(Some) Clinical boxes weeks 2-3 Flashcards
What does a back sprain involve?
Only ligaments
What does a back strain involve?
Some degree of muscle fibers tearing; it’s the most common cause of lower back pain
What two things can back spasms result from?
Muscle or ligament injury (both can be caused by heavy lifting)
How you do properly lift something to avoid strain on IV discs?
Hold object close to your body, don’t bend back
What test is used to determine if a patient with low back pain has a herniated IV disc? Explain it
Straight leg test; provider lifts pt’s leg with the pt’s leg fully straight, causing traction on the nerve root forming the sciatic nerve, which would replicate herniated disc pain
What part of an IV disc can be responsible for herniations? Where?
Nucleus pulposis can herniate posterolaterally (where anulus is thinner) and compress spinal nerve roots
The localized back pain of a herniated disc results from what?
Pressure on the longitudinal ligaments, periphery of anulus pulposis, and inflammation from chemical irritation from nucleus pulposis rupture
Chronic pain resulting from a herniated disc is likely of what origin?
Dermatomal (from the compressed spinal nerve root)
Where does most herniation occur?
L4-L5 or L5-S1
Sciatica is often caused by what?
Herniated lumbar IV disc or osteophytes that compress L5 or S1 component of sciatic nerve
In what region do symptom-inducing disc herniations occur almost as much as the lumbar region? What is compressed?
Cervical, compresses nerve exiting at that level
Rupture of an alar ligament of the atlas results in what?
A 30% increase in ROM to the opposite side
True or false: It has been shown that IV discs increase in size with age despite losing their turgor.
True; they become more convex and diameter increases between ages 20-70.
What causes osteophytes (bone spurs) to develop around the edges of the vertebral bodies?
Aging of IV discs combined with changing [increasingly concave] shape of vertebral bodies increase compressive forces on the peripheral part of the bodies, causing osteophytes
Obstructive arterial disease particularly affects what artery that supplies the spine?
Great segmental medullary artery
When a patient has their back flexed for a lumbar puncture, what ligament is stretched?
Ligament flava
1) What do radiographs of early to moderate osteoporosis show?
2) What about of advanced osteoporosis?
1) Demineralization (lower radiodensity of spongy bone of VBs, vertical striping b/c of loss of horizontal trabeculae)
2) Vertebral body collapse and increased thoracic kyphosis
What are the 5 categories of back pain causes?
1) Fibroskeletal structures
-like periosteum, ligaments, IV discs
2) Meninges
3) Synovial joints
4) Muscles
5) Nervous tissue
1) What are fibroskeletal structures and meninges of the spine innervated by?
2) What innervates the synovial joints and muscles of the back?
1) Recurrent (meningeal) branches of spinal nerves
2) Posterior rami (articular and muscular branches)
What are the 3 main causes of localized lower back pain?
Muscular, joint, or fibroskeletal
What is muscular lower back pain (LBP) usually caused by?
Reflexive cramping causing ischemia
Pain from vertebral fractures is often _____________ in nature, whereas pain from discs slipping is normally caused by ______________ (and disrupted posterolateral anullus fibrosis)
periosteal; ligaments
What minimizes blows to the calvaria?
Its convex nature
1) Hard blows to the head in thin areas are likely to cause what?
2) What are comminuted fractures?
3) What is the most frequent type of skull fracture? Describe.
4) What can happen if the calvaria is thick at point of impact?
1) Depressed fractures
2) Bone broken into several pieces
3) Linear calvarial fractures; fractures radiate away from point of impact in 2+ directions
4) Can bend inward without fracturing
1) What do basilar fractures involve? What can happen here?
2) Why can pterion fractures be life threatening?
1) Bones forming the cranial base (occipital around foramen magnum, temporal, or sphenoid); CSF can leak into nose or ear
2) Anterior branches of MMA are right below it, can cause epidural hematoma, which can put pressure on the cerebral cortex below it. Can kill within several hours
1) What is the dangerous part of the scalp?
2) How can things spread from this layer to the cranial cavity?
3) The epicranial aponeurosis is continuous with what?
4) What does the frontal belly of the occipitofrontals muscle insert into?
1) Loose connective tissue (below epicranial aponeurosis)
2) Emissary veins (pass through calvaria to meninges)
3) Temporal fascia attached to zygomatic arches
4) Skin
1) Why do facial lacerations tend to gape?
2) What does this property also enable?
1) Because the face doesn’t have a distinct layer of deep fascia and the SQ tissue is loose between facial muscle attachments
2) Fluid to collect/ facial swelling
What is trigeminal neuralgia (tic douloureux)? Why does it happen?
Sharp pains caused by touching the face; cause is unknown but could be due to a blood vessel compressing CNV’s sensory root
1) Anesthesiologists often use what pulse?
2) What is another pulse that can be palpated on the face?
1) Temporal artery pulse
2) Facial artery
1) When can the facial artery be occluded?
2) True or false: compression of the facial artery on one side stops all bleeding
3) What lacerations require pressure on both sides to stop bleeding?
1) B/c of pressure against the mandible where it crosses it
2) False, because it has so many anastomoses
3) Lip lacerations
