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Intro > MS-Back and Spine > Flashcards

MS-Back and Spine Flashcards

1
Q

Vertebrae

A

Small bones forming the backbone that protects the spinal cord and provides site for muscle attachment

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2
Q

How many vertebrae are in the vertebral column?

A

33

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3
Q

How many vertebrae are in each section of the vertebral column?

A

Cervical: 7
Thoracic: 12
Lumbar: 5
Sacral: 5 (fused)
Coccygeal: 3-5

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4
Q

If someone’s BONES hurt, what are the potential diagnoses?

A

bone fracture, infection, carcinoma

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5
Q

What is cancer of the back called when it is the primary source?

A

Multiple Myeloma

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6
Q

When cancer of the back is a secondary source, where are the common sites of origin?

A

Prostate, Breasts, Kidneys, Thyroid, Lungs

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7
Q

Spinal Nerves

A

Exit through the intervertebral foramen which is the space between two discs; Control carious functions in the body such as muscle strength and sensations

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8
Q

Dermatomes

A

Area on the surface of a body innervated by afferent fibers from one spinal root; Afferent fibers transmit nerve impulses from the periphery toward the central nervous system

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9
Q

What is the function of an intervertebral disc?

A

Acts as a shock absorber during running, walking, and jumping

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10
Q

What do intervertebral discs allow the spine to do?

A

flex and extend; bend laterally from side to side

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11
Q

What happens to intervertebral discs when people age?

A

Lose flexibility and compressibility

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12
Q

What is an intervertebral disc composed of?

A

Nucleus pulposus and annulus fibrosis

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13
Q

What is the nucleus pulposus?

A

inner semifluid which gives the disc its elasticity and compressibility

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14
Q

What is the annulus fibrosis?

A

strong outer ring of fibrocartilage which contains the nucleus pulposus and limits its expansion

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15
Q

Is a radiograph a good option for radiographic assessments?

A

No; High radiation load, only see calcium (bone)

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16
Q

Is an MRI a good option for radiographic assessments?

A

Yes; shows everything; evaluates discs for herniation and nerve impingement

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17
Q

Does everyone with back pain need to get an MRI?

A

No, it is reserved for patients in whom it would change therapy

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18
Q

How long does it take for routine herniated disc to get better?

A

4-6 weeks

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19
Q

MRI is the modality of choice to evaluate which type of herniation?

A

cervical herniated nucleus pulposus

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20
Q

What are the four natural curves of the spinal cord

A

Cervical - Concave; least pronounced
Thoracic - Convex
Lumbar - Concave
Pelvic - Concave; forward and downward

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21
Q

Lordosis

A

Accentuated lumbar curvature; Typically in infants or to counterbalance a protuberant abdomen (pregnancy/obesity)

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22
Q

Kyphosis

A

Accentuated thoracic curvature; Faulty posture, secondary to osteoporosis (“senile kyphosis”); more common in women

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23
Q

How frequent is lower back pain?

A

It is the second most common reason for seeking medical attention from primary care provider

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24
Q

Of people between the ages of 20-50, how many will experience LBP

A

60-80%

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25
Q

LBP is the most common reason for? Under what age?

A

Disability and lost productivity in adults younger than 45

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26
Q

What are the statistics for recovering from LBP regardless of treatment

A

In 6 weeks: 60-70%
In 12 weeks: 80%

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27
Q

What is the main responsibility of PCCs when dealing with LBP

A

Differentiate between life-threatening and non-life-threatening diseases; understand anatomy, ask appropriate subjective questions, and perform fundamentally sound PE

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28
Q

What is the most common cause of back pain?

A

Muscle strain

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29
Q

What is the pathophysiology of a muscle strain?

A

a paraspinal muscle is strained

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30
Q

What causes a muscle strain?

A

repeated movements, simple movements, poor muscle tone (inactivity, obesity, poor posture)

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31
Q

What are the symptoms of a muscle strain?

A

Pain with movement that is relieved with rest; muscle spasms

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32
Q

Where is the pain from a muscle strain felt?

