MSK Quiz 2: Part 1 Flashcards
1
Q
How many joints are usually involved in crystal deposition disease?
A
1 joint
2
Q
Crystals can be found in three locations:
A
synovium, cartilage, surrounding tissues
3
Q
What crystals are responsible for gout?
A
monosodium urate crystals
4
Q
What crystals are responsible for pseudogout?
A
calcium pryophosphate dehydrate crystals
5
Q
What crystals are responsible for chondrocalcinosis?
A
calcium pyrophosphate dehydrate crystals
6
Q
How do the crystals associated with gout form?
A
Urate saturation in the blood/body fluids forms monosodium urate crystals
7
Q
What is the end-point for gout?
A
chronic, destructive and debilitating polyarthritis
8
Q
Where are the most common areas for gout presentation?
A
1st metatarsophalangeal joint, ankle, midfoot, knee
9
Q
What are the three overaching risk factors for hyperuricemia?
A
Syndromes, Medications, Diet
10
Q
What syndromes put someone at risk for hyperuricemia?
A
hypertension, metabolic syndrome, and obesity
11
Q
What medications put someone at risk for hyperuricemia?
A
thiazide diuretics and low dose ASA
12
Q
What diets put someone at risk for hyperuricemia?
A
high purine diet, high-fructose corn syrup, excessive alcohol use
13
Q
What are examples of purine rich foods?
A
organ meat, select seafoods
14
Q
What are protective dietary foods for hyperuricemia?
A
vitamin C, coffee, cherries
15
Q
What are the four phases of hyperuricemia?
A
1) asymptomatic hyperuricemia, 2) acute gouty flare 3) intercritical gout 4) chronic tophaceous gout
16
Q
Asymptomatic hyperuricemia is defined as a serum urate concentration of?
A
> 7 mg/dL
17
Q
There’s a clear correlation between the likelihood of developing gout and?
A
increased serum urate
18
Q
Describe the etiology of gout
A
underexcretion (kidneys) and overproduction
19
Q
Between underexcretion and overproduction what’s the most common etiology for gout?
A
underexcretion (90%)
20
Q
Name the six causes of undersecretion in relation to gout:
A
reduced GFR/kidney disease, hypertension, obesity, systemic sclerosis, lead poisoning, drugs (diuretics, alcohol, ASA)
21
Q
What are the seven causes of overproduction in relation to gout:
A
genetic disorders, obesity, psoriasis, nicotinic acid (B3), alcohol, red meat/organ meant/shellfish, high fructose corn syrup
22
Q
What genetic disorder can lead to overproduction, causing gout?
A
hypoxanthine-guanine phosphoribosyltransferase deficiency
23
Q
Who is more affected by gout, men or women?
A
Men (3-6x more likely)
24
Q
Key age group for gout?
A
30-60
25
When are women more likely to experience gout?
after menopause
26
Describe the presentation of gout
sudden onset of pain, cardinal signs of inflammation, possible constitutional symptoms
27
Describe the inital gout attack?
monoarticular, lower extremity joints most common
28
Gout in the 1st metatarsophalangeal joint is called?
podagra
29
Advanced gout can lead to these four things?
subcutaenous tophus, urate kidney stones, joint damage, poly-articular attacks
30
DDx for gout?
cellulits, septic arthritis, trauma, sarcoidosis, pseudogout
31
DDx for advanced gout?
rheumatoid arthritis, reactive arthritis, CPPD arthropathy
32
What is the gold standard for diagnosing gout?
synovial fluid analysis
33
What will the synovial fluid analysis look like in gout?
needle-shaped crystals with strong negative birefringence
34
What tests would your order on someone with suspected gout?
synovial fluid analysis, serum urate level, urinary uric acid, CBC/ESR/CRP (r/o infection)
35
What imaging would your order for someone with suspected gout?
x-ray (r/o fracture), ultrasound (maybe)
36
Treatment for gout?
lifestyle modifications, RICE, NSAIDs or Colchicine or Corticosteroids, possibly opioids
37
What is the dosing for colchicine in acute gout?
1.2 po at first sign of flare, then 0.6 mg 1 hour later
38
What is the dosing for colchicine prophylaxis for gout?
