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REHAB > Spinal cord injury > Flashcards

Spinal cord injury Flashcards

1
Q

Injury to lumbar annual incidence %

A

5-10

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2
Q

Red Flags
Clinical Presentation:
Gait Ataxia/ upper motor neuron changes

A

Myelopathy

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3
Q

Red Flags
Clinical Presentation:
Bowel/ bladder/sexual dysfunction

A

Cauda equina syndrome

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4
Q

Red Flags
Clinical Presentation:
Night pain/ weight

A

Tumor

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5
Q

Red Flags
Clinical Presentation:
Fever/ chills

A

Infection ( TB of spine)

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6
Q

3 General types of cervical disk disorder

A

Herniated Nucleus Pulposus
Internal Disc Disruption
Degenerative Disc Disruption

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7
Q

Nucleus Pulposus

A

Type II collagen
Inside
Braces annulus

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8
Q

Annulus fibrosus

A

Type I collagen

Arranged obliquely

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9
Q

Degenerative Disc Disease
Aging effects
DECREASES

A

Proteoglycan molecular weight
Ratio of chondroitin-keratin
Nuclear water content

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10
Q

Degenerative Disc Disease
Aging effects
INCREASED

A

Cartilage cells
Amorphous tissue
Fibrous tissue

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11
Q

Degenerative Cascade (3)

A

Dysfunction
Instability
Stabilization

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12
Q

Result of repetitive trauma.
Z-joints undergo minor capsular tears, cartilage degeneration and synovitis causing abnormal motion.
Hypomobility

A

Dysfunction

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13
Q

Due to scar formation
Each successive injury caused incomplete healing of Z joint capsules and annular fibers
Hypermobility

A

Instability

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14
Q

Progression leads to z joint articular cartilage destruction , internal FIBROSIS, hypertrophy
Hypomobility

A

Stabilization

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15
Q

Are new bone formation that outpouch from the spine

A

Osteophyte

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16
Q

Are osteophytes that tries to breach the gap with next segment above the osteophyte

A

Syndesmophyte

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17
Q

HNP
No annulus defect.
Disc convexity is beyond vertebral margins

A

Bulging disc

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18
Q

HNP

Nuclear material protrudes into an annulus defect

A

Prolapsed disc

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19
Q

Nuclear material extends to the posterior longitudinal ligament

A

Extruded disc

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20
Q

Nuclear fragment free in the canal

A

Sequestered disc

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21
Q

HNP location
Mag or may nit have radicular symptoms
Possible multiroot involvement if affecting the cauda equina, or myelopathy if involving the spinal cord

A

Central

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22
Q

HNP location

More common in the lumbar spine due to tapering presentation of the PLL

A

Posterolateral

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23
Q

May or may not have low back pain

Possibly affects the exiting root of that level

A

Far lateral/ foramina

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24
Q

ROOT: C5
REFERRED PAIN:
PARESTHESIA:
WEAKNESS:

A

ROOT: C5
REFERRED PAIN: Shoulder and upper arm
PARESTHESIA: lateral side of arm, antecubital fossa
WEAKNESS: biceps

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25
Q

ROOT: C6
REFERRED PAIN:
PARESTHESIA:
WEAKNESS:

A

ROOT:
REFERRED PAIN: radial aspect of forearm
PARESTHESIA: thumb
WEAKNESS: biceps, brachioradialis

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26
Q

ROOT: C7
REFERRED PAIN:
PARESTHESIA:
WEAKNESS:

A

ROOT:
REFERRED PAIN: dorsal aspect of forearm
PARESTHESIA: index and middle fingers
WEAKNESS: triceps, pronator

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27
Q

ROOT: C8
REFERRED PAIN:
PARESTHESIA:
WEAKNESS:

A

ROOT:
REFERRED PAIN: ulnar aspect of forearm
PARESTHESIA: index and middle fingers
WEAKNESS: triceps, finger flexor

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28
Q

To centralize extremity pain, these are extension biased programs used for posterior lateral HNP

