Brainscape's Knowledge GenomeTM

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


See full index

Year 3 - MSK > Mini Symposium: Introduction, Spinal Injuries and Cases > Flashcards

Mini Symposium: Introduction, Spinal Injuries and Cases Flashcards

1
Q

what are the different areas of the spine?

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

what are the vertebra like in different regions?

A

basic block of the bony

  • 3 main types of vertebrae
  • similar
  • viewed from above
    1. vertebral body – WB surface
    2. spinal formamen – conating the cord and later the spinal nerve roots
    3. posterior elements, lamina superior and inferior articular procsess
    4. Pedicles
    5. spinous prcess and trasverese prcoess- allow muscle attachments

Spinal canal in the lumbar is smaller so there is less space for the cord

Laminar long and thin in the cervical region and small and thick in the lumbar region

The transverse processes in lumbar are nearly horizontal but in thoracic area they are oblique and in the cervical region they don’t have them

All vertebra have spinous process, bifid in the cervical region

Facet joints – synovial joints linking the vertebra in the posterior elements, coronal plane in the thoracic region to allow lateral tilting, in lumbar region they are more in sagittal plane which allows forwards flexion and extension

Foramen for the vertebral artery in the cervical region

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

each individual vertebrae _________ with the level below and above

A

articulates

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

thoracic spine is a rigid structure much less flex/ext. but allows _______

A

rotation

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

what is the shape of the spine?

A

7 cervical segments, t12 thoracic 5 lumbar , 5 sacral and variable coccygeal

charcetertistic s shape in sagital plane

cervical and lumbar lordosis balanced by t spine kyphosis

In the coronal plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the muscles around the spine?

A

Abdominal muscles also act on spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Nerve emerges at the _________ foramen at each level and if it is compressed it can cause pain that distribution of the spinal nerve

A

intervertebral

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

what is a dermatome?

A

A dermatome is an area of skin that is mainly supplied by a single spinal nerve

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

what is a myotome?

A

A myotome is the group of muscles that a single spinal nerve innervates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how are the dermatomes of the arms different form the legs?

A

In trunk horizontal distribution but in lower limb more vertical distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the myotoms of the upper limbs?

A

C5 - Shoulder abduction (deltoid)

C 6 - Elbow flexion/ Wrist extensors (biceps)

C 7 - Elbow extensors (triceps)

C 8 - Long finger flexors (FDS/FDP)

T 1 - Finger abduction (interossei)

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

what are the myotomes of the lower limbs?

A

L2 - Hip flexion (iliopsoas)

L3,4 - Knee extension (quadriceps)

L4 - Ankle dorsiflexion (tib ant)

L5 - Big toe extension (EHL)

S1 - Ankle plantar flexion (gastroc)

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

spinal inuries

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

what are different spinal injuries

A

fracutres (left)

spincal cord injuries - SCI (right)

(C5 translated on C6 on the left picture)

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

how many people with fractures/dislocation will also have SCI?

A
  • 15% of people with a fracture/dislocation will have SCI
  • Majority of people with SCI will have an accompanying column injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how many spinal cord injuries occur and in who?

A
  • 1000 SCI / year in the UK
  • 50 000 people in the UK living with paralysis
  • Male > Female
  • Peak 20-29yrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the most common causes of SCI?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what symptoms and signs would be seen in a complete SCI?

A

no motor or sensory function distal to lesion

no anal squeeze

no sacral sensation

ASIA Grade A (most severe group)

no chance of recovery

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

what symptoms and signs would be seen in a incomplete SCI?

A

Some function is present below site of injury

More favorable prognosis overall

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

can you determie acutley if it is complete or incomplete?

A

NOT ABLE TO DETERMINE ACUTELY AS PATIENT MAY BE IN SPINAL SHOCK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the different ASIA Classification?

A
22
Q

in ASIA Classification, is grade A or E worse?

A

A

23
Q

what are the different patterns of injury that may be seen?

A
  • Tetraplegia/Quadriplegia (above innervation of arms)
  • Paraplegia (injury level below innervation of arms)
  • Central Cord Syndrome
  • Anterior Cord Syndrome
  • Brown-Sequard Syndrome

Depends on where injury caused

Bottom 3 are incomplete injury

24
Q

what is tetraplegia?

A
  • AKA Quadriplegia
  • Partial or total loss of use of all four limbs and the trunk
  • Loss of motor/sensory function in cervical segments of the spinal cord
25
Q

how is tetraplegia caused?

A
  • Cervical fracture
  • Respiratory failure due to loss of innervation of the diaphragm
  • Phrenic nerve C3-5
  • ‘C5 keeps you alive’
  • Spasticity (in all 4 limbs)
26
Q

what is Spasticity and its cause?

A
  • Increased muscle tone
  • Upper motor neuron lesion
  • Spinal cord and above (CNS)
  • Injuries above L1

(Peripheral nerves not damaged)

27
Q

what is Paraplegia and its effects?

A
  • Partial or total loss of use of the lower-limbs
  • Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord
  • Arm function spared
  • Possible impairment of function in trunk
28
Q

what causes paraplegia?

