neck and LBP Flashcards
1
Q
what is a strain
A
denotes muscle-tendon injury
2
Q
what is a sprain
A
denotes ligamentous injury
3
Q
what is radiculopathy
A
- nerve root dysfunction
- signs and symptoms (pain, weakness, sensory loss, relfex loss) in a dermatomal distribution
4
Q
what is sciatica
A
radiculopathy in a root (L4, L5, or S1) contributing to the sciatic nerve symptoms along the posterior or lateral aspect of the lower leg to foot or ankle
5
Q
cervical, thoracic, and lumbar nerves come out where on the vertebral column
A
- cervical nerves come out above associated vertebral body
- thoracic and lumbar nerves come out below associated vertebral body
6
Q
Myelopathy (upper motor neuron) presents with what symptoms
A
- weakness in affected distribution
- hyperactive reflexes
- clonus
- spasticity
- muscle atrophy (late finding)
7
Q
radiculopathy (lower motor neuron) presents with what symptoms
A
- weakness in affected distribution
- hypoactive reflexes
- flaccidity
- muscle atrophy
8
Q
when a patient complains of back pain, what questions should you ask him/her?
A
- sensory changes (numbness, tingling)
- weakness
- loss of function
- change in bowel or bladder control
- previous episodes of pain
9
Q
for neck complaints, what areas should you examine
A
- neck
- shoulders
- upper extremities
10
Q
for low back complaints, what areas should you examine
A
- low back
- hips
- lower extremities
11
Q
where does the C6 dermatome run
A
lateral aspect of upper extremity from shoulder to thumb
12
Q
where does C5 dermatome run
A
- anterior: below clavicle and down lateral aspect of anterior upper extremity down to the wrist
13
Q
where does C7 dermatome run
A
- posterior: across upper back and down middle of posterior aspect of UE to 2nd and 3rd finger
14
Q
where does C8 dermatome run
A
- posterior: strip across upper back and down medial aspect of UE to 4th and 5th digits
15
Q
what dermatome runs across the nipple line
A
T4
16
Q
what dermatome runs across the umbilicus
A
T10
17
Q
C5 motor loss affects what muscles and motions
A
- deltoid
- some biceps
- shoulder abduction
18
Q
C6 motor loss affects what muscles and motions
A
- biceps
- brachioradialis (forearm flexion)
- wrist extensors
19
Q
C7 motor loss affects what muscles and motions
A
- triceps (forearm extension)
- wrist flexors
- finger extensor
20
Q
C8 motor loss affects what muscles and motions
A
- thenar eminence
- interossei of hand
21
Q
C5 affects what DTR
A
- biceps
- brachioradialis
22
Q
C6 affects what DTR
A
- biceps
- brachioradialis
23
Q
C7 affects what DTR
A
triceps
24
Q
L3 sensory loss
A
anterior thigh
25
L4 sensory loss
anteromedial thigh to medial leg
26
L5 sensory loss
* lateral thigh
* anterior calf
27
S1 sensory loss
* posterior calf
* heel
28
L3 motor loss
iliopsoas
29
L4 motor loss
quadriceps
30
L5 motor loss
* foot dorseflexion
* anterior tibialis
* extensor hallicus longus
31
S1 motor loss
* Gastocnemius (plantar flexion of the foot)
32
DTR associated with L3
knee jerk
33
DTR associated with L4
knee jerk
34
DTR associated with S1
achilles
35
MRI best evaluate what
* soft tissue
* neural compression
36
when is a bone scan indicated
infectious or metastatic disease
37
what study will help sort out root vs peripheral nerve vs plexus problem
electromyogram
38
what study will sort out problem with axon or myelin
nerve conduction studies
39
what are you looking for in spine films
* alignment
* disc space narrowing
* presence of osteo-phytes, especially involving the intervertebral foramina
40
this injury usually results from a rapid deceleration injury with hyperextension of neck, followed by flexion
cervical strain/sprain
41
clinical presentation
* **gradual** onset of neck stiffness and soreness
* often complain of muscle tightness
* may be aggravated by emotional stressors, poor posture, and poor sleeping habits
* may be accompanied by a tension type HA starting at the base of the skull
* may c/o shoulder pain
cervical strain/sprain
42
clinical presentation
* usually acute onset of pain secondary to an identifiable precipitating event (lifting or twisting)
