MSK Quiz 2: Part 1 Flashcards
How many joints are usually involved in crystal deposition disease?
1 joint
Crystals can be found in three locations:
synovium, cartilage, surrounding tissues
What crystals are responsible for gout?
monosodium urate crystals
What crystals are responsible for pseudogout?
calcium pryophosphate dehydrate crystals
What crystals are responsible for chondrocalcinosis?
calcium pyrophosphate dehydrate crystals
How do the crystals associated with gout form?
Urate saturation in the blood/body fluids forms monosodium urate crystals
What is the end-point for gout?
chronic, destructive and debilitating polyarthritis
Where are the most common areas for gout presentation?
1st metatarsophalangeal joint, ankle, midfoot, knee
What are the three overaching risk factors for hyperuricemia?
Syndromes, Medications, Diet
What syndromes put someone at risk for hyperuricemia?
hypertension, metabolic syndrome, and obesity
What medications put someone at risk for hyperuricemia?
thiazide diuretics and low dose ASA
What diets put someone at risk for hyperuricemia?
high purine diet, high-fructose corn syrup, excessive alcohol use
What are examples of purine rich foods?
organ meat, select seafoods
What are protective dietary foods for hyperuricemia?
vitamin C, coffee, cherries
What are the four phases of hyperuricemia?
1) asymptomatic hyperuricemia, 2) acute gouty flare 3) intercritical gout 4) chronic tophaceous gout
Asymptomatic hyperuricemia is defined as a serum urate concentration of?
> 7 mg/dL
There’s a clear correlation between the likelihood of developing gout and?
increased serum urate
Describe the etiology of gout
underexcretion (kidneys) and overproduction
Between underexcretion and overproduction what’s the most common etiology for gout?
underexcretion (90%)
Name the six causes of undersecretion in relation to gout:
reduced GFR/kidney disease, hypertension, obesity, systemic sclerosis, lead poisoning, drugs (diuretics, alcohol, ASA)
What are the seven causes of overproduction in relation to gout:
genetic disorders, obesity, psoriasis, nicotinic acid (B3), alcohol, red meat/organ meant/shellfish, high fructose corn syrup
What genetic disorder can lead to overproduction, causing gout?
hypoxanthine-guanine phosphoribosyltransferase deficiency
Who is more affected by gout, men or women?
Men (3-6x more likely)
Key age group for gout?
30-60
When are women more likely to experience gout?
after menopause
Describe the presentation of gout
sudden onset of pain, cardinal signs of inflammation, possible constitutional symptoms
Describe the inital gout attack?
monoarticular, lower extremity joints most common
Gout in the 1st metatarsophalangeal joint is called?
podagra
Advanced gout can lead to these four things?
subcutaenous tophus, urate kidney stones, joint damage, poly-articular attacks
DDx for gout?
cellulits, septic arthritis, trauma, sarcoidosis, pseudogout
DDx for advanced gout?
rheumatoid arthritis, reactive arthritis, CPPD arthropathy
What is the gold standard for diagnosing gout?
synovial fluid analysis
What will the synovial fluid analysis look like in gout?
needle-shaped crystals with strong negative birefringence
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)
What imaging would your order for someone with suspected gout?
x-ray (r/o fracture), ultrasound (maybe)
Treatment for gout?
lifestyle modifications, RICE, NSAIDs or Colchicine or Corticosteroids, possibly opioids
What is the dosing for colchicine in acute gout?
1.2 po at first sign of flare, then 0.6 mg 1 hour later
What is the dosing for colchicine prophylaxis for gout?
0.6 mg po daily or q12 hours
What is the treatment for recurrent/advanced gout?
Xanthine oxidase inhibitor or probenecide or pegloticase
What does xanthine oxidase inhibitors do?
blocks uric acid production
Name two examples of xanthine oxidase inhibitors?
allopurinol and febuxostat
Describe dosing of allopurinol for gout?
100 mg po daily (increase weekly to 200-300 mg/day)
Describe dosing of febuxostat for gout?
40 mg po daily; can increase to 80 mg daily
Describe dosing for probenecide for gout?
250 mg po daily x 1 week; increase to 500 mg po bid
When do you consider discontinuing probenecid for gout?
If attacks do not occur for 4 months
How does probenecid work for gout?
lowers tissue stores by increasing renal excretion of uric acid
Do xanthine oxidase inhibitors work for overproducers or underexcretors?
Both
Does probenecid work for overproducers or underexretors?
Underexretors
Describe dosing for pegloticase?