0.6 mg po daily or q12 hours
39
What is the treatment for recurrent/advanced gout?
Xanthine oxidase inhibitor or probenecide or pegloticase
40
What does xanthine oxidase inhibitors do?
blocks uric acid production
41
Name two examples of xanthine oxidase inhibitors?
allopurinol and febuxostat
42
Describe dosing of allopurinol for gout?
100 mg po daily (increase weekly to 200-300 mg/day)
43
Describe dosing of febuxostat for gout?
40 mg po daily; can increase to 80 mg daily
44
Describe dosing for probenecide for gout?
250 mg po daily x 1 week; increase to 500 mg po bid
45
When do you consider discontinuing probenecid for gout?
If attacks do not occur for 4 months
46
How does probenecid work for gout?
lowers tissue stores by increasing renal excretion of uric acid
47
Do xanthine oxidase inhibitors work for overproducers or underexcretors?
Both
48
Does probenecid work for overproducers or underexretors?
Underexretors
49
Describe dosing for pegloticase?
8 mg IV q 2 weeks
50
How does pegloticase work?
converts uric acid to allantoin which is readily secreted by the kidneys
51
What's the issue with pegloticase?
it's expensive; blackbox warning for anaphylaxis
52
Name three examples of CPPD deposition disease?
pseudogout, chondrocalcinosis, pyrophosphate atrophy
53
What is chondrocalcinosis?
calcification of hyaline cartilage or fibrocartilage; extracellular pyrophosphate accumulation around chondrocytes
54
Is CPPD deposition disease more common in men or women?
women
55
What's the cause of CPPD deposition disease?
Really it's unknown, but maybe altered metabolism of pyrophosphate (PPI)...hereditary (familial), sporadic (idiopathic), metabolic
56
What are metabolic causes of CPPD deposition disease?
hemochromatosis, hyperparathyroidism, hypomagnesemia, hypophosphatasia
57
How many joints does pseudogout impact?
monoarticular
58
How does pseudogout differ from gout?
not as abrupt onset and tends to last longer; usually affects larger joints
59
What's the most common location of pseudogout?
knee
60
What do you order to diagnose someone suspected of pseudogout deposition disease?
Xray, synovial fluid analysis
61
What will the synovial fluid look like in someone with pseduogout deposition disease?
squared off shape, positive birefringence
62
Treatment for pseudogout deposition disease
RICE, NSAIDs/corticosteroids/possibly colchicine
63
Symptoms of chondrocalcinosis?
asymptomatic; incidental finding on x-rays
64
Hydroxyapatite arthropathy is caused by?
a species of basic calcium phosphate
65
Hydroxyapatite arthropathy is identified by?
electron microscopy
66
What is hydroxyapatite arthropathy?
crystals in joints, tendons, ligaments and bursa
67
Demographic of those impacted by hydroxyapatite arthropathy?
younger
68
Causes of hydroxyapatite arthropathy
idiopathic, hereditary, metabolic (hypercalcemia)
69
What is a type of hydroxyapatite arthropathy that impacts the shoulder?
Calcific tendinitis
70
Calcific tendonitis impacts what muscle most often?
supraspinatus
71
What's the cause of calcific tendinitis?
unknown
72
Presentation of calcific tendinitis?
sudden onset of pain without MOI, pain resolves, painful again during reabsorption phase
73
Treatment of calcific tendinitis?
conservative vs. surgical
74
What's the condition where HA crystals destroy the RC and shoulder joint?
Milkwaukee Shoulder
75
Milwaukee SHoulder is most frequently seen in?
elderly females
76
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is most commonly seen in?
elderly men
77
Symptoms of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Largely asymptomatic, but large bridging causes more pain; dysphagia if in cervical spine
78
What is Diffuse Idiopathic Skeletal Hyperostosis?
the build up of calcium salts in the tendons and ligaments (calcification) and abnormal new bone growth (ossification) but the reason this happens is unknown
79
What is septic bursitis?
an infection of the bursa
80
Does septic bursitis impact superficial or deep more often?
superficial
81
Common sites of septic bursitis?
olecranon, prepatellar, infrapatellar, 1st MTP
82
Is septic bursitis more common in men or women?
