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Orthopedics > CM Back & Spine > Flashcards

CM Back & Spine Flashcards

1
Q

Number of Americans who have back pain at any given time

A

50 million

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2
Q

Lifetime chance of experiencing back pain

A

80%

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3
Q

Most common cause of disability under age 45

A

Back pain

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4
Q

Back pain

A
  • Most expensive health care costs in the 20-50 year age group
  • Est costs of treating back pain is $50 billion/yr
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5
Q

Cervical spine

A

C1-C7

Neck problems cause neck pain and/or arm pain

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6
Q

Thoracic spine

A

T1-T12

These vertebrae attach to the ribs and sternum giving this area greater stability, therefore less problems

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7
Q

Lumbar spine

A

L1-L5
This section bears the majority of the body’s weight, therefore this area is associated w/the most spine related problems

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8
Q

Sacral spine

A

The sacrum is composed of 5 bony segments fused together

4 bones extend down from the sacrum to form the coccyx

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9
Q

Intervertebral Discs

A

Made up of annulus fibrosus and nucleus pulposus

  • Spinal discs are located in between each of the vertebral bodies
  • Each disc named from which two vertebral bodies it lies between
  • Discs are fibrocartilage cushions serving as the spine’s “shock absorbers”
  • Discs allow for some vertebral motion: includes flexion/extension as well as some rotation
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10
Q

Neuroanatomy

A

Dermatomes-you should know these; very important for physical exam, consider carrying a pocket guide
**Document specific motor and sensory nerves, both normal and abnormal

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11
Q

Cervical motor nerves

A 
C4: trapezius, rhomboid
C5: deltoid, biceps
C6: wrist extensors
C7: triceps, wrist flexors
C8: finger flexors
T1: intrinsics
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12
Q

Lumber motor nerves

A 
L1: iliopsoas
L2: iliopsoas
L3: quadraceps
L4: tibialis anterior
L5: EHL, gluteus medius
S1: gastroc, soleus, peronei
S2-5: rectal examination
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13
Q

Cervical reflexes

A

C5: Biceps
C6: Brachioradialis
C7: Triceps

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14
Q

Lumbar reflexes

A

L4: Patellar
S1: Achilles

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15
Q

Muscle Strength Testing

A 
0/5 No function
1/5 Minimal contraction
2/5 Moves w/gravity eliminated
3/5 Resists gravity
4/5 Moves against gravity
5/5 Normal strenght
(Less than 5/5 is abnormal)
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16
Q

Spondylogenic Causes of Back pain

A 
Disc degeneration
Spondylolisthesis
Fractures
Inflammatory
Infection
Tumor
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17
Q

Non Spondylogenic Causes of Back pain

A

Vasculogenic
Viscerogenic
Neurogenic

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18
Q

Pathology of Disc Degeneration

A
  • “Dehydration”
  • Nucleus pulposus: desiccated, can lead to dehydration
  • Annulus fibrosis: fissures, can lead to dehydration
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19
Q

Aggravating Factors: Symptomatic Disc Degeneration

A 
Repetitive bending, lifting, twisting
Vibration (ex truck drivers)
Smoking
Osteoporosis
Genetic or Occupational
Anxiety/stress/depressed
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20
Q

RED FLAGS of Back Pain

A

Back pain in the elderly

Back pain in children w/out hx of trauma

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21
Q

Back Pain in Elderly

A
  • Compression Fx, spontaneous
  • Tumor
  • Infection
22
Q

Back Pain in Children

A
  • Rare compared to adults
  • Must be evaluated
  • Painful scoliosis is a red flag (Scoliosis is typically not painful)
23
Q

Radiculopathy

A
  • Characterized by pain which seems to radiate from the spine to extend outward to cause sxs away from the source
  • Common problem that results when a nerve root is compressed or irritated, or bone spurs present
  • Pts may complain of pain, numbness, tingling, or weakness (can be intermittent or constant-indicates worse problem
  • *Decreased sensation does NOT equal weakness
24
Q

