
Myasthenia Gravis MC in what population?
young women or old men
Myasthenia Gravis MC symptoms
weakness of eyes (ptosis), lips, face , and hands
thymoma or enlarged thymus
in Myasthenia Gravis weakness get worse with
repeated use of muscle or later in day
why the weakness get worse though the day with MG patients
Pt is loaded with Ach, by afternoon, Pt is depleted of Ach
what MG Pts are given?
anti-Ach esterase
edrophonium chloride
MG sensory findings
No sensory findings
MG Treatment
thymectomy, immunosuppressants, and anti-Ach drugs
Test to detect MG
tensilon
Eaton Lambert syndrome
- presynaptic disorder of inadequate Ach
- usually with underlying cancer
- symptoms as myasthenia gravis
Polio is caused by
viral infection
Polio is spread through
fecal oral
Polio attack
affects anterior horn cells
Polio Signs
muscle wasting and deformity
Polio prevention includes
Salk vaccine (dead virus) Sabin vaccine (live virus)