A

localized; never below the knee

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33
Q

What are the neurological symptoms of a muscle strain

A

NONE

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34
Q

What are the signs of a muscle strain?

A

tenderness and limited range of motion; walking up thighs when extending

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35
Q

What are the physical exam findings for someone suffering from a muscle strain?

A

They will have a normal neurological and vascular exam

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36
Q

Is it necessary to order any tests for a muscle strain?

A

No need for X-ray or MRI; unnecessary radiation from X-ray and will not see muscles anyway; insurance will not pay for an MRI

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37
Q

What are the non-pharmacological treatments for a muscle strain?

A

Educate on proper posture and lifting, present specific back exercises, limit bed rest to 2 days, and ice with deep massage

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38
Q

What PT exercises can be utilized to help stabilize the spine and prevent reoccurring muscle strains?

A

Abdominal and paraspinal strengthening, spinal and hamstring flexibility, awareness of posture, lifting techniques

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39
Q

What are the pharmacological treatments for a muscle strain?

A

NSAIDS x 3; Acetaminophen

40
Q

What does NSAIDs stand for?

A

Non-Steroidal Anti-Inflammatory Drugs

41
Q

What happens if someone takes too much acetaminophen?

A

liver damage; hepatotoxic

42
Q

What happens if someone takes too many NSAIDs?

A

Kidney damage; nephrotoxic

43
Q

What are some examples of NSAIDs?

A

ibruprofen; naproxen; aspirin; celecoxib

44
Q

What is an infection of the bone called?

A

Osteomyelitis

45
Q

What is the pathophysiology of a herniated disc?

A

Nucleus pulposus protrudes into the annulus fibrosis and thus impinges on a spinal nerve exiting the spinal column

46
Q

What is the prevalence of herniated discs?

A

only 2-5% of those that complain of back pain (60-80%) have a HNP

47
Q

How long does it take for most HNPs to resolve spontaneously?

A

within 6 weeks

48
Q

Where is it most common for a HNP to occur?

A

Lumbar spine; 95% are at L4-L5 or L5-S1 level

49
Q

When is it most common to experience a HNP?

A

old age; degenerative changes of discs occur as we age

50
Q

Does a HNP cause unilateral or bilateral pain?

A

unilateral

51
Q

What are the symptoms of a HNP?

A

Severe pain that radiates along a dermatome down the buttock and below the knee; may experience paresthesia/weakness along the dermatome and/or have difficulty performing some simple activities

52
Q

Is there a disruption of bowel or bladder function with a HNP?

A

No; sphincter will be tight; be sure to ask this

53
Q

What can be expected to find in a physical exam for a HNP

A

Positive neurological findings that are dermatomal including decreased reflexes, sensation, and strength

54
Q

What can be expected if a HNP is effecting the L5 dermatome?

A

dorsiflexion will be inhibited; patient will have difficulty walking on heels

55
Q

What can be expected if a HNP is effecting the S1 dermatome?

A

Plantar flexion will be inhibited; patient will have difficulty walking on toes

56
Q

What are the pharmacological treatments for a HNP?

A

NSAIDs, Narcotics, Epidural steroid injections

57
Q

How should narcotics be prescribed?

A

No longer than 7 days

58
Q

What are examples of narcotic medications?

A

Codeine, oxycodone, tramadol

59
Q

How long should activity be decreased for a HNP?

A

1-2 days

60
Q

How long does it take for most patients to improve from a HNP?

A

3-4 weeks

61
Q

What back disease is a very serious emergency?

A

Cauda equina syndrome

62
Q

What is the cauda equina?

A

nerves roots caudal to the level of spinal cord termination

63
Q

What is cauda equina syndrome?

A

a serious condition which results from a sudden reduction in the volume of the lumbar spinal canal that causes compression of multiple nerve roots and leads to muscle paralysis

64
Q

What part of the cauda equina is most vulnerable in cauda equina syndrome?

A

The sacral roots that control bladder and anal sphincter function (S2-S4)

65
Q

How common is cauda equina syndrome?