men
83
What's the cause of septic bursitis?
trauma to the skin (direct inoculation through the skin, rarely from cellulitis or hematogenous seeding)
84
Presentation of septic bursitis?
redness, warmth, swelling, usually no ROM restriction
85
How to diagnose septic bursitis?
x-ray (r/o other causes), aspiration
86
Aspiration of a septic bursa will likely show?
s. aureus
87
Three most common bugs in septic bursitis
s. aureus, beta hemolytic strep, aerobic gram negative bacilli
88
Chronic septic bursitis aspiration may show?
b. abortus, m. tuberculosis, fungus
89
DDx for septic bursitis?
gout, pseudogout, arthritis, trauma
90
Outpatient treatment for septic bursitis?
penicillin or 1st generation cephalosporin, if MRSA add tri/sulfa, if PCN allergy use clindamycin or linezolid
91
Inpatient treatment for septic bursitis?
IV nafcillin, oxacillin, or cefazolin; if MRSA, add vancomycin, daptomycin, or linezolid
92
What is septic arthritis?
infection of the joint, damages articular cartilage and bone
93
Septic arthritis is usually viral/bacterial/fungal?
most commonly bacterial; can be viral or fungal
94
Septic arthritis is usually caused by which organisms?
staphylococcus aureus or streptococci
95
Septic arthritis is usually caused by?
direct injury to the joint, hematogenous spread (indwelling catheters, IC, UTIs), contiguous osteomyelitis, rarely from arthrocentesis or arthroscopy
96
Septic arthritis risk factors
diabetes, alcoholism, cutaneous ulcers/skin infections, prosthetic joints, RA, OA, low economic status, immunosuppressive therapies, IV drug use
97
Where will an IV drug user typically present with septic arthritis?
SC or SI joint
98
If an IV drug user presents with an SC or SI septic arthritis what organism should be suspected?
pseudomonas aeroginosa
99
Presentation of septic arthritis?
very painful, red, hot, swollen joint; usually monoarticula, decreased ROM, possible fever
100
Which joint is most often affected by septic arthritis?
knee
101
What should you order for septic arthritis? (labs and imaging)
CBC with diff/ESR/CRP, synovial fluid analysis, plain films, blood cultures? cervical/urethral culture?
102
What will you see on plan films of septic arthritis?
usually normal, may see soft tissue swelling; radiolucent lines if prosthetic joint infection
103
What imaging can you order for chronic septic arthritis?
MRI (identify osteomyelitis), bone scan (evaluate for associated osteomyelitis)
104
Synovial fluid analysis of a septic arthritis will show?
WBCs >50,000, low glucose, high protein
105
Between ESR and CRP which is more specific and rises faster in relation to septic arthritis?
CRP
106
When would you order a cervical/urethra culture for septic arthritis?
if gonococcal
107
What would you order for chronic septic arthritis (labs)?
acid-fast, fungal, tick titers (Lyme disease)
108
DDx for septic arthritis?
acute rheumatic fever, bursitis, crystal-induced arthritis, hemarthrosis, lyme disease, OA, RA
109
Treatment of septic arthritis?
surgery, IV antibiotics based on culture and sensitivity for 4 weeks
110
What is osteomyelitis?
infection of the bone
111
Causes of osteomyelitis?
hematogenous spread, contiguous spread, inoculation at time of trauma or surgery
112
Hematogenous spread of osteomyelitis is more common in males or females?
males
113
Findings for osteomyelitis?
localized bone pain, possible sinus tract/swelling/abscess, possible constitutional symptoms
114
DDx for osteomyelitis?
neuropathic arthropathy, malignancies, fractures
115
Imaging for osteomyelitis?
Plain films (14% sensitivity, 76% specificity), MRI (will see bone marrow changes), CT scan (early cortical erosions), bone scan (high sensitivity, low specificity)
116
Labs for osteomyelitis?
CBC with diff (leukocytosis), elevated Sed/CRP, biopsy/culture from affected area
117
What's the gold standard for testing osteomyelitis?
biopsy or culture from affected area
118
Osteomyelitis treatment?
very difficult to eradicate, debridement and excision of infected bone (antibiotic spacer if in joint/infected prosthesis...can reconstruct bone later), IV antibiotics, antibiotic impregnated methylmethacrylate beads
119
Low back pain is common in?
works 30-60 years old
120
Low back pain symptoms usually resolve within?