* pain typically worsens with activity and is at least partially improved with rest
* often radiates to buttocks
* between 30-60% have had prior episodes
lumbar strain/sprain
43
when getting a c-spine xray, what must you see
must see C7; may need swimmer's view
44
what are the normal cervical spine films
* AP
* lateral
* odontoid (open mouth)
45
treatment for cervical, lumbar strain/sprain
1. "therapeutic trial" for at least 48 hrs
1. bed rest no more than 48 hrs
2. local ice or heat
3. massage
2. NSAIDS, muscle relaxants, analgesics
1. take **around the clock, NOT prn**
46
for a cervical, lumbar strain, how many will recover within 2 weeks with conservative therapy
50%
\*majority recover fully by 4 weeks
\*5-10% can develop chronic symptoms
47
what is cervical spondylosis
combination of degenerative disc disease and hypertrophy of ligamentum flavum and facets
\*can have radiculopathy and myelopathy (if spinal cord compressed)
48
what c-spine levels are most commonly affected in cervical spondylosis
* C4-5
* C5-6
* C6-7
49
herniated lumbar disc disease most commonly occurs at what levels
* L4-5
* L5-S1
50
in herniated lumbar disc disease, where are most herniations
postero-lateral because the posterior longitudinal ligament is weakest
51
in herniated lumbar disc disease, where does the pain classically radiate
from low back into legs (sciatica)
* pain is aggravated by sitting, coughing, or sneezing
52
what tests can you do in clinical practice to screen for herniated lumbar disc disease
SLR (straight leg raise)
53
treatments for cervical and lumbar spondylosis
* NSAIDs (ibuprofen; naproxen)
* Muscle relaxants
* cyclobenzaprine (Flexeril)
* urgent referral for neuro deficitis
54
clinical presentation
* acute LBP with sciatica
* urinary retention in 90%
* bilat lower extremity muscle weakness
* **saddle** anesthesia - involves buttocks, posterior/superior thighs and perineal region
* decreased anal sphincter tone
cauda equina syndrome
55
what is cauda equina syndrome
neurologic emergency that results from massive midline herniation
* trauma
* metastatic disease
56
what is spondylolysis
Spondylolysis refers to a small crack that forms in the posterior part of the vertebra (pars interarticularis)
* from repetitive hyperextension stresses
57
What is spondylolisthesis
* anterior displacement of one vertebra on another
* associated with degenerative disc disease
* \>50% displacement can cause narrowing of spinal cord or the neural foramina
58
at which vertebrae is spondylolisthesis most common
* L4-L5
* L5-S1
59
what is the primary symptom with spondylolisthesis
back pain
* aggravated by bending, lifting, twisting secondary to instability
60
what films do you need to include when assessing for spondylolisthesis
flexion and extension views
61
treatment of spondylolisthesis that is less than 50%
* exercise
* lumbar corset
* NSAIDs
62
treatment of spondylolisthesis with \>50% displacement
will require spinal fusion to stabilize
63
what is lumbar spinal stenosis
* congenital or acquired condition that narrows the neural foramen, creating compression on the spinal cord and/or nerve roots
* combination of ddd and hypertrophy of ligamentum flavum
64
what is the most common cause of neurologic leg pain in the elderly
lumbar spinal stenosis
65
clinical presentation
* progressive low back and bilat leg pain (buttocks, legs and thighs) that is aggravated by standing or walking
* **relieved by leaning forward** or laying suprine for 15-30 min
lumbar spine stenosis
66
imaging
* reduced height of intervertebral disc
* facet hypertrophy
* hypertrophy of ligamentum flavum
* narrowing of intervertebral foramina
lumbar spine stenosis
67
treatment for lumbar spine stenosis
1. NSAIDS, PT
2. epidural steroid injections
3. surgical intervention
1. intractable pain
2. neuro deficits
68
List RED FLAGS of LBP
* age \> 50
* hx of CA
* unexplained weight loss
* duration of pain \> 1 month
* immunosuppression
* fever
* urinary infection
* IV drug use
* worse when supine
