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MSK CM > Spinal > Flashcards

Spinal Flashcards

1
Q

how many vertebrae

A

33

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2
Q

how many:

  • cervical
  • thoracid
  • lumbar
  • sacral/coccyx
A

7 cervical
12 thoracic
5 lumbar
9 sacral/coccyx

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3
Q

what is the natural curvature of the neck

A

cervical lordosis aka anterior curve

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4
Q

what is the natural curvature of thoracic spine

A

posterior curve aka thoracic kyphosis

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5
Q

natural curve of the lumbar

A

lumbar lordosis aka anterior curve

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6
Q

what is normal order of curvature from head to tailbone

A

Lordosis
Kyphosis
Lordosis

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7
Q

what bears 80% of load

A

anterior arch–>vertebral body/discs

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8
Q

whats in the anterior arch

A

vertebral bodies/discs

takes 80% of weight load

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9
Q

pedicle

A

nerve roots

-area b/w body and transverse processes

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10
Q

whats in the posterior arch

A

takes on 20% of weight

  • pedicle
  • transverse process
  • superior and inferior articular processes
  • lamina
  • vertebral foramen
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11
Q

what is lamina

A

thin, plate like area b/w spinous and transverse processes

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12
Q

what runs thru vertebral foramen

A

vasculature

spinal cord

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13
Q

radicular pain

A

pain + numbness + tingling

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14
Q

what can we use to figure out what spinal root nerve has a problem

A

dermatome

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15
Q

dermatome

A

cutaneous area supplied by a single spinal nerve root

**used to figure out which sensory deficit goes with which nerve root

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16
Q

C _ _ and _ keep the ___ alive

A

C 3, 4, 5, keeps the diaphgram alive

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17
Q

C5 dermatome

-what does nerve control

A

covers the outer part of the upper arm down to about the elbow
**deltoid

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18
Q

C6 dermatome

-what does nerve control

A

covers thumb side of the hand and forearm

**control the wrist extensors (muscles that control wrist extension) and also provides some innervation to the biceps

19
Q

C7 dermatome

-what does nerve control

A

goes down the back of the arm and into the middle finger

**control the triceps (the large muscle on the back of the arm that straightens the elbow) and wrist extensor muscles

20
Q

C8 dermatome

-what does nerve control

A

pinky side of the hand and forearm

**helps control the hands, such as finger flexion (handgrip)

21
Q

L3 dermatome

A

front part of the thigh and inner part of the leg

22
Q

L4 dermatome

A

parts of the thigh, knee, leg, and foot

23
Q

L5 dermatome

A

parts knee, leg, and foot

24
Q

S1 dermatome

A

posterolateral thigh and leg and the lateral foot

25
Q

S2 dermatome

A

strip of skin along the back of the thigh and the upper calf
***medial aspect

26
Q

spinal stenosis

  • what is it
  • MCC? other etiologies (4)
  • MC in who
  • s/s
  • what makes s/s worse, better
  • Diagnostic test of choice
  • management
A

*narrowing of the spinal canal with impingement of the nerve roots

MCC by:

  1. degenerative arthritis
  2. spondylolysis

Other etiologies:

  • post-surgical
  • congenital
  • traumatic
  • inflammatory

MC in:
*adults over 60

S/S

  1. back pain
  2. numbness + paresthesias–>rad to buttocks & thighs bilaterally

S/S WORSE W/:
*extension: prolonged standing, walking upright, walking downhill

S/S BETTER W:

  • flexion: sitting, leaning forward (over shopping cart), walking uphill, cycling
  • lumbar flexion increases canal volume*

TOC=MRI

Management: 
*Pain control 
*PT-->cycling, swimming 
*steroid injections 
*surgical= decompression 
laminectomy 
******surgery only for refractory or severe cases*****
27
Q

Ankylosing Spondylitis

  • what is it
  • what joints are affected
  • RFs (2)
  • S/S
  • labs
  • imaging–initial test? most accurate?
  • tx
A