30 days
121
What is the spurling test?
narrows the neural foramen, will increase or reproduce radicular symptoms
122
Straight-leg raise is used to test?
herniated disk; pain in lumbar spine when asymptomatic side is raised
123
Seated Straight-leg raise is used to test?
Sciatic tension; if positive, patient should lead back when you raise the leg
124
FABER (flexion-abduction-external rotation) test is used to test?
hip and SI joint pathology
125
What are Waddell's signs?
a group of physical signs that may indicate non-organic or psychological component to chronic low back pain
126
What's the difference between a strain and sprain in the neck?
used interchangeably because it's difficult to determine muscle vs. ligament injury
127
What causes a cervical strain?
injury (trauma, whiplash)
128
What's whiplash?
acceleration-deceleration with rapid flexion-extension
129
Are adults or children impacted at higher rates for cervical strain?
adults
130
Presentation of a cervical strain?
Pain (anywhere from base of skull to thoracic region/SCM/trapezius), headache, sleep disturbances, fatigue, difficulty concentrating, possible radicular symptoms; swelling, tenderness, limited ROM
131
How to diagnose a cervical strain?
x-ray
132
Treatment of cervical strain?
medications (NSAIDs, muscle relaxers, corticosteroids), possible soft cervical collar, massage, cervical traction, PT with modalities, self-limted
133
Cervical strain resolves within?
4-6 weeks
134
Whiplash associated cervical strain resolves within?
6-12 months
135
What is cervical radiculopathy?
neurogenic pain in nerve roots; possibly with associated numbness, weakness, or loss of reflexes
136
What are some causes of cervical radiculopathy?
disc herniation, degenerative changes
137
Presentation of cervical radiculopathy?
neck and radicular pain with numbness and paresthesia, muscle spasms, muscle weakness, headaches, possible myelopathy signs, pain relief with hand over head (less compression of spinal nerve)
138
What is cervical myelopathy?
neurologic deficit due to compression of the spinal cord
139
Does cervical myelopathy happen gradually or suddenly?
gradual onset
140
What are long-tract signs?
signs that indicate upper motor neuron lesion
141
What are some long-tract signs?
palmar paresthesia, decreased finger dexterity, subtle gait differences, abnormal urinary function, pain is often absent, loss of vibration and position sense
142
What's the difference between cervical myelopathy and cervical radiculopathy?
Myelopathy is a loss of function in your upper and lower extremities because of compression of the spinal cord. Radiculopathy occurs when a nerve in your neck is compressed or irritated where it branches away from your spinal cord--can cause pain and muscle weakness.
143
When is it normal to have a positive Babinski test?
In infants
144
What is the positive babinski sign?
Positive sign is the toes fanning out
145
Brudzinski-Kernig test is used for?
meningeal irritation
146
Ankle clonus may show?
rhythmic dorsiflexion/plantar flexion they can't control
147
Cervical radiculopathy presentation?
TTP, decreased ROM, decreased lordosis, possible spurlings test positive, possible motor/sensory deficits
148
Imaging for cervical radiculopathy?
x-rays, MRI, CT myelogram, EMG/NCS
149
Treatment of cervical radiculopathy?
spontaneous resolution usually within 2-8 weeks, NSAIDs, cervical traction, avoid spinal manipulation
150
Delayed treatment of cervical radiculopathy can lead to?
muscle paralysis, weakness, chronic pain syndromes, may progress to myelopathy with spinal cord involvement
151
Cervical spondylosis is a general term that encompasses?
degenerative disc disease (herniation), bone spurs, changes in ligamentum flavum, neural foramen narrowing/stenosis
152
What is the most frequent cause of spinal cord dysfunction >55 y/o?
cervical spondylosis
153
Presentation of cervical spondylosis?
limited mobility, chronic neck pain that's worse with upright activity, paraspinous muscle spasm, headaches, radicular symptoms, interference with ADLs, myelopathy symptoms, tenderness, decreased ROM with pain, possible gait issues (myelopathy)
154
What special tests should you perform for cervical spondylosis?