A

Mckenzie Program

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29
Q

Flexion biased

For far lateral HNP

A

Williams

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30
Q

Degradation of the intern architecture of the disc without gross herniation

A

Internal disc disruption

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31
Q

Internal disc disruption grading

A

0- no annular disruption
1- inner 1/3 annular disruption
2- inner 2/3 annular disruption
3- outer 1/3 annular disruption +/- circumferential spreading

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32
Q

Degenerative changes to the spine resulting in disc narrowing, vertebral body, osteophytosis, and joint arthropathy

A

Spinal stenosis

Causes entrapment of the nerve leading to weakness and sensory loss

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33
Q

Decreased size of the vertebral canal secondary to hypertrophic facets, hypertrophic ligamentum flavun, disc encroachment or degenerative spondylolisthesis

A

Central stenosis

34
Q

The spinal cord is approx

A

10mm

35
Q

Spinal canal is

Length

A

17mm

36
Q

Relative stenosis

Length

A

12mm

Normal:17mm

37
Q

Absolute stenosis (length)

A

10mm

Normal:17 mm

38
Q

Tendons and muscles of other soft tissues
Nerve and nerve roots
Small and conplex joints

A

Low back pain

39
Q

Up to % of adult experience back pain at some point in life

A

> 80%
5th leading cause of medical office visits
Most common work related disability

40
Q

Most common cause of low back pain

A

Mechanical 80-90% -disc generation , fractured vertebrae, instability, unknown cause

Neurogenic 5-15% - herniated disc, spinal stenosis, osteophytes damage to the nerve root
Non- mechanical 1-2% -neoplasm, infection, inflammatory arthritis, paget
Referred visceral pain 1-2%- GI dse, kidney dse
Other 2-4%- fibromyalgia, faking pain

41
Q

Neuropathic component of low back pain causes:

A

Mechanical neuropathic nerve root pain
Local neuropathic pain
Inflammatory mediators

42
Q

Blocks the calcium channel which inhibit the transmission of C fibers pain to the cns

A

Transcutaneous electrical berve stimulation

43
Q

A vertebral defect most commonly seen in children and adolescents at the L5 vertebral level

A

Spindylosus

44
Q

Localized back pain exacerbated by motion( hyperextension), standing, lying prone and relieved with flexion

A

Spondylosis

45
Q

Collar on the scotty dog

A

Spondylosis

46
Q

A forward( anterolisthesis) or backward (retristhesis) slippage of one vertebral body on another

A

Spondylolisthesis

47
Q

Spondylolisthesis Etiology Class 1

A 
1- Dysplastic ( congenital) 
2 Isthmic ( MOST COMMON) 5-50
3 degenerative ( elderly)
4 traumatic (young) 
5 pathological ( any) 
6 postsurgical ( adult)
48
Q

Spondylolisthesis etiology

Criteria

A

1- Dysplastic ( congenital)
Congenital anormality lumosacral z joint
2 Isthmic ( MOST COMMON) 5-50
Pars intercularis fracture at l5-s1( subtype A)
Elingation (subtype b)
3 degenerative ( elderly)
Facet arthrosis causing subluxation ( common in l4-l5)
4 traumatic (young)
Acute fracture other than pars
5 pathological
Gen dse, CA, infxn, metabolic disorder
6. Postsurgical ( adult)
Excessive resection of neural arches

49
Q

Used if increased pain occurs despite decreased activity or in an increased slippage is suspected

A

TLSO ( spinal brace)

50
Q

An adolescent disorder of the vertebral end plates and apophysis resulting in an increased thoracic kyphosis ( involves 3 segmental vertebra)

A

Scheurmann’s disease ( epiphysitis)

51
Q

Etiology of scheurmann’s disease (3)

A

Anterior wedging of the vertebral bodies
Fixed thoracolumbar kyphosis
Intervertebral disc herniation

52
Q

Herniation of disc material thru vertebral endplate into the spongiosa of the vertebral body

