MSS18

Question 1

Components of spine exam

Answer 1

Inspection
Palpation
ROM
Neuromuscular exam
Special tests
Exam related areas

Question 2

Cervical Myelopathy

Answer 2

HX: Gradual progression, typically >50, loss of fine motor skills, gait disturbances, B/B dysfuction, motor weakness, LE numbness, weakness, pain
Exam: UMN findings, Hyperreflexia, Hoffman’s sign, positive Babinski, Lhermitt sign, Rhomberg sign, Wide base, ataxia, slow gait
Etiology: Spinal cord compression, usually gradual progression d/t osteophyte formation, spinal stenosis
Tx: surgery

Question 3

Lumbar strain

Answer 3

Hx: axial low back pain after acute injury (lifting)
Pain is WORSE with movement, BETTER with rest
Exam: localized muscle tenderness, REDUCED ROM, normal nuero
Etiology: muscle disruption from excessive stretch
Tx: rest, NSAIDS, PT

Question 4

Compression fracture

Answer 4

HX: usually SUDDEN onset of thoracic or lumbar pain
Exam: local tenderness, painful ROM (esp flexion), normal neuro
Image: Plain x-ray (loss in height, wedge shaped fracture), MRI or CT
Labs: check CBC, SPEP, Alk Phos, ESR (malignancy), DEX, endocrine (Osteoporosis)
Tx: NSAIDS, Bracing,
usually asymptomatic,
Associated with prolonged corticosteroid use, in younger pts consider malignancy

Question 5

Cauda equina syndrome

Answer 5

HX: chronic back pain, new saddle anesthesia/leg pain, bowel/bladder dysfunction, weakness, numbness
Exam: decreased rectal tone, reduced or absent reflexes, weakness
Etiology: herniated disc compressing cauda equina (L3/4)
Tx: Surgical Emergency

Question 6

Ankylosing spondylitis

Answer 6

Early: Widening of SI joints w/ sacroiliitis
Late: fusion of SI joints w/sacroilitis resulting in bamboo spine, ossification of longitudinal ligaments
HX: slow progressive back pain and stiffness. WORSE in morning and w/ prolonged activity. BETTER w/ exercise
Exam: Reduced ROM, tender over SI joint
Labs: CRP, Sed rate, HLA B27 +
TX: NSAIDS, PT, anti-TNFa if refractory to NSAIDS

Question 7

Fracture

Answer 7

Major trauma, minor truama w/ lifting in elderly, prolonged corticosteroid use, osteoporosis, age

Question 8

What is a dermatome and what are some key landmarks?

Answer 8

Dermatome is a region of skin innervated by somatic sensory nerve axons associated with a single DRG at a single spinal cord level.
C2: skull cap
C3: high turtleneck
C4: low collar shirt
T4: nipple
T7: xiphoid
T10: belly button
L1: inguinal canal
L4: knee
S2,3,4: sensitive

Question 9

What causes Herpes Zoster?

Answer 9

Reactivation of previous infection of DRG or sensory ganglion by varicella zoster. Presents as a rash confined to nerve sensory distribution. Localized pain with vesicles appear 72 to 96 hours later.

Question 10

How can you test the C5 myotome?

Answer 10

Biceps: Elbow flexion

Question 11

How can you test the C6 myotome?

Answer 11

Extensor carpi radialis: wrist extensor

Question 12

How can you test the C7 myotome?

Answer 12

Tricep: Elbow extensor

Question 13

How can you test the C8 myotome?

Answer 13

Flexor digitorium profundus: distal finger flexion

Question 14

How can you test the T1 myotome?

Answer 14

Abductor digiti minimi: little finger abduction

Question 15

How can you test the L2 myotome?

Answer 15

Iliopsoas: hip flexion

Question 16

How can you test the L3 myotome?

Answer 16

Quadraceps: knee extension

Question 17

How can you test the L4 myotome?

Answer 17

Tibialis Anterior: ankle dorsiflexion

Question 18

How can you test the L5 myotome?

Answer 18

Extensor Hallicus Longus: big toe extensor

Question 19

How can you test the S1 myotome?

Answer 19

Gastrocnemius: ankle pantarflexor

Question 20

Reflex testing

Answer 20

S1,2: achilles ( gastrocnemius)
L3,4: patellar (quads)
C5,6: biceps
C7,8: Triceps

Question 21

What is lhermittes sign?

Answer 21

passitive anterior cervical flexion elicts electric like sensation.
Indicates cervial spinal cord pathology

Question 22

What is Spurling’s Neck compression test?

Answer 22

Reproduction of radicular sxs with cervical spine extension, rotation and lateral rotation ( nerve root compression)

Question 23

What is Hoffman’s sign?

Answer 23

Flick pt’s middle finger–> causes flexion and adduction of thumb and index finger ( UMN problem)

Question 24

What is the straight leg raise?

Answer 24

Pt lies supine and pain is reproduced when leg is raised at 30-70 angle. (Lumbar nerve root pathology)

Question 25

What is the femoral nerve stretch test?

Answer 25

pt is put into prone position, knee is flexed and pain is reproduced in anterior thigh. (upper lumber nerve root pathology L2-L3)

Question 26

Disc herniation

Answer 26

Hx: Progressive pain in neck and arm, “shooting pain” down arm, numbness in arm
Pain: BETTER (C- lying; L: standing walking)/ WORSE: (C-ROM, Lumbar: sitting, bending, cough/sneeze)
Exam: Positive spurling, weak elbow extesion (C7), decreased sensation
Commonly: C6-C7 and L5-S1 (SLR +)
TX: avoid bedrest, NSAIDS, PT, Steroid injection

Question 27

Spondylolysis

Answer 27

congenital defect of acquired stress fracture
presents with NO slippage of adjacent vertebrae.
Radiologic: Scottie dog with a collar

Question 28

Spondylolisthesis

Answer 28

Anterior displacement of L5 body while the posterior fragment remains over S1
radiologic: Scottie dog w/ a broken neck

Question 29

Facet joint arthropathy

Answer 29

HX: axial low back pain, gradual onset (C- worse with cervical extension; Lumbar: worse standing/ walking)
Exam: pain provoked with active extension, ,relieved with flexion
Etiology: gradual degenerative changes/OA to facet joints
TX: NSAIDS, PT, steroids if refractory

Question 30

Lumbar stenosis

Answer 30

HX: Slowly progressive pain in back and in unilateral or bilateral LEG. (WORSE: with standing and walking specific distances) Relieved with lumbar flexion, sitting
Exam: no focal findings, neuro exam normal. Check pulses!
Etiology: narrowing of spinal canal
Tx: PT, walker, NSAIDS, steroids, Surgery