Ankylosing=stiffness of joints due to FUSION of joints

  • *chronic inflammatory arthropathy of axial skeleton
  • **spine + sacro iliac joints + progressive spine stiffness

RF:

  1. HLA-B27 positivity
  2. young males 15-30 YO

S/S:

  1. back pain + stiffness + decr ROM–>worse in the am or rest
  2. Kyphosis, Sacroilitis ** and large joint arthritis
  3. Extrarticular: Achilles tendon enthesitis, dactylitis, **Uveitis,
  4. cardiac: AV blocks, aortic regurg,
  5. pulm: fibrosis, decr chest expansion

LABS:

  1. increased ESR
  2. negative rheumatoid factor
  3. negative ANA

IMAGING:

  1. XR of SI joints is initial test
    * *shows sacroiliitis (narrowing of the joint) –>early finding
  2. bamboo spine: straightening of the spine (loss of normal lumbar curvature) + squaring and fusion of the vertebrae–>later findings
  3. MRI= most accurate test

MANAGEMENT:

  • first line: NSAIDS + exercise + PT
  • second line: Anti-TNF drugs if no resp to NSAIDS
  • –>Etanercept
  • –> Adalimumab
  • –> Infliximab
28
Q

Herniated Disc aka Nucleus Pulposus

  • MC where
  • S/S: pain incrs with?
  • PE findings
  • Diagnosis: TOC imaging?
  • TX: first line, 2nd line or worsening,
A

MC L5-S1

S/S:

  • Radicular back pain
  • unilateral
  • rad down the leg w/ paresthesias or numbness in dermatomal pattern

-pain INCRS with: coughing, straining, bending, sitting, Valsavla

PE

  • (+) straight leg raise
  • next: figure out which disc is the problem

DIAGNOSIS:

  • MRI is TOC
  • XR: will see loss of disc height

TX:

  • first line=conservative
  • -> NSAIDs + continuation of ordinary activities as tolerated
  • **if bed rest, should be brief
  • PT
  • more severe: muscle relaxers or oral steroids

*Corticoid injections if conservative tx fails (aka pain does not improve at all in two weeks OR it gets worse)

  • surgical tx:
  • ->laminectomy & discectomy if persistent, disabling pain >6 weeks not responding to other tx
29
Q

where is the junction b/w the mobile and non-mobile spine

-MC spot for?

A

L5-S1

**MC spot for herniated disc

30
Q

explain straight leg raise test

(+) finding means?

A

raising leg–>positive pain after 30 degrees but before 70 degrees
dont ask if this hurts and raise leg*

**INSTEAD: ask them, tell me when the pain starts hurting as you move leg upwards

31
Q

straight leg test reveals:

-anterior thigh pain with sensory loss to the medial ankle–>weak ankle dorsiflexion + loss of knee jerk

A

-l4 disc herniation

32
Q

straight leg test reveals:

  • lateral thigh/leg and dorsum of foot pain
  • weak big toe extension
  • walking on heels more difficult than on toes
  • normal reflexes
A

L5 disc herniation

33
Q

straight leg test reveals:

  • posterior leg/calf and plantar surface of foot
  • weak plantar flexion=walking on the toes is more difficult than on heels
  • loss of ankle jerk
A

S1 disc herniation

34
Q

compression fx

  • aka
  • occur?
  • s/s
  • diagnosis
A

burst fx
*occur: from jumping/falling from a great height, also can occur in elderly or bc of CA—- called pathologic lumbar compression fxs

S/S
*localized back pain with focal midline tenderness at level of fx

Diagnosis

  • xrays: loss of vertebral height
  • MRI or CT is neuro s/s

TX

  1. orthopedic & neurosurgery consult to determine appropriate workup and management
  2. conservative: observation, analgesics, bracing with gradual return to activity
  3. surgical: kyphoplasty may be used if s/s are severe or persistent
35
Q

Spondylolysis

  • define
  • due to?
  • MC where
  • MOA
  • CM
  • MC in who
A

Pars interarticularis defect due to failure of fusion or stress fx

  • MC at L5-S1
  • MOA: repetitive hyperextension trauma (football players, gymnasts, weight lifters

