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MSK > Spinal cord injury > Flashcards

Spinal cord injury Flashcards

1
Q

What are the three main types of vertebrae?

A
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2
Q

What is the role of the spinous process and transverse process?

A

Allow muscles and ligaments to attach

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3
Q

Which section of the spine will wear out first?

A

The Lordosis section will wear out the fastest because they carry out the most movement

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4
Q

When there is pressure on the spinal cord what sensation will be lost first?

A

Proprioproception

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5
Q

Which areas of spine allow for most flexion and extension?

A

Cervical and lumbar

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6
Q

Why is there limited extension/flexion in the thoracic spine?

A

Ribs stop flexion and extension in the thoracic spine

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7
Q

Label this axial MRI

A
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8
Q

At what level does the spinal cord usually end?

A

L1/2

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9
Q

What are the dermatomes of the arm?

A
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10
Q

What are the dermatomes of the leg?

A
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11
Q

What are the myotomes of the upper limb?

A
  • C5 - Shoulder abduction (deltoid)
  • C 6 - Elbow flexion/ Wrist extensors (biceps)
  • C 7 - Elbow extensors (triceps)
  • C 8 - Long finger flexors (FDS/FDP)
  • T 1 - Finger abduction (interossei)
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12
Q

What are the myotomes of the lower limb?

A
  • L2 - Hip flexion (iliopsoas)
  • L3,4 - Knee extension (quadriceps)
  • L4 - Ankle dorsiflexion (tib ant)
  • L5 - Big toe extension (EHL)
  • S1 - Ankle plantar flexion (gastroc)
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13
Q

What is the rhyme to rmb myotomes?

A

1,2 buckle my shoe

3,4 kick the door

5,6 pick up sticks

7,8 shut the gate

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14
Q

What is the relationship between spinal cord injury (SCI) and fracture?

A
  • 15% of people with a fracture/dislocation will have SCI
  • Majority of people with SCI will have an accompanying column injury
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15
Q

What classes as a complete SCI?

A
  • no motor or sensory function distal to lesion
  • no anal squeeze
  • no sacral sensation
  • ASIA Grade A
  • no chance of recovery
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16
Q

What classes as an incomplete SCI?

A
  • Some function is present below site of injury
  • More favorable prognosis overall
17
Q

What is tetraplegia?

A
  • AKA Quadriplegia
  • Partial or total loss of use of all four limbs and the trunk
  • Loss of motor/sensory function in cervical segments of the spinal cord
18
Q

What is paraplegia?

A
  • Partial or total loss of use of the lower-limbs
  • Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord
  • Arm function spared
  • Possible impairment of function in trunk
19
Q

What are some partial cord syndromes?

A
  • Central cord syndrome
  • Anterior cord syndrome
  • Brown-sequard syndrome
20
Q

How is a central cord injury caused and what are the SSx?

A
  • Hyperextension injury
  • Weakness of arms and legs
  • Perianal sensation & lower extremity power persevered
  • Common in very old
21
Q

How is an anterior cord injury caused and what are the SSx?

A
  • Hyperflexion injury
  • Anterior compression fracture
  • Damaged anterior spinal artery
  • Fine touch and proprioception preserved
  • Profound weakness
22
Q

What is Brown-sequard syndrome and what are the SSx?

A
  • Hemi-section of the cord
  • Penetrating injuries
  • Paralysis on affected side (corticospinal)
  • Loss of proprioception and fine discrimination (dorsal columns)
  • Pain and temperature loss on the opposite side below the lesion (spinothalamic)
23
Q

What is the main management of someone with a SCI?

A
  • To prevent secondary insult
24
Q

What is spinal shock?

A
  • Transient depression of cord function below level of injury
  • Flaccid paralysis
  • Areflexia
  • Last several hours to days after injury
25
Q

When is surgical fixation required? And preferred technique?

A
  • Unstable fractures
  • Vast majority are fixed from posterior
  • Pedicle screws are preferred method
26
Q

CASE 1

  • 56 year old lady
  • Neck pain
  • 6 months of worsening numbness in the hand
  • Difficulty doing buttons
  • Wide based gait

What would you do initially?

What could be the diagnosis?

A
  1. History and examination (+ imaging)
  2. Cervical myelopathy
27
Q

CASE 2

  • A 70 year old man presents with a “tired feeling” in both thighs which is precipitated by walking and relieved by rest.
  • He has a long history of backache

What are the main differentials?

How could you tell between the two?

A
  1. Spinal Stenosis, vascular disease
  2. Pulses/examination/history/smoking/diabetic/high BP
28
Q

CASE 3

  • A 70 year old lady presents with severe, worsening thoracic and lumbar back pain over several moths.
  • No history of trauma, pain worse on standing but still present when lying in bed at night.
  • History of weight

What are important differentials to include?

A
  1. Infection (Discitis)
  2. Tumour (metastatic)

MSK (33 decks)

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