Spinal Fractures Flashcards
What type of curve is in the cervical spine?
Lordosis
What type of curve is in the thoracic spine?
Kyphosis
What type of curve is in the lumbar spine?
Lordosis
Define a dermatome
Area of skin that is mainly supplied by a single spinal nerve
Define a myotome
Group of muscles that a single spinal nerve innervates
Shoulder abduction is what myotome?
C5
Elbow flexion/ wris exxtension is what myotome
C6
Elbow extension is via what myotome?
C7
Long finger flexion is via which myotome
C8
Finger abduction is via which myotome
T1
Hip flexion is via which myotome
L2
Knee extension is via which myotome?
L3, L4
Ankle dorsiflexion is via which myotome?
L4
Big toe extension is via which myotome?
L5
Ankle plantar flexion is via which myotome?
S1
Tenderness on spine common causes
Spinal fracture,
Infection of spine,
Malignancy of spine
Common lumbar abnormality gaits
Antalgic gait,
Foot drop gait
When someone is walking on their tip toes what myotome are they using?
S1
What myotome(s) are being used if someone is walking on their heels?
L4, L5
what is a characteristic cervical spine gait?
No proprioception so will look at feet, shuffle, take broad base, short steps
What is a +ve straight leg raise
Shooting pain in L5, S1
What is a +ve femoral stretch test?
Pain in L3, L4
What percentage of people with a fracture/ dislocation will have a spinal cord injury?
15%
Common causes of spinal cord injury?
Fall, RTC, Sport, Trauma, Knocked over, Sharp trauma
Complete spinal cord injury
No motor or sensory function distal to lesion, No anal squeeze, No sacral sensation, ASIA Grade A, No chance of recovery
Incomplete spinal cord injury?
Some function is present below site of injury,
More favourable prognosis
Can you determine if a spinal cord injury is complete or incomplete initially?
No as patient may be in spinal shock
ASIA classification A?
Complete,
No sensory or motor function preserved in sacral segments S4-S5
ASIA classification B?
Incomplete,
Sensory preserved below the neurological level and extending through sacral segments S4-S5,
No motor
ASIA classification C?
Incomplete,
Motor function below neurological level,
Key muscles have a grade <3
ASIA classification D
Incomplete,
Motor below neurological level,
Key muscle have a grade >3
ASIA classification E?
Normal motor and sensory function
Types of patterns of injury?
Tetraplegia, Paraplegia, Central cord syndrome, Anterior cord syndrome, Brown-Sequard Syndrome
Define tetraplegia
Partial/total loss of use of four limbs and trunk,
Loss of motor/sensory function in cervical segments of the spinal cord
Define paraplegia?
Partial/total loss of use of lower-limbs,
Impairment/ loss of motor/ sensory function in thoracic, lumbar or sacral segments of the spinal cord
When is central cord syndrome commonly seen?
In older patients with arthritic neck,
In an hyperextension injury
Presentation of central cord syndrome?
Weakness of arms > legs,
Perianal sensation and lower extremity power preserved
Partial cord syndrome caused by hyperextension?
Central cord syndrome
Partial cord syndrome caused by hyper flexion?
Anterior cord syndrome
Common cause of anterior cord syndrome
Anterior compression fracture,
Damaged anterior spinal artery
Presentation of anterior cord syndrome?
Profound weakness,
Fine touch and proprioception preserved
What partial cord syndrome is caused by hemi-section of the cord?
Brown-sequard Syndrome
Common cause of Brown-Sequard syndrome?
Penetrating injuries
Presentation of Brown-Sequard syndrome
Paralysis of affected side,
Loss of proprioception and discrimination,
Pain and temperature loss on opposite side below lesion
Management of spinal cord injury?
ABCD,
ATLS (advanced trauma life support)
Signs of neurogenic shock?
Low BP and HR, Loss of sympathetic tone, Vasopressors, Hypothermia, Injury above T6
Signs of spinal shock
Transient depression of cord function below level of injury,
Flaccid paralysis,
Areflexia,
Lasts several hours to days
Surgical fixation of spinal cord injury
Majority fixed posteriorly via pedicle screws
Long-term management of spinal cord injury?
Spinal cord injury unit, Physiotherapy, OT, Psychological support, Urological/ sexual counselling