Acute low back sprain/strain

A
  • Occurs when the muscles surrounding the spine are asked to stretch too far, lift too much weight, or move in such a way that they sustain very small tears
  • Because of the tearing of the muscles, small microscopic bleeding occurs which in turn results in pain and muscle spasm
  • AP and Lateral xrays if warranted (pt tenderness)
  • Majority managed w/course of NSAIDs, a very brief period of rest, and then a gradual return to full activity
  • Always consider weight loss, PT
25
Q

Herniated Disk

A

AKA slipped disc, bulging disc, disc protrusion

  • Most herniations occur in the age group 30-40
  • Usually fast onset
  • Usually not related to trauma or injury
  • Pt typically describes “sharp, shooting” pain
26
Q

Most common location of a herniated disc

A

L4-5 or L5-S1

27
Q

Herniated Disc Dx

A
  • Complete H&P, emphasis on neurologic exam
  • Deep tendon reflexes
  • Specific motor group testing
  • Sensory deficit to specific dermatome patterns: light touch and pin prick
  • Nerve root tension sigh: straight leg raise (pain thru sciatic, mimics sxs)
  • Severe pain and/or neurologic deficit warrants MRI,MRI myelogram (warning for renal problems); CT, EMG (nerve conduction study)
28
Q

Herniated Disc Tx

A
  • 85-90% of first time disc herniations will resolve within 3 months of onset of sxs w/o any tx modalities
  • Initially tx w/short term bed rest w/gradual return to normal activities
  • Other conservative modalities include PT, chiropractic, acupuncture, pilates, yoga
  • Surgical tx is warranted when all conservative measures fail or neurologic deficit is present
29
Q

Spondylosis:

A

Degenerative process of the spine

“Arthritis of the spine”

30
Q

Spondylolysis:

A

Defect that occurs in the posterior aspect of the spine known as the pars interarticularis

  • Essentially a stress fracture in the vertebral body
  • Defect=lysis=fracture
31
Q

Spondylolisthesis:

A

Occurs when one vertebra slips foreward on another resulting in a Scotty Dog Fx

  • A fracture w/slippage
  • Spondylolysis causes spondylolisthesis
  • Listhesis=Slippage
32
Q

Spondylolysis

A
  • Essentially a stress fracture in the vertebral body
  • Common cause of low back pain in children
  • 5% of the general population has this condition w/the vast majority being asx
  • MC in football linemen and young gymnasts
33
Q

Spondylolysis Dx

A
  • Typical sx include low back pain esp when involved in activities that place the spine in an extended position
  • Complete H&P (remember back pain in the pediatric population is a RED FLAG)
  • Dx is made w/imaging studies including plain flim xrays (oblique views), MRI, CT, Bone scan
34
Q

Spondylolysis Tx

A
  • Initial tx is rest and possible bracing w/hopes of the fracture healing
  • Progress into exercise w/emphasis in trunk and abdominal strengthening
  • Return to normal activity
35
Q

Spondylolisthesis

A
  • Occurs when one vertebrae slips forward on another
  • Produces a gradual deformity of the spine and narrowing of the vertebral canal
  • Known as the “Scotty Dog” fracture (Dog’s “neck” is broken)
  • A positive Scotty Dog sign is a fracture or defect thru the pars interarticularis
36
Q

Spondylolisthesis Notes

A
  • Spondylolysis and spondylolisthesis involve a defect in the pars interarticularis
  • Sometimes there is a positive scotty dog sign in pts w/spondylolysis and you can see the pars defect or fracture
  • It is usually very difficult to pick up on a positive Scotty Dog sign in spondylolysis (esp if it is minor and/or the injury is recent) on xray due to bowel gas, other structures overlying this subtle finding
  • Additionally, slippage or spondylolisthesis isn’t present
37
Q

Vertebral Compression Fx

A
  • Fracture of the vertebral body itself
  • Causes may include osteoporosis, trauma, infection and tumors
  • Compression fractures affect 25% of postmenopausal women
  • Only 33% of fx in elderly women are diagnosed; often misdiagnosed as “arthritis”
  • Remember your RED FLAGS for this age group
  • Typical presentation is an elderly female w/acute onset of mid back pain; this may be traumatic or non traumatic
  • Dx is typically made by pain xray studies; other imaging studies may include MRI, CT, Bone Scan
38
Q

