Spinal Injury Flashcards

1
Q

What do C5 + C6 myotomes innervates

A
  • C5 = Should abduction (deltoid)

- C6 = Elbow flexion/Wrist extensors (biceps)

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2
Q

What do C7 + C8 myotomes innervate

A
  • C7 = Elbow extensors (triceps)

- C8 = Long finger flexors (FDS/FDP)

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3
Q

What does T1 myotome innervate

A

Finger abduction (interossei)

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4
Q

What do L2 + L3,4 myotomes innervate

A
  • L2 = Hip flexion (iliopsoas)

- L3 + L4 = Knee extension (quadriceps)

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5
Q

What do L4 + L5 myotomes innervate

A
  • L4 = Ankle dorsiflexion (tib ant.)

- L5 = Big toe extension (EHL)

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6
Q

What does S1 myotome innervate

A

Ankle plantar flexion (gastroc)

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7
Q

2 peaks of spinal injury by age

A
  • 20-29 yrs

- 65+ yrs

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8
Q

3 most common causes of spinal injuries

A
  • Fall (41.7%)
  • RTA (36.8%)
  • Sport (11.6%)
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9
Q

Describe a complete spinal injury

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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10
Q

Describe an incomplete spinal injury

A
  • Some function is present below site of injury

- More favourable prognosis overall

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11
Q

What scoring system is used assess spinal injury severity

A

-ASIA Classification

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12
Q

5 patterns of spinal injury

A
  • Tetraplegia/Quadriplegia
  • Paraplegia
  • Central cord syndrome
  • Anterior cord syndrome
  • Brown-sequard syndrome
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13
Q

Symptoms of quadriplegia/tetraplegia

A
  • Partial or total loss of use of all four limbs + trunk
  • Loss of motor/sensory function cervical segments of the spinal cord
  • Spasticity
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14
Q

Cause of quadriplegia/tetraplegia

A
  • Results from cervical fracture
  • Resp. failure due damage to phrenic nerve (C3-5)
  • “C5 keeps you alive”
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15
Q

Describe paraplegia

A
  • Partial or total loss of use of 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
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16
Q

3 partial cord syndromes

A
  • Central cord syndrome
  • Anterior cord syndrome
  • Brown-sequard syndrome
17
Q

Cause of central cord syndrome

A
  • Older patients (arthritic neck)
  • Hyperextension injury
  • Centrally cervical tracts more involved
18
Q

Symptoms of central cord syndrome

A
  • Weakness of arms>legs

- Perianal sensation & lower extremity power preserved

19
Q

Cause of anterior cord syndrome

A
  • Hyperflexion injury
  • Anterior compression fracture
  • Damaged anterior spinal artery
20
Q

Symptoms of anterior cord syndrome

A
  • Fine touch + proprioception preserved

- Profound weakness

21
Q

Cause of brown-sequard syndrome

A
  • Hemi-section of the cord

- Penetrating injuries

22
Q

Symptoms of brown-sequard syndrome

A
  • Paralysis on affected side (corticospinal)
  • Loss of proprioception + fine discrimination (dorsal columns)
  • Pain + temperature loss on the opposite side below lesion (spinothalamic)
23
Q

Management of SCIs

A
  • Prevent a secondary insult

- Particularly in patients with incomplete injuries

24
Q

Describe spinal shock

A
  • Transient depression of cord function below level of injury
  • Flaccid paralysis
  • Areflexia
  • Last several hours to days after injury
25
Describe neurogenic shock
- Hypotension - Bradycardia - Hypothermia - Injuries above T6 - Secondary to disruption of sympathetic outflow
26
How to assess disability
- Assess neurological function | - Including PR + perianal sensation
27
Investigations for SCI
- X-rays - CT (bony anatomy) - MRI (if neuro deficit or children)
28
When to use surgical fixation on SCIs
Unstable fractures
29
Long term management of SCI
- SCI Unit (intermediate term) - Physio + occ. therapy - Psychological support - Urological/sexual counselling
30
Are SCIs common or rare
Spinal fractures are common but SCIs are rare
31
How to prevent secondary injury
ABCD
32
How to assess injury severity
Testing myotomes + dermatomes