Spinal Injury Flashcards
What do C5 + C6 myotomes innervates
- C5 = Should abduction (deltoid)
- C6 = Elbow flexion/Wrist extensors (biceps)
What do C7 + C8 myotomes innervate
- C7 = Elbow extensors (triceps)
- C8 = Long finger flexors (FDS/FDP)
What does T1 myotome innervate
Finger abduction (interossei)
What do L2 + L3,4 myotomes innervate
- L2 = Hip flexion (iliopsoas)
- L3 + L4 = Knee extension (quadriceps)
What do L4 + L5 myotomes innervate
- L4 = Ankle dorsiflexion (tib ant.)
- L5 = Big toe extension (EHL)
What does S1 myotome innervate
Ankle plantar flexion (gastroc)
2 peaks of spinal injury by age
- 20-29 yrs
- 65+ yrs
3 most common causes of spinal injuries
- Fall (41.7%)
- RTA (36.8%)
- Sport (11.6%)
Describe a complete spinal injury
- No motor or sensory function distal to lesion
- No anal squeeze
- No sacral sensation
- ASIA grade A
- No chance of recovery
Describe an incomplete spinal injury
- Some function is present below site of injury
- More favourable prognosis overall
What scoring system is used assess spinal injury severity
-ASIA Classification
5 patterns of spinal injury
- Tetraplegia/Quadriplegia
- Paraplegia
- Central cord syndrome
- Anterior cord syndrome
- Brown-sequard syndrome
Symptoms of quadriplegia/tetraplegia
- Partial or total loss of use of all four limbs + trunk
- Loss of motor/sensory function cervical segments of the spinal cord
- Spasticity
Cause of quadriplegia/tetraplegia
- Results from cervical fracture
- Resp. failure due damage to phrenic nerve (C3-5)
- “C5 keeps you alive”
Describe paraplegia
- 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
3 partial cord syndromes
- Central cord syndrome
- Anterior cord syndrome
- Brown-sequard syndrome
Cause of central cord syndrome
- Older patients (arthritic neck)
- Hyperextension injury
- Centrally cervical tracts more involved
Symptoms of central cord syndrome
- Weakness of arms>legs
- Perianal sensation & lower extremity power preserved
Cause of anterior cord syndrome
- Hyperflexion injury
- Anterior compression fracture
- Damaged anterior spinal artery
Symptoms of anterior cord syndrome
- Fine touch + proprioception preserved
- Profound weakness
Cause of brown-sequard syndrome
- Hemi-section of the cord
- Penetrating injuries
Symptoms of brown-sequard syndrome
- Paralysis on affected side (corticospinal)
- Loss of proprioception + fine discrimination (dorsal columns)
- Pain + temperature loss on the opposite side below lesion (spinothalamic)
Management of SCIs
- Prevent a secondary insult
- Particularly in patients with incomplete injuries
Describe spinal shock
- Transient depression of cord function below level of injury
- Flaccid paralysis
- Areflexia
- Last several hours to days after injury
Describe neurogenic shock
- Hypotension
- Bradycardia
- Hypothermia
- Injuries above T6
- Secondary to disruption of sympathetic outflow
How to assess disability
- Assess neurological function
- Including PR + perianal sensation
Investigations for SCI
- X-rays
- CT (bony anatomy)
- MRI (if neuro deficit or children)
When to use surgical fixation on SCIs
Unstable fractures
Long term management of SCI
- SCI Unit (intermediate term)
- Physio + occ. therapy
- Psychological support
- Urological/sexual counselling
Are SCIs common or rare
Spinal fractures are common but SCIs are rare
How to prevent secondary injury
ABCD
How to assess injury severity
Testing myotomes + dermatomes
