Spinal Cord and Root Dysfunction Flashcards
If there is a problem at the cervical level of the spinal cord, what is involved?
ARMS
-UMN if central
If there is a problem at the thoracic level of the spinal cord, what is involved?
Arms are not involved/minimally involved
-UMN if central
If there is a problem at the lumbar level of the spinal cord, what is involved?
LEGS
- NO UMN involvement
What is the ‘ASIA’ chart?
Describes a persons functional impairment as a result of their spinal cord damage
What kind of pain would be experience in a cervical disc prolapse?
Arm pain
Neck pain
Thoracic disc prolapses are common
FALSE - they are rare
What kind of pain would you get if you had a thoracic disc prolapse?
Thoracic
Describe a thoracic disc prolapse.
Usually central and causing a myelopathy
What kind of pain would someone with a lumbar disc prolapse experience?
Leg pain
Spinal claudication is usually intermittent
TRUE
When is spinal claudication worse?
On mobilising
When is spinal claudication better?
At ease or when bending forward
Where can pain from spinal claudication often be?
At the back of the thighs and calves
There is no altered sensation in spinal claudication
FALSE
What is spinal claudication?
A common symptom of lumbar spinal stenosis (LSS), causing impingement or inflammation of the nerves emanating from the spinal cord
Claudication can be?
Spinal or Vascular
Cauda equina should always be treated as an ________
EMERGENCY
What is critical in cauda equina syndrome?
TIME
What is the principle concern in cauda equina?
Urinary function
Describe the leg pain in cauda equina.
Usually bilateral
Describe the sensory loss in cauda equina.
Perianal sensory loss to a pin prick
At what spinal cord level does cauda equina syndrome usually occur?
S2-S4
What level of the spinal cord is cauda equina?
T12-L1
What can cauda equina syndrome be defined as?
Painless urinary retention with urinary incontinence (overflow)
What may men get with cauda equna?
Erectile dysfunction :(
List all the RED FLAGS of spinal cord dysfunction.
Bilateral leg pain Thoracic back pain Weight loss, night sweats, fever Night pain Sphincter disturbance Perianal sensory loss Age <20 or >55 History of carcinoma Progressive neurological deficit Trauma Immunocompromise
What is the colloquial phrase used to describe cervical myelopathy?
‘Numb, clumsy, hands’
Cervical myelopathy is usually BILATERAL
TRUE - but one side may be more affected than the other
Where do people with cervical myelopathy get paraesthesia?
Finger-tips
What do people with cervical myelopathy have problems with?
Fine motor tasks
What tests should be done in someone with suspected cervical myelopathy?
Hoffman’s and Lhermitte’s sign
What are the risk factors for failed back syndrome?
- BMI
- Diabetes
- Smoking
What is failed back syndrome?
Chronic pain following back surgeries with recurrent and residual compression of the spinal cord
- nerve injury
What 4 things can a patient get as a result of failed back syndrome?
- Infection
- Fibrosis
- Arachnoiditis
- Depression, anxiety
What is syrinx?
A fluid filled cavity within the spinal cord
Neck and back pain is often __________
DEGENERATIVE
There is lots of benefits of surgery for people with neck/back pain
FALSE
How should a patient with neck/back pain be managed?
Conservative - physio, analgesia
What is tone like in an UMN problem?
Increased
What is tone like in a LMN problem?
Decreased
Is there atrophy in an UMN problem?
No - there may be some late on
Is there atrophy in a LMN problem?
Yes - early
Are there fasciculations in an UMN problem?
NO
Are there fasciculations in a LMN problem?
YES
What is a fasciculation?
A brief spontaneous contraction affecting a small number of muscle fibres, often causing a flicker of movement under the ski
Describe reflexes in an UMN problem.
Brisk
Describe reflexes in a LMN problem.
Decreased/absent
Describe plantars in UMN problems.
Up-going
Describe plantars in a LMN problem.
Down-going
Describe clonus in UMN problems.
Present
Describe clonus in LMN problems.
Absent
What is clonus?
Muscular spasm involving repeated, often rhythmic, contractions.