8 mg IV q 2 weeks
How does pegloticase work?
converts uric acid to allantoin which is readily secreted by the kidneys
What’s the issue with pegloticase?
it’s expensive; blackbox warning for anaphylaxis
Name three examples of CPPD deposition disease?
pseudogout, chondrocalcinosis, pyrophosphate atrophy
What is chondrocalcinosis?
calcification of hyaline cartilage or fibrocartilage; extracellular pyrophosphate accumulation around chondrocytes
Is CPPD deposition disease more common in men or women?
women
What’s the cause of CPPD deposition disease?
Really it’s unknown, but maybe altered metabolism of pyrophosphate (PPI)…hereditary (familial), sporadic (idiopathic), metabolic
What are metabolic causes of CPPD deposition disease?
hemochromatosis, hyperparathyroidism, hypomagnesemia, hypophosphatasia
How many joints does pseudogout impact?
monoarticular
How does pseudogout differ from gout?
not as abrupt onset and tends to last longer; usually affects larger joints
What’s the most common location of pseudogout?
knee
What do you order to diagnose someone suspected of pseudogout deposition disease?
Xray, synovial fluid analysis
What will the synovial fluid look like in someone with pseduogout deposition disease?
squared off shape, positive birefringence
Treatment for pseudogout deposition disease
RICE, NSAIDs/corticosteroids/possibly colchicine
Symptoms of chondrocalcinosis?
asymptomatic; incidental finding on x-rays
Hydroxyapatite arthropathy is caused by?
a species of basic calcium phosphate
Hydroxyapatite arthropathy is identified by?
electron microscopy
What is hydroxyapatite arthropathy?
crystals in joints, tendons, ligaments and bursa
Demographic of those impacted by hydroxyapatite arthropathy?
younger
Causes of hydroxyapatite arthropathy
idiopathic, hereditary, metabolic (hypercalcemia)
What is a type of hydroxyapatite arthropathy that impacts the shoulder?
Calcific tendinitis
Calcific tendonitis impacts what muscle most often?
supraspinatus
What’s the cause of calcific tendinitis?
unknown
Presentation of calcific tendinitis?
sudden onset of pain without MOI, pain resolves, painful again during reabsorption phase
Treatment of calcific tendinitis?
conservative vs. surgical
What’s the condition where HA crystals destroy the RC and shoulder joint?
Milkwaukee Shoulder
Milwaukee SHoulder is most frequently seen in?
elderly females
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is most commonly seen in?
elderly men
Symptoms of Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Largely asymptomatic, but large bridging causes more pain; dysphagia if in cervical spine
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
What is septic bursitis?
an infection of the bursa
Does septic bursitis impact superficial or deep more often?
superficial
Common sites of septic bursitis?
olecranon, prepatellar, infrapatellar, 1st MTP
Is septic bursitis more common in men or women?
men
What’s the cause of septic bursitis?
trauma to the skin (direct inoculation through the skin, rarely from cellulitis or hematogenous seeding)
Presentation of septic bursitis?
redness, warmth, swelling, usually no ROM restriction
How to diagnose septic bursitis?
x-ray (r/o other causes), aspiration
Aspiration of a septic bursa will likely show?
s. aureus
Three most common bugs in septic bursitis
s. aureus, beta hemolytic strep, aerobic gram negative bacilli
Chronic septic bursitis aspiration may show?
b. abortus, m. tuberculosis, fungus
DDx for septic bursitis?
gout, pseudogout, arthritis, trauma
Outpatient treatment for septic bursitis?
penicillin or 1st generation cephalosporin, if MRSA add tri/sulfa, if PCN allergy use clindamycin or linezolid
Inpatient treatment for septic bursitis?
IV nafcillin, oxacillin, or cefazolin; if MRSA, add vancomycin, daptomycin, or linezolid
What is septic arthritis?
infection of the joint, damages articular cartilage and bone
Septic arthritis is usually viral/bacterial/fungal?
most commonly bacterial; can be viral or fungal
Septic arthritis is usually caused by which organisms?
staphylococcus aureus or streptococci
Septic arthritis is usually caused by?
direct injury to the joint, hematogenous spread (indwelling catheters, IC, UTIs), contiguous osteomyelitis, rarely from arthrocentesis or arthroscopy
Septic arthritis risk factors
diabetes, alcoholism, cutaneous ulcers/skin infections, prosthetic joints, RA, OA, low economic status, immunosuppressive therapies, IV drug use
Where will an IV drug user typically present with septic arthritis?
