Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Lecture 12 Clinical Correlates > Flashcards

Lecture 12 Clinical Correlates Flashcards

1
Q

What is cervical spondylosis?

A

Chronic degenerative osetoarthritis affecting intervertebral joints in the cervical spine
(disc degeneration, narrowing of joint space, osteophytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the primary pathology in cervical spondylosis?

A
  • Age-related disc degeneration
  • osteophytosis (osteophytes formation adjacent to end plates of vertebral bodies)
  • facet joint osteoarthitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can cervical spondylosis cause radiculopathy/myelopathy?

A
  • narrowing of intervertebral foramina can put pressure on spinal nerves= RADICULOPATHY
  • narrowing of spinal canal can put pressing on the spinal cord= MYELOPATHY (less common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of myelopathy/radiculopathy:

A

Myelopathy: global muscle weakness, gait dysfunction, loss of balance, loss of bowel/bladder control
Radiculopathy: dermatomal sensory symptoms (pain/paraesthesia), myotomal motor weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Jefferson’s fracture?

A

Fracture of anterior/posterior arches of atlas vertbra

  • due to axial loading (down centre)
  • present to A&E supporting head in their hands
  • bursting open of C1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What damage does the Jefferson’s fracture cause?

A
  • pain but NO neurological signs (burst reduces impingment on spinal cord)
  • may be damage to arteries at base of skull leading to secondary sequelae (stroke, ataxia, Horner’s syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does ‘sequelae’ mean?

A

Condition resulting from another disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is ataxia?

A

Group of disorders affecting balance, speechand co-ordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Horner’s syndrome?

A

Damage to symathetic trunk

  • miosis (decreased pupil size)
  • partial ptosis (droopy eyelid)
  • anhidrosis (reduced sweating on affected side of face)
  • enophthalmos (sunken appearance of eyes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Hangman’s fracture?

A

Axis vertebra is fractured through pars interarticularis

  • due to forcible hyperextension
  • fracture is unstable and requires treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Does Hangman’s fracture cause injury?

A

Fracture tends to expand spinal canal, reducing risk of spinal cord injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is an odontoid process fracture caused by?

A

Flexion/extension
Hyperextension injury of cervical spine: elderly with osteoporosis falling forward onto forehead
Hyperflexion: falling against a wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you detect and odontoid fracture?

A
  • open mouth AP X-ray

- CT of cervical spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is whiplash?

A

Forceful hyperextension-hyperflexion injury of the cervical spine causing tearing of cervical muscles/ligaments
e.g. a car being struck from the rear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is the cervical spine prone to whiplash?

A

The head is 7-10% of body weight and is balanced on cervical spine which has high mobility/low stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does hyperextension/hyperflexion lead to?

A

Secondary oedema
Haemorrhage
Inflammation
Muscles respond by contracting in attempt to splint neck= neck stiffness and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the symptoms of whiplash?

A

Arm pain/paraesthesia

  • shoulder injuries due to holding steering wheel at time of collision
  • lower back pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can develop in response to disc/facet joint injury?

A

Chronic myofascial pain syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a protective measure against spinal chord injury in the cervical spine?

A

Large vertebral foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Can whiplash result in spinal cord injury?

A

Yes to the cervical cord

  • significant movement of vertbrae as it is highly mobile and ligaments/capsules are loose
  • soft tissue swelling is seen (there is no fracture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does cervical intervertebral disc prolapse occur?

A
  • tear in annulus fibrosus
  • nucleus pulposus protrudes with impingement into adjacent nerve root/spinal cord
  • sometimes sequestration occurs where some of the extruded nucleus pulposus separates and enters the spinal canal where it is eventually resorbed resolving symptoms
22
Q

What age group does cervical intervertebral disc prolapse occur in?

A

30-50 yo

23
Q

Why does only a small herniation cuase significant pain in cervical region?

A

Discs arent very large, so little space available for exiting nerves so a small herniation can impinge on a nerve and cause pain

24
Q

What symptoms occur in cervical intervertebral disc herniation?

A

Depends on site of prolapse
Paracentral: impinge of spinal nerve > radiculopathy
Canal filling prolapse: acute spinal cord compression

25
Q

What will a patient with a left sided C5/6 prolapse complain of?

A

Paraesthesia in left C6 dermatome
Weakness in left C6 myotome
Pain in neck that will radiate down left arm to C6

26
Q

What is cervical myelopathy?

A

Spinal cord dysfunction due to compression of the cord by narrowing of the spinal canal

27
Q

What is a common cause of cervical myelopathy and who does it affect?

A

Degenerative stenosis of spinal canal due to cervical spondylosis
50-80 yos

28
Q

What is cervical spondylotic myelopathy?

