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Clin Med II - Ortho > CSP/TSP > Flashcards

CSP/TSP Flashcards

1
Q

C1

A

The atlas

Has no vertebral body and no spinous process

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2
Q

Occiput-C1 articulation

A

Two superior concave facets that articulate with the occipital condyles (hold the skull)
3 ligaments provide stability
- Transverse
- Alar
- Apical
Makes up 50% of neck flexion and extension

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3
Q

C2

A

The Axis

Has odontoid process (dens) and body

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4
Q

C1-C2 (atlantoaxial) articulation

A

Diarthrodial joint that provides
50° (of 100) cervical rotation
10° (of 110) of flexion/extension
0° (of 68) of lateral bend

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5
Q

C1 to C7

A

Have a transverse foramen

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6
Q

C2 to C6

A

Have bifid spinous process

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7
Q

Curve of the cervical spine

A

Lordotic curve

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8
Q

Cervical ligaments - in general

A

Ligamentum flavum
PLL
ALL

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9
Q

Ligamentum flavum

A

Covers the dura

Connects under the facet joints to create a small curtain over the posterior openings between the vertebrae

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10
Q

PLL

A

Runs up and down behind the spine

Inside the spinal canal

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11
Q

ALL

A

On the front side of the vertebrae

Firmly unites with periosteum and annulus

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12
Q

Intervertebral discs

A

Accounts for 25% of spine height
Not present at C1-C2
Annulus fibrosus
Nucleus pulposus

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13
Q

Annulus fibrosus

A

Outer structure that encases the nucleus pulposus
Characterized by high tensile strength and its ability to prevent inervetebral distraction
Remain flexible enough to allow for motion

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14
Q

Nucleus pulposus

A

Central portion of the intervertebral disc composed of gel and approx. 88% water
Responsible for height of the intervertebral disc
Resist compression and distributes forces evenly to endplates of vertebrae

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15
Q

Nerve roots

A

Exit above corresponding pedicle through foramen (below in the TSP and LSP)
Travels horizontally to exit (in contrast to lumbar that descends before it exits)
There is an extra C8 nerve root that does not have a corresponding vertebral body

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16
Q

Exam - Inspection

A 
Alignment in sagittal and coronal plane
Skin defects 
Muscle atrophy
Prior sx scars
Fasiculations / tremors
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17
Q

Exam - Palpation

A

Know your landmarks

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18
Q

Exam - ROM

A

May document absolute degrees or relative to anatomic landmark (eg chin rotates to right shoulder)

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19
Q

Normal ROM of CSP

A

Flexion - 50
Extension - 60
Rotation - 80
Lateral bend - 45

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20
Q

Exam - Sensory

A

Document sensation to all dermatomes
Perform light touch in all pts - stroke lightly with finger
If a deficit, proceed with other sensory types
- pain
- vibration
- temperature
- two point discrimination

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21
Q

Motor

A 
C5: Deltoid - Shoulder abduction
C6: Biceps - Elbow flexion
C6: ECR - Wrist extension
C7: Triceps - Elbow extension
C7: FCR - Wrist flexion
C8: FDP - Flexion middle finger
T1 - Hand interossei - spread fingers
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22
Q

Muscle grading system

A

1 - muscle contraction is visible but there is not movement to the joint
2 - active joint movement is possible with gravity eliminated
3 - Movement can overcome gravity but not resistance from the examiner
4 - The muscle group can overcome gravity and move against some resistance from the examiner
5 - Full and normal power against resistance

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23
Q

Reflexes

A

Biceps - C5, C6
Brachioradilais - C5, C6
Triceps - C7

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24
Q

Congenital Torticollis - in general

A

Most common position is lateral flexion and rotation
Rare - <2% incidence
May accompany clavicular fx, esp. in neonates
Up to 20% of children with congenital muscular torticollis have congenital hip dysplasia as well

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25
Q

Congenital Torticollis - causes

A

Birth trauma to the SCM M., results in fibrosis or compartment syndrome
Intrauterine malpositioning leads to unilateral shortening of SCM
May be associated with SCM tumor, called fibromatosis colli
Often have undergone breech or difficult forceps delivery

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26
Q

Congenital Torticollis - dx

A

Clinical

If refractive to tx or palpable mass, do neck US and CSP x-ray

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27
Q

Congenital Torticollis - Tx

A

PT
Home exercise program
positioning
Botox or sx for severe refractive cases >6-12m duration

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28
Q

Torticollis - in general

A

Common term for cervical dystonia

May also be static or a dynamic tremor

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29
Q

Torticollis - causes

A

Idiopathic
Inherited due to genetic mutation
Acquired - infection, vascular abnormality, brain injury, toxins
Drug exposure (levodopa, dopamine agonists, antipsychotic drugs, anticonvulsants, SSRIs, metoclopramide Reglan)
Neurological - CP, Huntington dz, Parkinson’s
Psychogenic

