MSk Focus - Neuro Conditions Flashcards
What is myelopathy?
Tends to give you unilateral symptoms
Usually in cervical spine
Compression on the spinal cord in the central canal
Can be caused by central stenosis
What causes myelopathy?
Could be:
Central disc herniation
Age related changes (bony spurs and or osteophytes)
Trauma/instability
Spondyloisthesis
Ligament thickening
Postoperative problems
Rarely - infections, tumours, cysts
What do C3,C4 and C5 supply that is important?
Supply lungs and cardiovascular system
‘C3,C4,C5 keeps you breathing and alive!’
Signs and symptoms of myelopathy:
Always ask about these
Gait disturbances (ataxia, falls, clumsiness, balance) - cannot place foot where they want to
Fine motor skills and coordination changes (doing up buttons etc)
Possibly neck pain an or bilaterally symptoms (pain,weakness,p+n’s,numbness)
Possibly low back pain and symptoms in all four limbs
Hyperreflexia
Possibly bladder and bowel disturbances
Risk factors for myelopathy -
Older age, degenerative changes, stenosis
Rheumatoid arthritis and ankylosing spondylitis (systemic autoimmune)
Trauma, upper cervical instability
Management of myelopathy -
Conservative - may try physio, increase strength around the area and carefully increase ROM
Or
Surgical (fusion/stabilisation)
What is Cauda equina syndrome (CES) ?
Rare but serious
Compression on the collection of nerves at the bottom of the spinal cord (horses tail)
Most common cause is herniation of lumbar disc (45%)
Could also be stenosis, tumour, discitis and trauma
Symptoms can mimic other conditions
Course of Cauda equina -
Urgent medical attention
48 hours - MRI and bladder scanning
If true CES - needs immediate surgery (spinal decompression) to try to prevent longstanding symptoms
Post surgery - physio to gradually return to normal function
Possibly urology care if still symptomatic
Signs and symptoms of CES -
Urine retention
Loss of anal tone
Saddle anaesthesia
Bilateral leg pain and/or numbness
Sexual dysfunction
What is radiculopathy?
A change in neurological function from nerve root compression, irritation or sensitivity
Tends to give bilateral symptoms
Eg sciatica
Signs and symptoms or radiculopathy:
Normally either:
Cervical - arm symptoms
Lumbar - leg symptoms
(Rarely thoracic)
Pain in dermatomal distribution
Sensory symptoms (paraesthesia, anaesthesia, allodynia - completely altered sensation) in Dermatome
Motor loss in the relevant nerve root (Myotome)
Reflex changes (reduced/hyporeflexia)
Myotome, muscle they supply and the test:
C2 -
C3 -
C4 -
C5-
C2 - cervical flexors. Test: cervical flexion
C3 - cervical extensors. Test: cervical extension
C4 - cervical side flexors. Test: cervical side flexion
C5 - deltoid. Test: shoulder abduction
Myotome, muscle they supply and the test:
C6 -
C7 -
C8 -
T1 -
T2 -
C6 - biceps. Test: elbow flexion
C7 - triceps. Test: elbow extension
C8 - forearm flexors. Test: flexes wrist and fingers
T1 - small finger abductors. Test: abduction of fingers
T2 - iliopsoas. Test: hip flexion
Myotome, muscle they supply and the test:
L3,L4 -
L4,L5,S1 -
L5 -
S1 -
L3,L4 - quadriceps. Test - knee extension
L4,5,S1 - hamstrings. Test: knee flexors
L5 - tibialis anterior and extensor hallicus longus. Test: dorsiflexion of ankle and great toe.
S1 - gastrocnemius, soleus. Test: ankle plantar flexion
What is quite common for patients with radiculopathy to prevent with?
Really high SIN factor
Treatment and management of radiculopathy -
Physio tends to be the first treatment and management
Sometimes surgery eg laminectomy - remove some of lamina to make hole bigger
What is peripheral nerve entrapment/irritation?
An area in the peripheral nerves in which the nerve can become irritated
Can be located at an ‘interface’ (small anatomical space eg carpal tunnel) or area in which the nerve passes through a small anatomical space.
Signs and symptoms peripheral nerve irritation -
May give pain and/or sensory symptoms at the interface and distal to the area the nerve supplies
Depends what type of nerve it is - some are sensory, motor or both
Eg. Carpal tunnel - median nerve - towards thumb and fingers may be pain
Management for peripheral neuropathies -
Physio/non invasive treatment
Education, activity modification, ROM, strength, function
If carpal tunnel syndrome (CTS) - splinting?
Oral medications seem to have poor benefit
Cortico steroid injections may provide short term relief
Potential surgery - often decompression or release if conservative management failed to
Don’t forget the brain! Yellow flags - often psychological factors to consider
What investigations can be done for neural conditions?
Myelopthay -
Radiculopathy -
Peripheral nerve entrapment -
CES -
Myelopthay - full spine MRI
Radiculopathy - MRI of local region eg cervical
Peripheral - EMG studies - nerve conduction studies, stick needles into nerves and send electric shocks down them to see if muscles will contract (painful)
CES - lumbar MRI/full spine MRI