A

Myelopathy secondary to cervical spondylosis

-result of degenerative changes in age

29
Q

What are some degenerative changes that develop with age leading to cord compression?

A

-ligamentum flavum hypertrophy/buckling
-facet joint hypertrophy
-disc protrusion
-osteophyte formation
Reduce diameter in spinal canal

30
Q

What are some causes leading to cervical myeolopathy?

A
  • congenital stenosis of spinal canal
  • cervical disc herniation
  • spondylolisthesis (anterior slippage of vertebral body on one below)
  • trauma
  • tumour
  • RA affecting cervical spine
31
Q

What is the normal width of the spinal canal and the width where you myelopathic experience?

A

17-18 mm

Myelopathic symptoms: 12-14 mm

32
Q

What are the symptoms of cervical myelopathy?

A

Non-specific

  • may manifest also in lower/upper limb symptoms due to damage of long tracts of the spinal cord
  • loss of balance
  • poor coordination
  • decreased dexterity
  • weakness
  • numbness
  • paralysis in severe cases
  • rapid deterioration of gait and hand function (ofetn in older patients)
33
Q

Is pain a symptom of cervical myelopathy?

A

Not always

-absence of pain often leads to delay in diagnosis

34
Q

What do upper cervical lesions often cause?

A
  • loss of manual dexterity

- dysdiadochokinesia: impaired ability to perform rapid alternating movements

35
Q

What do lower cervical lesions lead to?

A

Spasticity and loss of proprioception in legs

  • legs feel heavy and experience reduced exercise tolerance
  • gait disturbance: many falls
36
Q

What happens when a long tract in the spine becomes damaged?

A

Protective capabilities are less effective. Long tracts usually dampen spinal reflexes so a person does not overreact to stimuli

  • so patient may demonstrate an exagerrated reponse to stimulation
  • seen in positive HOFFMAN’s/BABINSKI sign
37
Q

What is teh Hoffman’s test?

A

Dr holds middle finger at middle phalanx and flicks fingernail

  • if patients thumb/index finger don’t move= normal/negative
  • if patients thumb/index finger move= abnormal/positive
38
Q

What is the Babinski sign?

A

Lateral side of foot is stroked from heel to toes

  • people over 2/3 years: toes flex downwards (plantarflex)
  • Abnormal/positive: hallux (big toe) dorsiflexes, toes fan
39
Q

What is L’Hermitte’s phenomenon?

A

Sensationof intermittent electric shocks in limbs, exacerbated by neck flexion (associated with cervical myelopathy)

40
Q

What happens when compresssion to spinal cord is severe?

A
  • quadriplegia (paralysis of all 4 limbs)

- sphincter dysfunction (obstruction in bile flow: can lead to pancreatitis)

41
Q

What happens if a patient develops myelopathy at level of C5?

A
  • neck pain
  • weakness of shoulder abduction, external rotation, weaknessof all myotomes distally
  • paraesthesia from shoulder distally, trunk and lower limbs
42
Q

What are the most common causes of thoracic cord compression?

A
  • vertebral fractures with bony fragments in spinal canal

- tumours in spinal canal (metastases to spine are very common- especially from lung, thyroid, kindey, prostate, breast)

43
Q

What would a metastasis in T12 cause and why?

A

Compresion of L4-L5 segments of spinal cord

-as the cord is shorter than the vertebral column

44
Q

How do pathogens reach bones/tissues of the spine?

A
  • haematogenous
  • direct inoculation during invasive spinal procedures
  • spread from adjacent soft tissue infection
45
Q

What is the most common route for a septic focus from somewhere else in the body to reach the spine?

A

Haematogenous spread via arterial blood supply to vertebral bodies but can occur through venous retrograde

46
Q

What is infection of the vertebral disc called?

A

Spondylodiscitis/discitis

-commonly occurs in immunocomprimsied patients (diabetes/HIV)

47
Q

How do organisms enter the disc?

A

In adults the disc is avascular, so organisms are deposited in vertebral body by segmental artery leading to bony ischameia and infarction.
-necrosis of bone allows direct spread of organisms to adjacent disc space, epidural space, adjacent vertebral bodies

48
Q

Most common organisms in spinal canal infection:

A
  • staphylococcus aureus

- gram negative bacilli (E.coli)

49
Q

Most common organisms to infect after a surgical procedure:

A

-coagulase-negative staphylococci (staph.epidermidis)

50
Q

What organisms are seen in injecting drug users?

A
  • candida

- pseudomonas

51
Q

How can infection of spinal canal lead to neurological damage?

A
  • septic thrombosis leading to ischaemia
  • compression of neural elements by abcess/inflammed tissue
  • direct invasion of neural elements by inflammatory tissue
  • mechanical collapse of bone leading to instability

MSK (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions