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7333 Bringman > Exam 2- SCI part 1 > Flashcards

Exam 2- SCI part 1 Flashcards

1
Q

what are the 5 leading causes of SCI

A
  1. MVA
  2. falls; mostly in elderly
  3. GSW/ stabbing/ acts of violence
  4. other
  5. sports
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2
Q

other non-traumatic etiologies

A
  • ~Infection
  • ~Autoimmune
  • ~Cancer/ tumor
  • ~Stenosis (the spondy ies)
  • ~Cyst
  • ~Stroke; embolic or thrombus
  • ~Laxity of ligaments in the joints (Downs syndromes have lax joints- don’t do gymnastics)
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3
Q

stereotypical SCI pt

A
  • ~18-27
  • ~male
  • ~white

*average age is going up because more falls from the elderly

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4
Q

Details on Quads

A

~cervical region injured

~will affect UE and LE

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5
Q

Details on Paras

A

~thoracic, lumbar, or sacral region injuried

~will normally have full UE ability and not LE

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6
Q

cervical SCI injury causes

A
  • ~hyperextension
  • ~hyper flexion
  • ~axial loading
  • ~rotation
  • ~side bending
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7
Q

cervical SCI: hyperextension

A
  • ~Will affect ALL (rupture), PLL(disruption), distraction of vertebra, SC will get stretched, vertebra may be fractured and go into the SC
  • ~Person who falls and catches chin on something as they fall
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8
Q

cervical SCI: hyper flexion

A
  • ~Will affect posterior structures; tear drop fracture- off the anterior vertebra body
  • ~Whip lash; football (leading with head)
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9
Q

cervical SCI: axial loading

A
  • ~Pressure straight down
  • ~have loaded vertebra that will cause the vertebra to burst- lots of pieces; a bone fragment can get to the SC
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10
Q

cervical SCI: rotation

A
  • ~Facets can break
  • ~Usually on one side; can cause brown sequard- injures one side of the SC
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11
Q

What is different about cervical (compared to thoracic)

A
  • ~More mobility
  • ~Thoracic is protected by more muscles and ribs
  • ~Will take more to cause damage (a lot more!) in the thoracic
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12
Q

Thoracic SCI injuries

A
  • ~GSW and stabbing is the most common (Associated with Brown Sequard)
  • ~MVA
  • ~Compression fracture
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13
Q

What levels of the thoracic are injured the most often?

A

T12, L1 is where most of the injuries occur

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14
Q

compression fractures of the thoracic

A
  • ~Little old ladies
  • ~Falling/ plopping- sitting to fast
  • ~They are curved over (causing the vertebra the be shaped more wedged)
  • ~boobs cause the lades to curve over more
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15
Q

MVA of the thoracic

A
  • ~Seat belt could cause a SCI instead of the pt dying in a major MVA
  • ~When the force of the accident causes the vertebra to move completely forward
  • ~Where there is more of a slope/ more movement
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16
Q

Lumbar SCI injuries

A
  • ~Falls/ compression
  • ~MVA (Seat belts)

**same that happens in Thoracic spine happens in lumbar spine

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17
Q

What surgical fixation do you use for a compression fraction

A
  • ~ORIF- open reduction internal fixation
  • ~to help fuse the spine together when the pt has major displacement of the spine
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18
Q

What surgical fixation do you use for a burst fracture

A

repair with a cage with crushed bone

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19
Q

Complete SCI injury

A

no sacral sparing

20
Q

Incomplete SCI injury

A
  • ~If they have sacral sparing at levels S4-5, this is intact; sensation, motor, or both intact
  • ~Tested by inserting a finger in anus (can they feel it, squeeze, both)
21
Q

Spinal shock

A
  • ~Don’t label a person as incomplete or complete right away bc of spinal shock
  • ~Can last days, weeks, months
  • ~Body is in a state of shock and may or may not recover
  • ~Can test primitive reflexes here
22
Q

what primitive reflexes are tests for spinal shock?