Vertebral Compression Fx Tx

A
  • Majority of mild to mod compression fx are treated w/immobilization in a brace or corset for 6-12 wks
  • Surgery: balloon kyphoplasty or vertebroplasty (inject cement); surgical stabilization
39
Q

Osteoporosis (AKA Metabolic Bone Disease)

A
  • Compression fx: common cause of spine pain in the elderly, those w/malnutrition, on corticosteroids, EtOH abuse, smokers
  • Sudden onset of spine pain w/o obvious trauma
  • Usually w/muscle spasm
  • Increased w/standing, walking, bending
  • Often improved w/recumbence
  • Takes at least 3 months to heal
40
Q

Spine Tumors

A
  • Primary bone tumors are uncommon; however, in 75% of cases, the vertebral body tumors are malignant (Multiple myeloma-MC; chordoma; osteosarcoma-very aggressive; hemangioma)
  • Metastatic lesions: to and from lung, breast, and prostate are MC
  • Radiographic imaging: Plain xrays, radionuclide bone scnas, MRI, CT guided bx for dx
  • Determine if hot or cold (vascular or avascular)
41
Q

Spinal Stenosis

A
  • “choking”
  • Spinal cord or spinal nerve roots are compressed, producing pain, tingling and weakness
  • Radiates into the butt and down the leg
  • Classically, worse w/standing and walking, relieved w/sitting and resting
  • The grocery cart sign: leaning foreward
42
Q

Spinal Stenosis Tx

A
  • Avoid activities or motion that put the spine in extension
  • NSAIDs or other oral analgesics
  • Epidural steroid injections, no more than 3/yr
  • PT should consist of exercises that emphasize “flexion” type exercises and pelvic tilts
  • Surgical decompressoin of the stenotic neuroalignments (goal is to “take the pressure off the nerves”)
  • Fortunately, surgical intervention is successful and rewarding
43
Q

Cervical Fx

A
  • Fracture of one or more cervical vertebrae = broken neck
  • Often involves muscle sprain, dislocation of the intervertebral discs and damage to the spinal cord
  • This is a MEDICAL EMERGENCY: prompt evaluation and tx is essential
  • Cervical spine injuries cause an estimated 6000 deaths and 5000 new cases of quadriplegia each year
44
Q

Cervical Fx Tx

A
  • Initially complete immobilization of the cervical spine
  • Various forms of diagnostic imaging is warranted (xray, CT, MRI)
  • Minor fractures may require simple soft collar bracing w/observation
  • Severe fracture/dislocatoins may require halo traction and surgical stabilization
45
Q

Cauda Equina Syndrome

A
  • Occurs when there is severe compression on the cauda equina
  • MEDICAL EMERGENCY requiring surgical decompression
  • Failure to recognize=BAD, PERMANENT DEFICITS
  • Innervates B&B: lifetime incontinence and sexual function compromised
46
Q

Cauda Equina Causes

A

Tumors/Lesions
Trauma
Spinal Stenosis (Lumbar)
Inflammatory conditions

47
Q

Cauda Equina Signs

A
  • Multiple: depends on nerve roots affected

- Weakness, saddle anesthesia, incontinence are common

48
Q

Cauda Equina Tx:

A
  • MEDICAL EMERGENCY
  • Emergent spinal decompression
  • If caused by trauma, immobilization as well
49
Q

Scoliosis

A
  • Curvature of the spine
  • Affects 2-3% of the population, or an est 6 million americans
  • Affects infants, adolescents and adults
  • Priarmy age of onset is between 10-15
  • 85% of cases are classified as idiopathic
  • Dx made by H&P and plain xrays
  • If underlying neurologic cause is suspected, MRI scan is warranted
  • In the primary care setting, if adequate xrays are available, obtain full spine (PA and Lat) views and observe or refer to specialty clinic
50
Q

Scoliosis Tx

A

General guidelines for tx include:

  • Curves less than 20 degrees=observation
  • Curves between 20-40 degrees=bracing
  • Curves greater than 40 degrees=surgical correction

Orthopedics (5 decks)

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