A

Rare; 0.2-2% of all disc herniations

66
Q

What is the pathophysiology of cauda equina syndrome?

A

Lumbar disc disease - herniation massive; central disc protrusion

67
Q

What is the classic triad of symptoms?

A

Saddle anesthesia, Bilateral lower extremity weakness, bowel or bladder dysfunction

68
Q

*Cauda equina syndrome symptoms typically onset in what type of patients?

A

those with pre-existing back condition that suddenly becomes excruciating

69
Q

*What type of leg pain can be expected with cauda equina syndrome?

A

severe bilateral radicular leg pain

70
Q

*When suffering from cauda equina syndrome what can be expected in the lower extremities?

A

bilateral symmetric weakness and sensory loss; difficulty rising from seated position without help of chair arms

71
Q

*Where is a common area to lose sensation when suffering from cauda equina syndrome?

A

in the anal, perianal, and genital region; “Do you feel different when you wipe?”

72
Q

What problem occurs with cauda equina syndrome that is very important for a healthcare provider to ask about?

A

bladder retention or overflow incontinence; Trouble starting or stopping/incontinence

73
Q

What is a difference between a HNP and cauda equina syndrome that is tested by a healthcare provider?

A

HNP - tight anal sphincter; Cauda equina syndrome - lax anal sphincter tone

74
Q

What is the treatment for cauda equina syndrome?

A

Immediate surgical referral

75
Q

What happens if cauda equina syndrome surgery is delayed?

A

It can lead to permanent loss of bowel and bladder control, impotence, sensory abnormalities, and bilateral weakness

76
Q

What Greek word does scoliosis come from?

A

Crookedness

77
Q

What does the curvature of the spine have to be for it to be considered scoliosis?

A

> 10 degrees

78
Q

When is the common time of onset for scoliosis?

A

Infancy, Early childhood, Adolescence

79
Q

What type of scoliosis accounts for up to 85% if scoliosis cases?

A

Adolescent Idiopathic Scoliosis

80
Q

What is the etiology of AIS?

A

It is unknown, but potentially hereditary and multifactorial

81
Q

Who is more common to suffer from AIS and at what age?

A

Females ages 10-16 (puberty)

82
Q

What is the structural change from AIS?

A

The vertebral bodies rotate towards convexity; The spinous processes rotate towards concavity

83
Q

What are the symptoms of AIS?

A

Typically none; symptoms only present if curvatures becomes very large and restricts pulmonary function (typically not until 100+ degrees)

84
Q

When should an exam for AIS be performed on age appropriate patients?

A

An AIS exam should be given at any given chance: sick call visits, school PEs, drivers license PEs, etc.

85
Q

What can be seen in an AIS patient’s shoulders?

A

Shoulder height asymmetry

86
Q

What can be seen in an AIS patient’s scapulas?

A

Unilateral scapula prominence

87
Q

What can be seen at an AIS patient’s waistline?

A

Waistline asymmetry; Asymmetric distance between elbow and flank

88
Q

What can be seen in an AIS patient when asked to lean forward with legs and palms together?

A

Rib hump; Intercostal space discrepancy between two sides

89
Q

What can be used to diagnose scoliosis?

A

Cobb angle; measures degree of curvature using a scoliometer

90
Q

How does a healthcare provider decide treatment?

A

Degree of curvature as measured by the Cobb angle and skeletal maturity or non-skeletal maturity status

91
Q

What should be done if the Cobb angle is 50 degrees or greater?

A

Surgery should be discussed at the time of presentation regardless of skeletal maturity

92
Q

A curve with a Cobb angle >50 at skeletal maturity may progress how much?

A

one degree per year

93
Q

What will happen if the Cobb angle is less than 50 degrees when skeletal maturity is reached?

A

It will not get worse

94
Q

What are two treatment options for AIS?

A

Braces and surgery

95
Q

What is the goal of treatment for AIS?

A

rotate and straighten the vertebral bodies so it is straight again

96
Q

What is ORIF surgery to treat AIS?

A

Open reduction internal fixation; rods and screws are put on either side of the vertebral column and are screwed into the vertebral bodies

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