A
  1. ~Bulbocavernosus
  2. ~Cremasteric
  3. ~Anal wink
23
Q

Bulbocavernosus reflex is

A
  • ~pull on glans penis
  • ~can also pull on catheter

Reflex causes anal sphincter contraction

24
Q

Cremasteric reflex is

A

rub on inside of thigh and will cause scrotum will tighten up

25
Q

Anal wink reflex is

A

stroke the area around the anus

reflex causes contraction of external anal sphincter

26
Q

syndromes of the spinal cord

A
  1. ~central cord syndrome
  2. ~brown- sequard
  3. ~anterior cord
  4. ~posterior cord
  5. ~conus medullaris
  6. ~cauda equina
27
Q

Central cord syndrome

A
  • ~Effects the center of the spinal cord
  • ~More UE than LE
  • ~Flaccid UE; relatively fine LE
  • ~Can’t get up, but can walk when they are up *he think of a penguin*
28
Q

Brown sequard syndrome

A
  • ~Hemi section of the SC
  • ~Ipsilateral loss - motor, proprioception, vibratory sense, deep touch, discriminative touch
  • ~Contralateral loss - pain, temperature, crude touc
29
Q

anterior cord syndrome

A
  • ~Anterior part is damaged
  • ~You have proprioception, vibratory, deep touch, discriminative touch
  • ~Don’t have motor, pain, temp, crude touch
30
Q

posterior cord syndrome

A
  • ~Use to be associated with syphilis
  • ~Loss dorsal column input; don’t know where your legs are in space (no proprioception)
  • ~If the lights are off, they have no idea where the limbs are
31
Q

conus medullaris/ cauda equina syndrome

A
  • ~Cauda equina is Lower than conus medullaris, so less is injured
  • ~b/b injured
32
Q

what does ASIA stand for?

A

America spinal (cord) injury association

33
Q

ASIA

A
  • ~Have the perfect way to motor and sensory test you patients
  • ~Gives data on where they are

**you have to test every level for both sides!!

34
Q

How do you label a SCI (motor)

A
  • ~asia’s key muscles *need to know them;
  • ~You test until you get to anything that is not a 5/5
  • ~If you have a 5/5 above the level- 3/5 and 4/5 would have the line below
  • ~If you have 5/5 above the level- 2/5 and below would have the line above
35
Q

Muscle groups for motor

A
  • ~C5- elbow flexors
  • ~C6- wrist ext
  • ~C7- elbow ext
  • ~C8- finger flexors
  • ~T1- abductors
  • ~L2- hip flexors
  • ~L3- knee extensors
  • ~L4- DF
  • ~L5- great toe ext
  • ~S1- ankle PF
  • ~C4 and up- diaphragm will stop working
    • ~We will be able to shrug because it is innervated by spinal accessory
36
Q

How do you label motor levels in the thoracic?

A

You have to look at the sensory level (only can test motor to T1 and can again at L2)

37
Q

How do you label SCI (sensory)

A
  • ~Labeled as 2 as being able to feel (normal), 1 (impaired/diminished), 0 (absent)
  • ~If you have below normal, (1 or 0) you will have defects at this part
38
Q

On ASIA, the way to mark if it is complete/ incomplete is if there is

A

anal sparing: if there is anal sensation or motor

39
Q

What are the levels that ASIA assigns depending on the SCI?

A
  • ~A
  • ~B
  • ~C
  • ~D
  • ~E
40
Q

ASIA- A

A
  • ~If you have complete- you are an A- will probably stay at an A: worse level
  • ~NO anal sparing, will stay A unless you somehow get back anal
41
Q

ASIA- B

A

If you have incomplete- you have at least a B

  • ~there is no motor function past the level, but there is some sensory
  • ~also has sacral sparing
42
Q

ASIA- C

A
  • ~you have incomplete
  • ~motor function is persevered below the neurological level and more than half if key muscles below the neurological level have a muscle grade less than 3
43
Q

ASIA- D

A
  • ~you have incomplete
  • ~motor function is persevered below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3
44
Q

ASIA- E

A

YOU ARE NORMAL

45
Q

What does ZPP stand for?

A

zone of partial preservation

46
Q

ZPP

A
  • ~only applied to complete
  • ~if there is a trace of movement in an area, then you need to give them credit for that movement
  • ~this is the lowest level that there is something activating (for motor and sensory on left and right)
47
Q

how do we give credit for how much sensory or motor the pt has? (incomplete or complete)

A
  • ~there is a total sensory and total motor score
  • ~this will show how much below the level of the injury has some sensation/motor

7333 Bringman (23 decks)

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