Spurling's test, Babinksi Sign, Brudzinski-Kernig Test, Ankle Clonus
155
Imaging for cervical spondylosis?
x-ray, MRI, CT myelogram
156
Treatment for cervical spndylosis?
conservative vs. surgical (decompression and fusion)
157
What's the most frequent cause of lost work time and disability in adults <45 years old?
Lumbar sprain/strain
158
Most lumbar strains/sprains resolve within?
30 days
159
What causes lumbar sprains/strains?
lifting/straining, trauma
160
What are contributing factors to lumbar sprains/strains?
poor fitness, poor body mechanics, job dissatisfaction, smoking, psychosocial issues
161
Presentation of lumbar sprain/strain?
LBP, radicular pain to buttocks/posterior thigh, difficulty ambulating, difficulty sleeping/finding comfortable position, low back or SI joint tenderness, decreased ROM, motor and sensory exam (radiculopathy; L4-S1), special tests
162
What must you ask (r/o) for lumbar sprain/strain?
bowel and bladder function, saddle anesthesia, weakness in the lower extremities
163
"bowel and bladder function, saddle anesthesia, weakness in the lower extremities" are used to r/o?
cauda equina syndrome
164
What is cauda equina syndrome?
compression of the nerve roots distal to the conus medullaris
165
What spinal nerves control bladder and anal sphincter function?
S2-S4
166
What can cause cauda equina syndrome?
central disk herniation, epidural abscess, epidural hematoma, vertebral burst fracture
167
How do you treat cauda equina syndrome?
Surgical emergency--immediate decompression syndrome
168
Symptoms of cauda equina syndrome?
radicular pain and numbness in both legs, perineal numbness in saddle distribution, lower extremity weakness/paralysis (symmetric), difficulty raising from a seated position, unable to heel and toe walk, anal sphincter tone
169
Imaging for cauda equina syndrome?
MRI, CT myelogram
170
Imaging for lumbar sprain/strain
Possibly plain films (always after trauma or with atypical symptoms)
171
Where do the ribs attach to the spine?
T12
172
Treatment of lumbar sprain?
pain control, PT, patient education (body mechanics, lifting techniques)
173
Chronic low back pain begins after x days?
90 days
174
Presentation of chronic low back pain?
LBP radiating to 1 or both buttocks (mechanical pain; worse with movement), stiffness, intermittent pain down back of leg, pain relief with lying down; recurrent and episodic; TTP lumbar and/or SI joint, side or forward list due to muscle spasm, normal motor and sensory exam, decreased ROM, positive SLR
175
Imaging for chronic low back paiN?
Plan films (look for degenerative changes, loss of joint space), MRI (structural changes).
176
Treatment of chronic low back pain?
patient education, comprehensive pain management program (psychological testing, injections, biofeedback, cognitive/behavior conditioning programs, spinal cord stimulation, psychotherapy, detoxification programs)
177
Lumbar herniated disc is caused by?
nucleus pulposus extrusion
178
Why does nucleus pulposus extrusion occur?
posterolateral portion weakens over time
179
Most common lumbar herniated discs?
L4-5; L5-S1
180
Presentation of lumbar herniated disc?
abrupt vs insidious, low back pain with unilateral radicular leg pain, exacerbated (sitting, walking, standing, coughing, sneezing), radiates from buttock down posterior leg to foot (remember lumbar strain doesn't go past knee); TTP lumbar spine, decreased ROM, sciatic (pain down posterior leg), positive seated SLR and SLR (asymptomatic leg is raised, increases pain on symptomatic side), if upper nerve roots then reverse SLR
181
What's sciatica?
inflammation of the sciatic nerve
182
L3-L4 lumbar herniated disc findings?
ankle dorsiflexion; sensory loss of medial malleolus
183
L4-L5 lumbar herniated disc findings?
great toe dorsiflexion; sensory loss of dorsal third metatarsophalangeal joint
184
L5-S1 lumbar herniated disc findings?
ankle plantar flexion; sensory loss of lateral heel
185
Imaging for lumbar herniated disc?
plain films (degenerative changes), MRI (neurologic changes and intolerable pain)
186
Treatment of lumbar herniated disc
conservative (NSAIDs, rest, PT, epidural steroid injections, manipulative therapy, traction, acupuncture) vs. surgical decompression (microdisectomy, laminectomy)
187
Define claudication?