A

Schmorl’s nodes

Seen in scheurmann’s dse

53
Q

Typically assoc with osteoporosis

Commonly seen in thoracolumbar junction

A

Compression fracture

54
Q

Dennis 3 column criteria

ANTERIOR

A

Stable
Anterior longitudinal ligament
Anterior 2/3 of the vertebral body and annulus fibrosis

55
Q

Dennis 3 column theory

MIDDLE

A

Unstable
Posterior longitudinal ligament
Posterior 1/3 of the vertebral body and annulus fibrosis

56
Q

Dennis 3 column theory

POSTERIOR

A

Stable
Ligmanetum flavum, supraspinous and infraspinous ligament
Post. Elements: pedicles, facets, spinous process

57
Q

Sudden onset of constant thoracolumbar pain.

Exacerbated with valsalva maneuvers, turning in bed, coughing, or incidental such as stepping off a curb

A

Compression fracture

58
Q 
Etiology: 
Hyper/hypomobile joint patterns
Repetitive overloads 
Trauma
Capsular tears/ injury
A

Sacroiliac joint dysfunction

59
Q

Acute or gradual back, buttock, leg or groin pain with tenderness over the joint

If ask for flexion, abduction, external rotation- there will be pain in the groin, px cant achieve these positions

A

Sacroiliac joint dysfunction

60
Q

Pain reproduction with FLEXION, ABDUCTION, and EXTERNAL ROTATION of the hip joint, ipsilateral pain occurs in the degenerative hip
Contralateral pain in the dysfunctional S1 joint

A

Patrick’s (faber) test

61
Q

Sacroiliac joint pain is reproduced with dropping the involved leg off the table while the contralateral hip is held in flexion

A

Gaenslen’s test

62
Q

SI joint pain with downward force placed on the iliac crest

A

Iliac compression test

63
Q

SI joint pain with hip extension and ilium rotation

A

Yeoman’s test

64
Q

Monitor PSIS motion when the px raises the leg to 90 deg. The PSIS on raised leg should rotate down. Restriction of this motion is considered abnormal

A

Gillet test

65
Q

Monitor the PSIS of the seated px as they bend forward. Asymmetric cephalad motion of the PSIS indicated a sacroiliac dysfunction.

A

Sealed flexion

66
Q

A general spinal deformity characterized by lateral curvatures and vertebral rotation

A

Scoliosis

67
Q

Test for scoliosis

Ask the px to bend forward, you can see asymmetry because of vertebral rotation

A

Adam’s test

68
Q

When you do x ray and do bending views, if there is no decrease in the curvature of the spine. May not reduce curvature with surgery or bracing

A

Fixed structural scoliosis

69
Q

Reducible, can still manage the lx with surgery or bracing

Scoliosis

A

Reducible functional curve

70
Q

An angle formed by the perpendicular lines drawn from the end plates pf the most tilted proximal and distal vertebrae to measure scoliotic curve

A

Cobb angle

71
Q

Cobb angle Grade

Pedicle in full view no rotation

A

A

72
Q

Cobb angle Grade

Pedicle disappearing

A

B

73
Q

Cobb angle Grade

Pedicle disappears

A

C

74
Q

Cobb angle Grade
Pedicle disappears
Contralateral pedicle move to midline

A

D

75
Q

Cobb angle Grade
Complete pedicle rotation.
Contralateral pedicle moves beyond midline

A

E grade ++++

76
Q

Degree of angulation required for treatment

Observation
Bracing
Surgery

A

<20
20-40
>45 (<35 neuromuscular disease)

77
Q

Curve of ______ - it is a must to request pulmonary function test

A

<40

78
Q

Brace that encompassed the chin and occiput

A

Milwaukee brace

79
Q

3 forces in milwaukee brace

A

Postero-anterior force
Antero- posterior
Upward force

80
Q

Brace without chin piece

Below PA

A

Yamamoto brace

REHAB (3 decks)

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