CM

  • most cases asymptomatic
  • low back pain with activity—-MC in kids and adolescents

DIAGNOSIS

  • xray: lateral views: radioluscent defect in pars
  • CT scan
  • bone scan

TX
1. low-grade or asympto: observation, no activity or restriction

  1. Sympto: PT and activity restriction in some PTs
  2. Bracing may be helpful for acute pars stress reaction or failed PT
36
Q

Spondylolisthesis

  • what is it
  • MOA… MC? other causes
  • CM.. MC?
  • diagnosis
A
  • Forward slipping of a vertebra on another–>bilateral fracture or defect of the pars interarticularis
  • MOA: usually a complication of spondylolysis
  • other causes: trauma, malignancy, congenital anomilies

CM

  • most are asympto
  • lower back pain MC symptom
  • nerve compression: sciatica, bowel or bladder dysfunction and neurologic deficits if severe

DIAGNOSIS:

  • xray: forward slipping of a vertebra. LATERAL views: used to measure slip angle and grade
  • MRI: if neuro s/s present

TX

  1. mild: tx like spondylolysis–PT, activity restrction in some cases
  2. severe: cases may need surgical intervention
37
Q

spondylolysis vs spondylolisthesis

A

spondylolysis–>defect of pars interarticularis from stress fx or failure to fuse—scottie dog sign–lumbar oblique projection–mc L5-S1

spondylolisthesis—>forward slipping of the vertebrae on another + bilateral fx or defect of pars interarticularis

38
Q

Cauda Equina Syndrome

  • define
  • where does SC end
  • where does cauda equina start and end
  • role of cauda equina
  • MCC and other causes
  • CM
  • diagnosis—toc
  • tx
A
  • mix of s/s that occur bc of spinal nerve compression in lumbosacral region
  • SC ends at L1 ad L2–>cauda equina aka horses tail starts BELOW and goes from L2-S5
  • cauda equina carries motor and sensory nerves and innervates bladder

MCC=lumbar disc herniation
Other causes: spinal inj, tumor, trauma, epidural abscess, epidural hematoma, vertebral fx

EMERGENCY— call ortho/surgery/neuro IMMEDiATELY **

CM

  • back pain PLUS any ONE of the following:
    1. radiculopathy: BILAT leg radiation of pain, weakness in multiple root distributions (L3-S1)
    2. Involvement of S2-S4 spinal nerve roots: SADDLE ANESTHESIA–>decr sensation to buttocks, perineum and inner surfaces of the thigh—-ED too!
    3. New onset urinary or bowel retention OR incontinence
    4. Decr anal sphincter tone on PE

DIAG

  • MRI toc
  • if MRI contra (ex pt has pacemaker)—CT

TX—CALL ORTHO/SURGERY/NEURO ASAP

  1. emergent decompression
  2. Corticosteroids to reduce infalmm
39
Q

anterior thigh pain; weak ankle dorsiflexion; loss of knee jerk

A

L4 herniation

40
Q

s/s for L4 herniation

A
  • anterior thigh pain
  • weak ankle dorsiflexion
  • loss of knee jerk
41
Q

lateral thigh/leg and dorsum of foot pain; weak big toe extension. Walking on heels more difficult than on toes. Reflexes normal

A

L5 disc herniation

42
Q

s/s for L5 disc hern

A
  • lateral thigh/leg and dorsum of foot pain
  • weak big toe extension
  • walking on heels more diff than toes
  • reflexes normal
43
Q

posterior leg/calf and plantar surface of foot; weak plantar flexion = walking on the toes is more difficult than on heels. Loss of ankle jerk

A

s/s of S1 disc hern

44
Q

s/s of S1 disc hern

A
  • posterior leg/calf and plantar surface of foot pain
  • weak plantar flexion
  • walking on the toes is more diff than heels
  • loss of ankle jerk

MSK CM (12 decks)

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