A
  • Thoracic/Lumbar fractures
  • Associated chest or abdominal Injuries
  • Spasticity if injury of spinal cord (i.e. above L1)
  • Bladder/ Bowel function affected (as it would be in quadrapaliga)
29
Q

what are some partial cord syndromes?

A
  • Central cord syndrome
  • Anterior cord syndrome
  • Brown-Sequard syndrome
30
Q

who and how does central cord syndrome occur in?

A
  • Older patients (arthritic neck)
  • Hyperextension injury
  • Centrally cervical tracts more involved
31
Q

what ar ethe effects of Central Cord Syndrome?

A
  • Weakness of arms > legs
  • Perianal sensation & lower extremity power persevered
32
Q

how is anterior cord syndrome caused?

A
  • Hyperflexion injury
  • Anterior compression fracture
  • Damaged anterior spinal artery (area in grey)
33
Q

what are the effects of anterior cord syndrome?

A
  • Fine touch and proprioception preserved
  • Profound weakness

poor prognois of recovery

Corticospinal tract damaged so loss of motor function, spinothalamic tract damaged so lose pain but posterior column still in tact

34
Q

what is Brown–Sequard Syndrome and how is it caused?

A
  • Hemi-section of the cord
  • Penetrating injuries
35
Q

what are the effects of Brown–Sequard Syndrome?

A
  • Paralysis on affected side (corticospinal)
  • Loss of proprioception and fine discrimination (dorsal columns)
  • Pain and temperature loss on the opposite side below the lesion (spinothalamic)
36
Q

what is the management of patients with a SCI?

A
  • Key to the management of a patient with SCI is to prevent a secondary insult
  • Particularly in patients with incomplete injuries
  • ABCD
  • ATLS (advanced trauma life support)
37
Q

what is A in the ABCD manage of a SCI?

A

Airway (C spine control)

Don’t want further damage, stop movement

Give oxygen

38
Q

what is B in the ABCD manage of a SCI?

A

Breathing

  • Ventilation and Oxygenation
  • Concomitant chest Injuries
39
Q

how is circulation managed?

A
  • IV fluids
  • Consider Neurogenic Shock
  • low BP and HR
  • Loss of sympathetic tone (High injuries above T6 to the spinal cord the sympathetic outflow to the heart and blood flow is reduced)
  • Vasopressors (maximize blood supply and improve circulation to the cord)

Most people with spinal cord injuries have other injuries

Most shock in trauma is due to loss of blood

40
Q

what are the features of spinal shock?

A
  • Transient depression of cord function below level of injury
  • Flaccid paralysis (no tendon reflexes)
  • Areflexia
  • Last several hours to days after injury
41
Q

what are the features of Neurogenic Shock?

A

When you lose sympathetic tone

Hypotension

Bradycardia

Hypothermia

Injuries above T6

Secondary to disruption of sympathetic outflow

42
Q

how is disability managed in SCI?

A
  • Asses Neurological Function
  • Including PR and Perianal sensation
  • Log Rolling
  • Document
43
Q

what imaging is done?

A
  • X Rays
  • CT Scanning- bony anatomy
  • MRI – if neurological deficit or children
44
Q

how is surgical fixation done?

(Can be managed conservatively or surgically)

A
  • Unstable fractures
  • Vast majority fixed from posteriorly
  • Pedicle screws preferred method
45
Q

what is the long term management of SCI?

A
  • Spinal Cord Injury Unit - intermediate term
  • Physiotherapy
  • Occupational therapy
  • Psychological support
  • Urological/Sexual counseling
46
Q

Summary:

  • Although spinal fractures are common ___ is rare
  • Complete injuries have no ________ below trauma
  • Incomplete injuries have _______ function
  • Preventing secondary insult is key - ____
  • Assessment involves testing ________ and _________
  • Important to understand the difference between _________ and spinal shock
A

SCI

function

variable

ABCD

myotomes

dermatomes

neurogenic

47
Q

cases

A
48
Q

Case 1:

  • 56 year old lady
  • Neck pain
  • 6 months of worsening numbness in the hand
  • Difficulty doing buttons
  • Wide based gait

What would you do?

What could be the diagnosis?

A

What would you do? - History and Exam

What could be the diagnosis? - Cervical myelopathy

This effects gait, weakness in lower limbs and spasticity

Definitive diagnosis made by MRI

(Between 4 and 5 in picture)

49
Q

Case 2:

  • A 70 year old man presents with a “tired feeling” in both thighs which is precipitated by walking and relieved by rest
  • He has a long history of backache

What are the main differentials?

How could you tell between the two?

A

What are the main differentials?

Spinal stenosis

Peripheral Vascular Disease

How could you tell between the two?

History: distribution, risk factors

Examination: pulses

50
Q

Case 3:

  • A 70 year old lady presents with severe, worsening thoracic and lumbar back pain over several moths.
  • No history of trauma, pain worse on standing but still present when lying in bed at night.
  • History of weight loss

What are the important diagnosis to include?

A

What are the important diagnosis to include?

  • Infection- disctis
  • Metastatic Malignancy to the spine

Year 3 - MSK (45 decks)

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