SC or SI joint
If an IV drug user presents with an SC or SI septic arthritis what organism should be suspected?
pseudomonas aeroginosa
Presentation of septic arthritis?
very painful, red, hot, swollen joint; usually monoarticula, decreased ROM, possible fever
Which joint is most often affected by septic arthritis?
knee
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?
What will you see on plan films of septic arthritis?
usually normal, may see soft tissue swelling; radiolucent lines if prosthetic joint infection
What imaging can you order for chronic septic arthritis?
MRI (identify osteomyelitis), bone scan (evaluate for associated osteomyelitis)
Synovial fluid analysis of a septic arthritis will show?
WBCs >50,000, low glucose, high protein
Between ESR and CRP which is more specific and rises faster in relation to septic arthritis?
CRP
When would you order a cervical/urethra culture for septic arthritis?
if gonococcal
What would you order for chronic septic arthritis (labs)?
acid-fast, fungal, tick titers (Lyme disease)
DDx for septic arthritis?
acute rheumatic fever, bursitis, crystal-induced arthritis, hemarthrosis, lyme disease, OA, RA
Treatment of septic arthritis?
surgery, IV antibiotics based on culture and sensitivity for 4 weeks
What is osteomyelitis?
infection of the bone
Causes of osteomyelitis?
hematogenous spread, contiguous spread, inoculation at time of trauma or surgery
Hematogenous spread of osteomyelitis is more common in males or females?
males
Findings for osteomyelitis?
localized bone pain, possible sinus tract/swelling/abscess, possible constitutional symptoms
DDx for osteomyelitis?
neuropathic arthropathy, malignancies, fractures
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)
Labs for osteomyelitis?
CBC with diff (leukocytosis), elevated Sed/CRP, biopsy/culture from affected area
What’s the gold standard for testing osteomyelitis?
biopsy or culture from affected area
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
Low back pain is common in?
works 30-60 years old
Low back pain symptoms usually resolve within?
30 days
What is the spurling test?
narrows the neural foramen, will increase or reproduce radicular symptoms
Straight-leg raise is used to test?
herniated disk; pain in lumbar spine when asymptomatic side is raised
Seated Straight-leg raise is used to test?
Sciatic tension; if positive, patient should lead back when you raise the leg
FABER (flexion-abduction-external rotation) test is used to test?
hip and SI joint pathology
What are Waddell’s signs?
a group of physical signs that may indicate non-organic or psychological component to chronic low back pain
What’s the difference between a strain and sprain in the neck?
used interchangeably because it’s difficult to determine muscle vs. ligament injury
What causes a cervical strain?
injury (trauma, whiplash)
What’s whiplash?
acceleration-deceleration with rapid flexion-extension
Are adults or children impacted at higher rates for cervical strain?
adults
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
How to diagnose a cervical strain?
x-ray
Treatment of cervical strain?
medications (NSAIDs, muscle relaxers, corticosteroids), possible soft cervical collar, massage, cervical traction, PT with modalities, self-limted
Cervical strain resolves within?
4-6 weeks
Whiplash associated cervical strain resolves within?
6-12 months
What is cervical radiculopathy?
neurogenic pain in nerve roots; possibly with associated numbness, weakness, or loss of reflexes
What are some causes of cervical radiculopathy?
disc herniation, degenerative changes
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)
What is cervical myelopathy?
neurologic deficit due to compression of the spinal cord
Does cervical myelopathy happen gradually or suddenly?
gradual onset
What are long-tract signs?
signs that indicate upper motor neuron lesion
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
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.
When is it normal to have a positive Babinski test?
In infants
What is the positive babinski sign?
Positive sign is the toes fanning out
Brudzinski-Kernig test is used for?
meningeal irritation
Ankle clonus may show?
rhythmic dorsiflexion/plantar flexion they can’t control
Cervical radiculopathy presentation?
TTP, decreased ROM, decreased lordosis, possible spurlings test positive, possible motor/sensory deficits
Imaging for cervical radiculopathy?
x-rays, MRI, CT myelogram, EMG/NCS
Treatment of cervical radiculopathy?
spontaneous resolution usually within 2-8 weeks, NSAIDs, cervical traction, avoid spinal manipulation
Delayed treatment of cervical radiculopathy can lead to?
muscle paralysis, weakness, chronic pain syndromes, may progress to myelopathy with spinal cord involvement
Cervical spondylosis is a general term that encompasses?
degenerative disc disease (herniation), bone spurs, changes in ligamentum flavum, neural foramen narrowing/stenosis
What is the most frequent cause of spinal cord dysfunction >55 y/o?
cervical spondylosis
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)
What special tests should you perform for cervical spondylosis?