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30
Q

Torticollis - dx

A

Clinical but workup for cause

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31
Q

Torticollis - tx

A

Tx cause
PT
Botox - type A

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32
Q

Cervical Strain / Sprain - in general

A

The result of a stretch injury to the soft tissue elements of the CSP

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33
Q

Strain

A

Muscle or tendon

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34
Q

Sprain

A

Ligament

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35
Q

Cervical Strain / Sprain - causes

A

Acute - whiplash
Repetitive / chronic
Abnormal posture - carrying a heavy suitcase on one side of the body, computer work, weak core

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36
Q

Cervical Strain / Sprain - presentation

A 
Axial pain
Stiffness
Muscle spasms
Ha
Neck fatigue
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37
Q

Cervical Strain / Sprain - exam

A

Tenderness with palpation
Painful +/- decreased ROM
No radicular signs

38
Q

Cervical Strain / Sprain - imaging

A

XR +/- MRI

39
Q

Cervical Strain / Sprain - Tx

A

Cervical collar is as short term tx - 1-2 wks

Modalities: ice, heat massage, topical analgesics, PT

40
Q

Disc Herniation - in general

A

Most common is C5-6 and C6-7
Disc may compress either the SC or the exiting nerves or both
Pressure on an exiting cervical nerve root can cause changes in sensory, motor and/or reflex function in the innervated areas (radiculopathy)

41
Q

Disc Herniation - exam

A

Weakness
Decreased sensation
Asymmetric reflexes
Special tests

42
Q

Spurling’s test

A

Perform if you suspect nerve root compression
Place pt in slight extension & lateral flexion.
Apply axial force
Closes the neuroforaminal space
Positive if pain in a radicular, dermatomal pattern on ipsilateral side
Specific, but not sensitive, in dx acute radiculopathy

43
Q

Distraction test

A 
Used when currently symptomatic
Relieves symptoms
Supine or sitting - place hands at occiputs and apply gentle distraction
Positive if reduces symptoms
Indicated a neuroforaminal compression
44
Q

Disc Herniation - imaging

A

XR
MRI - test of choice
CT/Myelogram

45
Q

Disc Herniation - tx

A

Nearly 90% can be tx conservatively - PT, rest, modalities, NSAIDs, oral steroids, CESI

46
Q

Disc Herniation - sx

A

Pain management has failed
Intractable upper limb with imaging evidence of a correlating nerve root compression
Mechanical instability of the spine associated with disc herniation
S/s of neurological deficits are increasing
The disc herniation is massive and compresses the SC (myelopathy)

47
Q

Myelopathy - in general

A

SC compression

48
Q

Myelopathy - causes

A 
Trauma
Infection
Inflammatory or autoimmune d/o
Tumor
Degenerative spondylosis
Disc herniation
49
Q

Myelopathy - presentation

A 
Myelopathic or "upper motor neuron" findings
Hyperreflexia
Tremor
Loss of fine motor control
Babinski's
Hoffman's
Spasticity
Ankle clonus
Often painless
May present with difficulty walking
Coordination issues
Incontinence or retention
Loss of fine motor control
50
Q

Hoffman’s sign

A

Hold and secure the middle phalanx of the long finger and then flick the distal phalanx
Positive is involuntary contraction of the thumb and index finger IP joints

51
Q

Ankle clonus test

A

Rapidly flex the foot into dorsiflexion (upward), inducing a stretch to the gastrocnemius M.
Positive is tapping of the foot.
Only a sustained clonus (5 beats or more) is considered abnormal

52
Q

Babinski reflex

A

Lateral side of the sole of the foot is rubbed with a blunt instrument or device from the heel along a curve to the metatarsal pads
Positive is when the hallux dorsiflexes and the other toes fan out

53
Q

Myelopathy - imaging

A

MRI - preferred

CT/Myelogram, if MRI is CI

54
Q

Myelopathy - tx

A

Involves decompressing the SC through various procedures depending on cause, spinal level and each pt

55
Q

Sponylosis - causes

A

Dehydrated, shrinking discs
Aged herniated/cracking disc
Osteophyte formation
Contractures of ligaments and joint capsules

56
Q

Sponylosis - in general

A

Degenerative condition
Typically begins to be seen at 40-50yo
M>W
Most commonly occurs at C5-6 > C6-7 levels

57
Q

Sponylosis - RF

A

Frequent lifting
Smoking
Driving

58
Q

Sponylosis - chronic changes

A

May lead to

  • Radiculopathy
  • Myelopathy
  • Both
59
Q

Sponylosis - tx

A

Symptom management

  • PT
  • Pain clinic
  • NSAIDs
60
Q

Odontoid fx - imaging

A

Seen on open mouth odontoid view XR
CT best next test for fx and stability eval
MRI if neurological symptoms exist

61
Q

Odontoid fx - types

A

1 - avulsion of tip, rarely neurological s/s, usually stable - brace
2 - the waist , high non-union rate - halo or sx
3 - involves the body of C2 - brace

62
Q

Hangman’s fx - in general

A

Fx of the pars interarticularis on the pedicle of the C2 verebrae
Most common of all CSP fx
Extreme hyperextension to the neck - MVA
May result in spondylolisthesis-slipping of C2 on C3

