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clinical medicine exam 3 > neck and LBP > Flashcards

neck and LBP Flashcards

1
Q

what is a strain

A

denotes muscle-tendon injury

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2
Q

what is a sprain

A

denotes ligamentous injury

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3
Q

what is radiculopathy

A
  • nerve root dysfunction
  • signs and symptoms (pain, weakness, sensory loss, relfex loss) in a dermatomal distribution
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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

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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
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6
Q

Myelopathy (upper motor neuron) presents with what symptoms

A
  • weakness in affected distribution
  • hyperactive reflexes
  • clonus
  • spasticity
  • muscle atrophy (late finding)
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7
Q

radiculopathy (lower motor neuron) presents with what symptoms

A
  • weakness in affected distribution
  • hypoactive reflexes
  • flaccidity
  • muscle atrophy
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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
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9
Q

for neck complaints, what areas should you examine

A
  • neck
  • shoulders
  • upper extremities
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10
Q

for low back complaints, what areas should you examine

A
  • low back
  • hips
  • lower extremities
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11
Q

where does the C6 dermatome run

A

lateral aspect of upper extremity from shoulder to thumb

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12
Q

where does C5 dermatome run

A
  • anterior: below clavicle and down lateral aspect of anterior upper extremity down to the wrist
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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
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14
Q

where does C8 dermatome run

A
  • posterior: strip across upper back and down medial aspect of UE to 4th and 5th digits
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15
Q

what dermatome runs across the nipple line

A

T4

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16
Q

what dermatome runs across the umbilicus

A

T10

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17
Q

C5 motor loss affects what muscles and motions

A
  • deltoid
  • some biceps
  • shoulder abduction
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18
Q

C6 motor loss affects what muscles and motions

A
  • biceps
  • brachioradialis (forearm flexion)
  • wrist extensors
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19
Q

C7 motor loss affects what muscles and motions

A
  • triceps (forearm extension)
  • wrist flexors
  • finger extensor
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20
Q

C8 motor loss affects what muscles and motions

A
  • thenar eminence
  • interossei of hand
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21
Q

C5 affects what DTR

A
  • biceps
  • brachioradialis
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22
Q

C6 affects what DTR

A
  • biceps
  • brachioradialis
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23
Q

C7 affects what DTR

A

triceps

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24
Q

L3 sensory loss

A

anterior thigh

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25
Q

L4 sensory loss

A

anteromedial thigh to medial leg

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26
Q

L5 sensory loss

A
  • lateral thigh
  • anterior calf
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27
Q

S1 sensory loss

A
  • posterior calf
  • heel
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28
Q

L3 motor loss

A

iliopsoas

29
Q

L4 motor loss

A

quadriceps

30
Q

L5 motor loss

A
  • foot dorseflexion
  • anterior tibialis
  • extensor hallicus longus
31
Q

S1 motor loss

A
  • Gastocnemius (plantar flexion of the foot)
32
Q

DTR associated with L3

A

knee jerk

33
Q

DTR associated with L4

A

knee jerk

34
Q

DTR associated with S1

A

achilles

35
Q

MRI best evaluate what

A
  • soft tissue
  • neural compression
36
Q

when is a bone scan indicated

A

infectious or metastatic disease

37
Q

what study will help sort out root vs peripheral nerve vs plexus problem

A

electromyogram

38
Q

what study will sort out problem with axon or myelin

A

nerve conduction studies

39
Q

what are you looking for in spine films

A
  • alignment
  • disc space narrowing
  • presence of osteo-phytes, especially involving the intervertebral foramina
40
Q

this injury usually results from a rapid deceleration injury with hyperextension of neck, followed by flexion

A

cervical strain/sprain

41
Q

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
A

cervical strain/sprain

42
Q

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
A

lumbar strain/sprain

43
Q

when getting a c-spine xray, what must you see

A

must see C7; may need swimmer’s view

44
Q

what are the normal cervical spine films

A
  • AP
  • lateral
  • odontoid (open mouth)
45
Q

treatment for cervical, lumbar strain/sprain

A
  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
Q

for a cervical, lumbar strain, how many will recover within 2 weeks with conservative therapy

A

50%

*majority recover fully by 4 weeks

*5-10% can develop chronic symptoms

47
Q

what is cervical spondylosis

A

combination of degenerative disc disease and hypertrophy of ligamentum flavum and facets

*can have radiculopathy and myelopathy (if spinal cord compressed)

48
Q

what c-spine levels are most commonly affected in cervical spondylosis

A
  • C4-5
  • C5-6
  • C6-7
49
Q

herniated lumbar disc disease most commonly occurs at what levels

A
  • L4-5
  • L5-S1
50
Q

in herniated lumbar disc disease, where are most herniations

A

postero-lateral because the posterior longitudinal ligament is weakest

51
Q

in herniated lumbar disc disease, where does the pain classically radiate

A

from low back into legs (sciatica)

  • pain is aggravated by sitting, coughing, or sneezing
52
Q

what tests can you do in clinical practice to screen for herniated lumbar disc disease

A

SLR (straight leg raise)

53
Q

treatments for cervical and lumbar spondylosis

A
  • NSAIDs (ibuprofen; naproxen)
  • Muscle relaxants
    • cyclobenzaprine (Flexeril)
  • urgent referral for neuro deficitis
54
Q

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
A

cauda equina syndrome

55
Q

what is cauda equina syndrome

A

neurologic emergency that results from massive midline herniation

  • trauma
  • metastatic disease
56
Q

what is spondylolysis

A

Spondylolysis refers to a small crack that forms in the posterior part of the vertebra (pars interarticularis)

  • from repetitive hyperextension stresses
57
Q

What is spondylolisthesis

A
  • 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
Q

at which vertebrae is spondylolisthesis most common

A
  • L4-L5
  • L5-S1
59
Q

what is the primary symptom with spondylolisthesis

A

back pain

  • aggravated by bending, lifting, twisting secondary to instability
60
Q

what films do you need to include when assessing for spondylolisthesis

A

flexion and extension views

61
Q

treatment of spondylolisthesis that is less than 50%

A
  • exercise
  • lumbar corset
  • NSAIDs
62
Q

treatment of spondylolisthesis with >50% displacement

A

will require spinal fusion to stabilize

63
Q

what is lumbar spinal stenosis

A
  • 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
Q

what is the most common cause of neurologic leg pain in the elderly

A

lumbar spinal stenosis

65
Q

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
A

lumbar spine stenosis

66
Q

imaging

  • reduced height of intervertebral disc
  • facet hypertrophy
  • hypertrophy of ligamentum flavum
  • narrowing of intervertebral foramina
A

lumbar spine stenosis

67
Q

treatment for lumbar spine stenosis

A
  1. NSAIDS, PT
  2. epidural steroid injections
  3. surgical intervention
    1. intractable pain
    2. neuro deficits
68
Q

List RED FLAGS of LBP

A
  • age > 50
  • hx of CA
  • unexplained weight loss
  • duration of pain > 1 month
  • immunosuppression
  • fever
  • urinary infection
  • IV drug use
  • worse when supine

clinical medicine exam 3 (7 decks)

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