Spurling’s test, Babinksi Sign, Brudzinski-Kernig Test, Ankle Clonus
Imaging for cervical spondylosis?
x-ray, MRI, CT myelogram
Treatment for cervical spndylosis?
conservative vs. surgical (decompression and fusion)
What’s the most frequent cause of lost work time and disability in adults <45 years old?
Lumbar sprain/strain
Most lumbar strains/sprains resolve within?
30 days
What causes lumbar sprains/strains?
lifting/straining, trauma
What are contributing factors to lumbar sprains/strains?
poor fitness, poor body mechanics, job dissatisfaction, smoking, psychosocial issues
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
What must you ask (r/o) for lumbar sprain/strain?
bowel and bladder function, saddle anesthesia, weakness in the lower extremities
“bowel and bladder function, saddle anesthesia, weakness in the lower extremities” are used to r/o?
cauda equina syndrome
What is cauda equina syndrome?
compression of the nerve roots distal to the conus medullaris
What spinal nerves control bladder and anal sphincter function?
S2-S4
What can cause cauda equina syndrome?
central disk herniation, epidural abscess, epidural hematoma, vertebral burst fracture
How do you treat cauda equina syndrome?
Surgical emergency–immediate decompression syndrome
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
Imaging for cauda equina syndrome?
MRI, CT myelogram
Imaging for lumbar sprain/strain
Possibly plain films (always after trauma or with atypical symptoms)
Where do the ribs attach to the spine?
T12
Treatment of lumbar sprain?
pain control, PT, patient education (body mechanics, lifting techniques)
Chronic low back pain begins after x days?
90 days
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
Imaging for chronic low back paiN?
Plan films (look for degenerative changes, loss of joint space), MRI (structural changes).
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)
Lumbar herniated disc is caused by?
nucleus pulposus extrusion
Why does nucleus pulposus extrusion occur?
posterolateral portion weakens over time
Most common lumbar herniated discs?
L4-5; L5-S1
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
What’s sciatica?
inflammation of the sciatic nerve
L3-L4 lumbar herniated disc findings?
ankle dorsiflexion; sensory loss of medial malleolus
L4-L5 lumbar herniated disc findings?
great toe dorsiflexion; sensory loss of dorsal third metatarsophalangeal joint
L5-S1 lumbar herniated disc findings?
ankle plantar flexion; sensory loss of lateral heel
Imaging for lumbar herniated disc?
plain films (degenerative changes), MRI (neurologic changes and intolerable pain)
Treatment of lumbar herniated disc
conservative (NSAIDs, rest, PT, epidural steroid injections, manipulative therapy, traction, acupuncture) vs. surgical decompression (microdisectomy, laminectomy)
Define claudication?
Claudication is pain and/or cramping in the lower leg due to inadequate blood flow to the muscles.
What is spinal stenosis?
narrowing of lumbar spinal canal with compress on nerve roots
Common sites for spinal stenosis?
L3-4, L4-5, L2-3
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
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)
Imaging for spinal stenosis?
Plain films (up to T10); MRI; EMG/NCS
Spinal stenosis treatment
Conservative (pain control, PT, water therapy, body mechanics), surgery (quality of life, decompression vs. spinal fusion)
When does the SI joint move?
raising from sitting position
Causes of SI joint dysfunction (6)?
trauma, leg-length inequalities, tight myofascial structures (iliopsoas), scoliosis, hip OA, pregnancy
SI Joint Dysfunction presentation:
Pain: stabbing, knife-like; buttocks and posterior legs; worse with prolonged sitting/twisting/rotating
PE of SI Joint Dysfunction:
evaluate symmetry, hip rotation, limb lengths, scoliosis; TTP; special tests
Special tests for SI Joint dysfunction
Compression test (lay supine, hands on ASIS, press down on pelvis), FABER test
Imaging for SI Joint dysfunction?
plain films, CT scan
Treatment of SI Joint dysfunction?
conservative
What’s coccydynia?
tailbone pain
Is coccydynia more common in men or women?
women
Causes of coccydynia?
Trauma (fall, childbirth), prolonged sitting on hard surfaces, degenerative changes, metastatic CA
Presentation of coccydynia?
pain with sitting, BM, sexual intercourse
PE of coccydynia?
