Neurological Flashcards
What is the MOI for spinal cord injury?
Compression (vertebrae slip back into spinal cord)
Contusion (bam)
Distraction (tensile load through spinal cord)
*usually don’t see spinal cord laceration/transection, more so tissue damage
What will dictate which deficits will happen when looking at motor and sensory consequences of SCI?
The level of injury (ex. Cervical/thoracic/lumbar)
We have a spinal cord classification, consisting of
Different levels of injury and function (partial or more complete loss of sensory and motor function)
Most of our spinal cord injuries will be in which part of the spine? Why is this a problem?
Cervical, dangerous because it’s the highest cervical level
If you mess it up it impacts a lot of areas
Damaging the dorsal roots would mean what?
More sensory issues, afferent
If we injury ventral roots, what does this mean
Efferent, can anticipate motor deficits if the injury focused here
Whats the SCI example krista gave in class? Ie MOI
Tackled, head in ground
- axial / compressive load going through spine
- might go into extreme flexion or extension of cervical spine near head
- excessive cervical flexion
What could happen with vertebrae from an SCI MOI
- vertebrae might not line up
- dislocation of ZA joint in cervical spine
- if you move vertebrae forward you might get spinal cord issues
- can also have fracture of vertebrae, if you fracture the point the other part could go into spinal cord
- fracture/dislocation + issue at spinal cord level
What injury mimics fhe signs and symptoms of a cervical SCI but is transient/short lived in nature?
Cervical cord neuropraxia
What might a cervical cord neuropraxia look like
- mimics full spinal cord injury
- crushes, damages, person can’t feel limbs
- reverses in short period of time (miracle!)
- on the surface looks super severe
- could be a minute/24/48 hours/2 weeks but these effects are temporary, no actual damage to spinal cord
Cervical cord neuropraxia could also be referred to as
Spinal cord concussion
- mimics some physiological impacts
- similar metabolic dysfunction
What are the types of spinal cord injury? In order from least to most severe
Neuropraxia, axonotmesis, neurotmesis
Describe neuropraxia in terms of severity
- axons are fully intact
- the epineurial layer has some level of disruption
- has been stressed in some way but connectivity is still fully there
- that’s why we get this function back, did jot actually break up communication piece
- temporary
Describe the severity of axonotmesis
- have some disruption in connectivity of the axon
- will have longer recovery time, could be as long as 3 months
- structural disruption in axon
Describe the severity of neurotmesis
- disruption all the way through axon and epineurial layer
What condition presents a higher risk for CCN?
Congenital spinal stenosis
Define stenosis and how it would be applied to the spinal cord
Narrowing of pathway/hole (in this case spinal canal)
- less space for spinal cord to fit in
- when comparing anterior posterior dimensions of vertebral body and canal, should be roughly equal in healthy people (in stenosis this canal is 80% width)
Given the structure of the spinal cord, why might stenosis be an issue in certain sections?
- spinal cord doesn’t have a consistent cross sectional area
- bottom in lumbar is more narrow cause less nerve innervation
- cervical spine hs the largest cross sectional area
- if we have a smaller spinal canal this could be an issue
What is the MOI for brachial plexus neuropraxia?
- Traction mechanism (pull apart)
- Compression mechanism (compressing nerve roots thst build the brachioplexus right aa they branch out of SC, happens in opposite direction of flexion)
- compression of lateral flexion and extension will, close down on nerve roots
- nerve exits intervertebral foramen (check) - Direct blow (to brachioplexus)
- exposed, just a thin muscle layer on top, window between muscles leaves a weak spot
What happens to the head to pull the brachioplexus apart?
Head is pulled away from shoulder in some way
- sometimes falling, sometimes pulling
- lateral flexion of cervical spine pulls it apart
*review anatomy, nerve origins between c5 and t1
What lay terminology describes brachial plexus neuropraxia?
Burner or a stinger
Which spinal nerves are typically affected in brachial plexus neuropraxia?
Even though we can think of whole brachioplexus as available for damage, usually it’s upper part (c5, c6 nerve roots)
- c5 and c6 are more superficial and vulnerable
Describe the clinical presentation of brachialplexus neuropraxia
- unilateral issue, shows up in one arm only
- reduction in cervical spine ROM and pain
- have function below the site of injury (difference between sci and this)
- injury location is anything fed by brachioplexus
- neurological symptoms can dissolve
Most people will return to play in how many hrs after brachial plexus neuropraxia? Why?
24
- doesn’t rip apart axons/communication structure, therefore transient
What other condition is brachial plexus neuropraxia associated with?
Congenital spine stenosis
When we’re in a field setting and one of these happens, we will look at
Broader neurological testing
Define a dermatome
The area of skin that a specific spinal nerve collects sensory information from
- mapped area on surface of body that matches up with spinal nerve
Describe dermatome testing
- most neural structures will have motor and sensory components
- sensation is where we will test dermatome
- a specific part of body is sped by specific spinal nerve
- to test function of spinal level, we can test their ability to detect sharp stimuli or soft dull stimulus (don’t poke the skin, just poking or brushing something along it)
What area corresponds to c5
Lateral side of elbow and upper arm
What area corresponds to c6
Finger 1 and 2, radial side of forearm
What area corresponds with c7
Finger 3
What area corresponds with c8
Finger 4 and 5
What area corresponds with t1?
Ulnar side of elbow and forearm
Tingling in pinky could mean what?
Issue with c8
Define myotome
A joint action (or actions) produced by a group lf muscles that rely heavily on the motor messages traveling along that spinal nerve *motor output
- every action is driven by partnerships of different spinal nerves
- we can kook at global function and say it’s generally influenced by l2 for example
- of you want to test l2, you can ask person to do hip flexion
How can we test myotomes?
Can do resisted strength tests and see what they can do
- can provide hints that it’s a neurological injury
- resistance test (grade out of 5), isometric with rom tables
What myotome area corresponds to c5
Elbow flexion
What movement corresponds with c6
Wrist extension
What movement corresponds with c8?
Finger flexion
What movement corresponds with t1?
Finger abduction
