Exam 3: SCI part 1 of 3 (from Spring 2015) Flashcards
what are the 5 leading causes of SCI
- MVA
- falls; mostly in elderly
- GSW/ stabbing/ acts of violence
- other
- sports
other non-traumatic etiologies
- ~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)
stereotypical SCI pt
- ~18-27
- ~male
- ~white
*average age is going up because more falls from the elderly
Details on Quads
~cervical region injured
~will affect UE and LE
Details on Paras
~thoracic, lumbar, or sacral region injuried
~will normally have full UE ability and not LE
cervical SCI injury causes
- ~hyperextension
- ~hyper flexion
- ~axial loading
- ~rotation
- ~side bending
cervical SCI: hyperextension
- ~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
cervical SCI: hyper flexion
- ~Will affect posterior structures; tear drop fracture- off the anterior vertebra body
- ~Whip lash; football (leading with head)
cervical SCI: axial loading
- ~Pressure straight down
- ~have loaded vertebra that will cause the vertebra to burst- lots of pieces; a bone fragment can get to the SC
cervical SCI: rotation
- ~Facets can break
- ~Usually on one side; can cause brown sequard- injures one side of the SC
What is different about cervical (compared to thoracic)
- ~More mobility
- ~Thoracic is protected by more muscles and ribs
- ~Will take more to cause damage (a lot more!) in the thoracic
Thoracic SCI injuries
- ~GSW and stabbing is the most common (Associated with Brown Sequard)
- ~MVA
- ~Compression fracture
What levels of the thoracic are injured the most often?
T12, L1 is where most of the injuries occur
compression fractures of the thoracic
- ~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
MVA of the thoracic
- ~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
Lumbar SCI injuries
- ~Falls/ compression
- ~MVA (Seat belts)
**same that happens in Thoracic spine happens in lumbar spine
What surgical fixation do you use for a compression fraction
- ~ORIF- open reduction internal fixation
- ~to help fuse the spine together when the pt has major displacement of the spine
What surgical fixation do you use for a burst fracture
repair with a cage with crushed bone
Complete SCI injury
no sacral sparing
Incomplete SCI injury
- ~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)
Spinal shock
- ~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
what primitive reflexes are tests for spinal shock?
- ~Bulbocavernosus
- ~Cremasteric
- ~Anal wink
Bulbocavernosus reflex is
- ~pull on glans penis
- ~can also pull on catheter
Reflex causes anal sphincter contraction
Cremasteric reflex is
rub on inside of thigh and will cause scrotum will tighten up
Anal wink reflex is
stroke the area around the anus
reflex causes contraction of external anal sphincter
syndromes of the spinal cord
- ~central cord syndrome
- ~brown- sequard
- ~anterior cord
- ~posterior cord
- ~conus medullaris
- ~cauda equina
Central cord syndrome
- ~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*
Brown sequard syndrome
- ~Hemi section of the SC
- ~Ipsilateral loss - motor, proprioception, vibratory sense, deep touch, discriminative touch
- ~Contralateral loss - pain, temperature, crude touc
anterior cord syndrome
- ~Anterior part is damaged
- ~You have proprioception, vibratory, deep touch, discriminative touch
- ~Don’t have motor, pain, temp, crude touch
posterior cord syndrome
- ~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
conus medullaris/ cauda equina syndrome
- ~Cauda equina is Lower than conus medullaris, so less is injured
- ~b/b injured
what does ASIA stand for?
America spinal (cord) injury association
ASIA
- ~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!!
How do you label a SCI (motor)
- ~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
Muscle groups for motor
- ~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
How do you label motor levels in the thoracic?
You have to look at the sensory level (only can test motor to T1 and can again at L2)
How do you label SCI (sensory)
- ~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
On ASIA, the way to mark if it is complete/ incomplete is if there is
anal sparing: if there is anal sensation or motor
What are the levels that ASIA assigns depending on the SCI?
- ~A
- ~B
- ~C
- ~D
- ~E
ASIA- 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
ASIA- B
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
ASIA- C
- ~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
ASIA- D
- ~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
ASIA- E
YOU ARE NORMAL
What does ZPP stand for?
zone of partial preservation
ZPP
- ~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)
how do we give credit for how much sensory or motor the pt has? (incomplete or complete)
- ~there is a total sensory and total motor score
- ~this will show how much below the level of the injury has some sensation/motor