TTP (need to check rectally), evaluate other areas of the lumbar spine, GI/gynecologic exams
Imaging for coccydynia
plain films, MRI (r/o other metastatic disease if suspect it)
Treatment of coccydynia
conservative (PT, change activity, nerve block) vs. surgical (coccygectomy)
What’s spondylolysis?
pars interarticularis defect
What’s spondylolisthesis?
forward translation of one vertebra to another
Spondylolisthesis Grade 1
1-25%
Spondylolisthesis Grade 2
25-50%
Spondylolisthesis Grade 3
51-75%
Spondylolisthesis Grade 4
76-100%
What causes spondylolysis/spondylolisthesis?
repetitive hyperextension (gymnasts, football linemen)
Most common locations for isthmic spondylolisthesis (pars interarticularis stress fracture)
L5-S1, then L4-L5
What percentage of spondylolysis are not associated with spondylolisthesis?
50%
Where are most common locations for degenerative spondylolisthesis (facet arthropathy)?
L4-L5
Presentation of spondylolysis/spondylolisthesis?
back pain with movement, radiculopathy (can mimic spinal stenosis)
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
Treatment of spondylolysis/spondylolisthesis
conservative (including weight loss) vs. surgical (skeletally immature, stabilization of defect)
Adverse outcomes of spondylolysis/spondylolisthesis
progressive slippage of vertebral body, chronic back pain, paralysis, cauda equina syndroma
What’s scoliosis?
lateral curvature of the spine
What are causes of childhood scoliosis?
idiopathic, neuromuscular, congenital
What are causes of scoliosis after skeletal maturity?
degenerative spondylosis, degenerative spondylolisthesis, osteoporosis, degenerative disc disease (DDD)
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)
PE of scoliosis?
inspection for deformity, gait analysis, neuro exam
Imaging for scoliosis
full-length PA and lateral plain films; EMG (radiculopathy vs neuropathy)
Treatment of scoliosis?
skeletally immature (observation, bracing, spinal fusion); skeletally mature (conservative vs. surgical)
When is bracing warranted for skeletally immature scoliosis?
curves 25-45 with underarm orthosis 18-23 hours/ day
When is spinal fusion warranted for skeletally immature scoliosis?
Curves >45
When is surgery warranted for the skeletally mature scoliosis?
> 50-60
Are primary tumors of the spine common?
no
Common sites metastases to spine originated?
breast, lung, prostate, colon, thyroid, kidney
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)
PE for metastatic disease
inspect for deformity, TTP, neuro exam
Imaging for metastatic disease
AP/lateral plain films, bone scan to identify mets
Treatment of metastatic disease
dependent on tumor type; chemo, radiation, hormone therapy; decompression and stabilization with post-op radiation
Causes of vertebral fractures
Major trauma, minor trauma (osteoporosis, tumors, infections, LT steroid use)
When should you ALWAYS suspect a cervical spine fracture?
traumatic brain injury, unconscious or intoxicated persons
Cervical spine injuries impact men or women more?
men
Presentation of vertebral fractures?
MOI specific; severe neck or back pain; paraspinous muscle spasm, bone tenderness, possible neurologic defects
PE vertebral fractures?
swelling, ecchymosis, TTP, gap/step-off between vertebra, motor and sensory function, perianal sensation, sphincter tone, bulbocavernosus reflex
Imaging for cervical vertebral fractures
x-ray (AP, lateral, odontoid view)
Burst of C1 AKA
Jefferson Fracture
Bilateral fracture of C2 pedicles AKA
Hangman’s fracture
Hangman’s fracture MOI
hyperextension
Spinous process avulsion AKA
Clay-Shoveler’s
Common sites for Clay-Shoveler’s?
C7>C6>T1
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
What are the goals of treating vertebral fractures?
preventing neurologic injury, restoring stability, restoring normal function
Kyphoplasty is for which vertebra?
thoracic
Vertebroplasty is for which vertebra?
lumbar
What is a soft cervical collar used for?
short term use for cervical sprains
What degree is the neck at in a soft cervical collar?
10 degree flexion
When is a philadelphia collar used?
immobilizes c-spine when suspect a fracture
The philadelphia collar allows for?
rotational control
What’s the benefit of a rigid cervical orthosis?
greater limitation of c-spine movement
What’s a halo brace?
4 screws with bars connecting to a plastic vest on the chest; immobilization of C-spine
What does a three-point spine orthosis limit?
flexion and extension
When is a three-point spine orthosis used?
thoracic sprains or minimal compression fractures
When is a total-contact thoracolumbosacral orthosis (TLSO; clamshell) used?
thoracolumbar fractures, postop-spinal fusion
Elastic belts provide?
abdominal support
Elastic belts are used for?
mild lumbar sprains
What does lumbosacral corset provide?
a little ROM restirction
When is a lumbosacral corset used?
lumbar sprain/acute disk herniation