Claudication is pain and/or cramping in the lower leg due to inadequate blood flow to the muscles.
188
What is spinal stenosis?
narrowing of lumbar spinal canal with compress on nerve roots
189
Common sites for spinal stenosis?
L3-4, L4-5, L2-3
190
Presentation of spinal stenosis?
can be sudden or insidious, neurogenic claudication (fatigue and weakness from proximal to distal; sitting or lying relieves the pain), pain relief with sitting forward/leaning, possible low back pain
191
PE of spinal stenosis?
proprioception may be impaired--positive Romberg test (eyes closed, estimate 30 seconds, feet together), segmental sensory changes, possible abnormal reflexes, normal tibial pulses, possible urinary or bowel symptoms (anal sphincter tone rarely affected)
192
Imaging for spinal stenosis?
Plain films (up to T10); MRI; EMG/NCS
193
Spinal stenosis treatment
Conservative (pain control, PT, water therapy, body mechanics), surgery (quality of life, decompression vs. spinal fusion)
194
When does the SI joint move?
raising from sitting position
195
Causes of SI joint dysfunction (6)?
trauma, leg-length inequalities, tight myofascial structures (iliopsoas), scoliosis, hip OA, pregnancy
196
SI Joint Dysfunction presentation:
Pain: stabbing, knife-like; buttocks and posterior legs; worse with prolonged sitting/twisting/rotating
197
PE of SI Joint Dysfunction:
evaluate symmetry, hip rotation, limb lengths, scoliosis; TTP; special tests
198
Special tests for SI Joint dysfunction
Compression test (lay supine, hands on ASIS, press down on pelvis), FABER test
199
Imaging for SI Joint dysfunction?
plain films, CT scan
200
Treatment of SI Joint dysfunction?
conservative
201
What's coccydynia?
tailbone pain
202
Is coccydynia more common in men or women?
women
203
Causes of coccydynia?
Trauma (fall, childbirth), prolonged sitting on hard surfaces, degenerative changes, metastatic CA
204
Presentation of coccydynia?
pain with sitting, BM, sexual intercourse
205
PE of coccydynia?
TTP (need to check rectally), evaluate other areas of the lumbar spine, GI/gynecologic exams
206
Imaging for coccydynia
plain films, MRI (r/o other metastatic disease if suspect it)
207
Treatment of coccydynia
conservative (PT, change activity, nerve block) vs. surgical (coccygectomy)
208
What's spondylolysis?
pars interarticularis defect
209
What's spondylolisthesis?
forward translation of one vertebra to another
210
Spondylolisthesis Grade 1
1-25%
211
Spondylolisthesis Grade 2
25-50%
212
Spondylolisthesis Grade 3
51-75%
213
Spondylolisthesis Grade 4
76-100%
214
What causes spondylolysis/spondylolisthesis?
repetitive hyperextension (gymnasts, football linemen)
215
Most common locations for isthmic spondylolisthesis (pars interarticularis stress fracture)
L5-S1, then L4-L5
216
What percentage of spondylolysis are not associated with spondylolisthesis?
50%
217
Where are most common locations for degenerative spondylolisthesis (facet arthropathy)?
L4-L5
218
Presentation of spondylolysis/spondylolisthesis?
back pain with movement, radiculopathy (can mimic spinal stenosis)
219
PE of spondylolysis/spondylolisthesis
look at curvature, loss of lordosis, spinous process step-off; possible decreased DTRs, motor exam is usually normal, decreased strength test after walking, positive SLR
220
Treatment of spondylolysis/spondylolisthesis
conservative (including weight loss) vs. surgical (skeletally immature, stabilization of defect)
221
Adverse outcomes of spondylolysis/spondylolisthesis
progressive slippage of vertebral body, chronic back pain, paralysis, cauda equina syndroma
222
What's scoliosis?
lateral curvature of the spine
223
What are causes of childhood scoliosis?
idiopathic, neuromuscular, congenital
224
What are causes of scoliosis after skeletal maturity?