63
Q

Hangman’s fx - imaging

A

Get CT to check for instability

64
Q

Hangman’s fx - tx

A

Immobilization for 4-6 wks, if no displacement vs. sx

65
Q

Burst fx - in general

A

Fall from a height, landing on one’s feet
Compressive failure of vertebral body
Most common at throacolumbar junction (T10-L2)
Less common in proximal TSP b/c the ribs help to stabilize
TSP canal is narrow in relation to the SC, so that thoracic SC injuries commonly are complete

66
Q

Jefferson fx

A

Burst fx of C1

Diving accidents

67
Q

Chance fx - in general

A

A flexion-distraction injury - lapbelt injury
Most commonly at the thoracolumbar junction
50% includ abdominal injuries

68
Q

Burst fx - imaging

A

XR - AP, lat, obliques
MRI - important to eval for injury to the posterior elements
CT - important to eval degree of bone injury and retropulsion of posterior wall into canal

69
Q

Columns of spine

A

Anterior column
Middle column
Posterior column

70
Q

Anterior column

A

ALL
Anterior 2/3 of the vertebral body
Anterior 2/3 of the intervertebral disc

71
Q

Middle column

A

Posterior 1/3 of the vertebral body
Posterior 1/3 of the intervertebral disc
PLL

72
Q

Posterior Column

A 
Everything posterior to the PLL
Pedicles
Facet joints and articular processes
Ligamentum flavum
Neural arch and interconnecting ligaments
73
Q

Chance fx - tx (non-operative)

A

Immobilization in TLSO
Neurlogically intact pts
stable injury patterns with intact posterior elements
<50% vertebral height is lost
Minimal comminution
Must be followed for non-union and kyphotic deformity

74
Q

Chance fx - tx (operative)

A

Sx decompression and stabilization

Hx three level above and two level below but modern pedicle screws have changed this to allow fewer levels

75
Q

Compression Fx - in general

A

Osteoporosis is the most common cause
Estimated to affect 1/4 of all postmenopausal women in the US
W>M
People who have sustained one osteoporotic VCF have x5 risk of sustaining a 2nd one
Mets tumor for MM should be considered in pts <55 with no hx of trauma

76
Q

Compression Fx - presentation

A

May be asymptomatic and incidentally found on XR
Present with midline back pain
May radiate to ribs
Typically neuro intact

77
Q

Compression Fx - imaging

A

XR - dx the fx

MRI or bone scan confirms the acuity

78
Q

Compression Fx - tx

A

Tx the osteoporosis
Conservative at least 2 week before considering sx
Kyphoplasty or verebroplasty with bx for failure

79
Q

Thoracic Outlet Syndrome

A

Poorly categorized symptoms - vary
Similar s/s to other neuro or vascular condition like
- CTS
- Ulnar neuropathy (cubital tunnel syndrome)
- Cervical radiculopathy
- Brachial plexus injuries
- Myelopathy

80
Q

Types of Thoracic Outlet Syndrome

A

Neurogenic

Vascular

81
Q

Neurogenic Thoracic Outlet Syndrome - in general

A

Compression of lower brachial plexus, usally by tissue band that connects C7 to first rib
Most common type - 95%
W>M
Often mis-dx early on

82
Q

Neurogenic Thoracic Outlet Syndrome

A 
May present with Anterior shoulder pain
Clavicular pain
N/T in arm
Weakness
Angina
May be asymptomatc at rest
83
Q

Neurogenic Thoracic Outlet Syndrome - imaging

A

CXR / Clavicle XR to r/o cervical rib

84
Q

Cervical rib

A

An extra rib
Present in <1% of population
May be normal bone structure or undeveloped fibrous tissue

85
Q

Vascular Thoracic Outlet Syndrome - in general

A

If the subclavian A. is compressed, pts may notice color changes, claudication or a vague pain in the arm or hand
If the subclavian vein is compressed, there may be swelling of the arm, distension of the veins or a diffuse pain in the arm or hand
Makes the referral urgent as this may be thrombus
Pure TOS types aer rare and pts often present with s/s indicative of more than one type

86
Q

Vascular Thoracic Outlet Syndrome - RF

A 
Poor posture
Hx of chest or clavicle trauma
Kyphosis
Large breasts
Overhead athletes / workers
87
Q

Vascular Thoracic Outlet Syndrome - exam

A

Work-up of CSP and shoulder are normal

88
Q

Vascular Thoracic Outlet Syndrome - imaging

A

MRI of brachial plexus, NCS/EMG and doppler with angiogram is suspect vascular

89
Q

Vascular Thoracic Outlet Syndrome - tx

A

PT/OT can help restore postural imbalances

Refer to ortho or CT surgeon

90
Q

Adson test

A

A provocative test by compression of the subclavian A. by a cervical rib or tightened anterior and middle scalene M.
Passively extend, abduct and externally rotate affected arm while palpating the radial pulse
Ask pt to take a deep breath and hold it in
Ask pt to extend neck and rotate the head towards affected side
Positive if loss of radial pulse

91
Q

Roos or East test

A

Have pt sit up with good posture
Shoulders abducted to 90° and externally rotated
Open and close fist for 1 min
Positive if reproduction of s/s

Clin Med II - Ortho (13 decks)

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