Clinical knowledge - movement and control Flashcards
Signs of cerebellar problems
nystagmus dysarthria finger-nose ataxia intention tremor dysdiadokokinesis heel-knee-shin ataxia gait ataxia falls signs are ipsilateral lesions don't produce paralysis, paresis or deficits in termination or initiation of movement
scoliosis
sideways curvature of spine
compresses lungs and abdominal organs
reduces total capacity of lungs
treating scoliosis
can be realigned with surgical rods with flexibility
spinal implant works for adults but children are still growing so treating them is difficult as repetitive surgery is required
what is a laminectomy
remove lamina to expose spinal cord or repair herniated disc
replaced by wires
spina bifida occulta
tuft of hair at point of missing spinous process
degeneration of intervertebral discs
occurs over time
causes loss of height
herniated intervertebral disc
nucleus pulposus seeps out of annulus fibrosis
how to test for scoliosis?
ask patient to bend over
one side will go lower than the other
caudal epidural injections
commonly used during birth process
commonly used imaging for spine
x-rays CT MRI myelography isotype studies ultrasound
checking x-ray of cervical spine
A = alignment and adequacy - fractures, disruption of lines, margins between bones/ intervertebral discs B = bone C = cartilage S = soft tissues
when to use CT scan
if there is a suspicion of spinal injury
axial, sagittal or coronal can be used to look for prevertebral soft tissue swelling and cartilage or bony abnormalities
when to use x-ray
look for alignment
vertebral height
intervertebral spaces
presence of osteophytes
degenerative changes on x-rays
hypertrophy of ligaments cannot be seen but can cause more problems than osteophytes
intervertebral discs cannot be seen
kyphosis
is normal but exaggerated curvature of thoracic spine is pathological
can get kyphosis and scoliosis = kyphoscoliosis
spondylolistesis
normally affects lumbar spine
can be degenerative as ligaments become lax
can be caused by abnormality in pars interarticularis
pars defect can predispose to this
vertebra slipping backwards or forwards on 1 below
MRI use
best for visualising spinal cord and nerve roots
important for looking at cauda equina
disc degeneration
loss of height
loss of hydration
disc prolapse
loss of disc water loss of height degeneration of annulus fibrosis protrusion or extrusion can impinge on nerves tension reduced in outer disc
myelography
less commonly used due to MRI used for those who cannot undergo MRI injection of contrast into vertebral canal to view nerve roots and check for compression invasive more risks than MRI contrast injected into subdural space Used to diagnose disc prolapse
ultrasound
can be used to see spinal canal contents in neonates
used for spina bifida occulta, cord tethering or masses - congenital abnormalities
when can ultrasound of a baby’s spine be done?
up to 3 months of age as posterior elements haven’t been matured so the ultrasound beams can get through
bone scan
injection of radioactive tracer
osteoblastic abnormalities uptake the radioactive tracers
looks for cancers
multiple bony metastases
what are the most likely causes of multiple bony metastases
prostate or breast cancer