degenerative spondylosis, degenerative spondylolisthesis, osteoporosis, degenerative disc disease (DDD)
225
Presentation of scoliosis?
pain, possible radiculopathy (common if L4-L5, extensor hallicis longus weakness), deformity (shorter, hump), cardiopulmonary decompensation (not common, associated with severe thoracic curves)
226
PE of scoliosis?
inspection for deformity, gait analysis, neuro exam
227
Imaging for scoliosis
full-length PA and lateral plain films; EMG (radiculopathy vs neuropathy)
228
Treatment of scoliosis?
skeletally immature (observation, bracing, spinal fusion); skeletally mature (conservative vs. surgical)
229
When is bracing warranted for skeletally immature scoliosis?
curves 25-45 with underarm orthosis 18-23 hours/ day
230
When is spinal fusion warranted for skeletally immature scoliosis?
Curves >45
231
When is surgery warranted for the skeletally mature scoliosis?
>50-60
232
Are primary tumors of the spine common?
no
233
Common sites metastases to spine originated?
breast, lung, prostate, colon, thyroid, kidney
234
Presentation metastatic disease
incident finding, back pain (primary tumor), neurologic finding; pain with weight bearing activities (relieved by rest), pain at night, radiculopathy, progression varies, possible constitutional symptoms (weight loss, fatigue, decreased appetite, night sweats, fever/chills)
235
PE for metastatic disease
inspect for deformity, TTP, neuro exam
236
Imaging for metastatic disease
AP/lateral plain films, bone scan to identify mets
237
Treatment of metastatic disease
dependent on tumor type; chemo, radiation, hormone therapy; decompression and stabilization with post-op radiation
238
Causes of vertebral fractures
Major trauma, minor trauma (osteoporosis, tumors, infections, LT steroid use)
239
When should you ALWAYS suspect a cervical spine fracture?
traumatic brain injury, unconscious or intoxicated persons
240
Cervical spine injuries impact men or women more?
men
241
Presentation of vertebral fractures?
MOI specific; severe neck or back pain; paraspinous muscle spasm, bone tenderness, possible neurologic defects
242
PE vertebral fractures?
swelling, ecchymosis, TTP, gap/step-off between vertebra, motor and sensory function, perianal sensation, sphincter tone, bulbocavernosus reflex
243
Imaging for cervical vertebral fractures
x-ray (AP, lateral, odontoid view)
244
Burst of C1 AKA
Jefferson Fracture
245
Bilateral fracture of C2 pedicles AKA
Hangman's fracture
246
Hangman's fracture MOI
hyperextension
247
Spinous process avulsion AKA
Clay-Shoveler's
248
Common sites for Clay-Shoveler's?
C7>C6>T1
249
Treatment for cervical vertebral fracture?
Immobilization, methylprednisolone 30 mg/kg bolus followed by drip 5.4 mg/kg/h x 23 hours; conservative vs. surgical
250
What are the goals of treating vertebral fractures?
preventing neurologic injury, restoring stability, restoring normal function
251
Kyphoplasty is for which vertebra?
thoracic
252
Vertebroplasty is for which vertebra?
lumbar
253
What is a soft cervical collar used for?
short term use for cervical sprains
254
What degree is the neck at in a soft cervical collar?
10 degree flexion
255
When is a philadelphia collar used?
immobilizes c-spine when suspect a fracture
256
The philadelphia collar allows for?
rotational control
257
What's the benefit of a rigid cervical orthosis?
greater limitation of c-spine movement
258
What's a halo brace?
4 screws with bars connecting to a plastic vest on the chest; immobilization of C-spine
259
What does a three-point spine orthosis limit?
flexion and extension
260
When is a three-point spine orthosis used?
thoracic sprains or minimal compression fractures
261
When is a total-contact thoracolumbosacral orthosis (TLSO; clamshell) used?
thoracolumbar fractures, postop-spinal fusion
262
Elastic belts provide?
abdominal support
263
Elastic belts are used for?
mild lumbar sprains
264
What does lumbosacral corset provide?
a little ROM restirction
265
When is a lumbosacral corset used?
lumbar sprain/acute disk herniation
