Spinal injury (part of spinal symposium) Flashcards

1
Q

Which myotomes supply which arm muscles?

A

Shoulder Abduction - Deltoid - C5

Elbow flexion & Wrist extension = C6

Elbow extension = C7

Finger flexion (FDS/P) = C8

Finger Abduction (interossei) = T1

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2
Q

Which myotomes supply the lower limbs?

A

Hip flexion - Iliopsoas - L2

Knee Extension - Quads - L3/4

Ankle Dorsiflexion - Tib Ant - L4

Hallucis Extension - EHL - L5

Ankle Plantar Flexion - Gastroc - S1

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3
Q

Peak demographic for a spinal cord injury?

A

Males 20-29yrs

Majority caused by falls or RTAs

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4
Q

How do we grade spinal injuries?

A

ASIA grading A–>E

A = complate (no sensory/motor function preserved)

B-D = Incomplete

E = Normal function

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5
Q

Define Quadraplegia and how it happens?

A

Partial/total loss of use of all 4 limbs & trunk

Due to damage in cervical cord (Phrenic keeps you alive)

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6
Q

Define Paraplegia?

A

Partial/total loss of use of lower limbs +/- bladder/bowel

Thoracic/lumbar/sacral injury

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7
Q

What type of injury is likely to occur in an elderly patient who falls and hyperextends their neck?

A

A central Cord Syndrome

Damage to the central cervical tracts in older people with arthritic necks who hyperextend, typically when falling

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8
Q

How does a central cord syndrome look?

A

Weakness greater in arm than legs

Perianal sensation & lower limb power largely preserved

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9
Q

What happens in anterior cord syndrome?

A

You daage everything but the dorsal columns –> Profound weakness but retaining fine touch and proprioception

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10
Q

How could an anterior cord syndrome be caused?

A
  • Hyperflexion
  • Ant Compression fracture
  • Ant Spinal artery damage
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11
Q

What is brown-sequard syndrome?

A

Hemi-section of the cord due to a penetrating injury

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12
Q

How does brown-sequard syndrome present?

A
Ipsilateral Paralysis (CST damage)
Ipsilateral loss of proprioception & fine touch (dorsal columns)
Contralateral loss of pain & temp (STT)
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13
Q

When are you likely to see brown-sequard syndrome?

A

Let’s just say if you do ever see it make sure to check the sky for flying pigs

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14
Q

How do you manage an acute Spinal cord injury?

A

ABCD incl:

  • C-spine control
  • Ventilation & O2
  • Fluids
  • Vasopressors for neurogenic shock
  • Log rolling
  • Assess neuro function incl. PR & perinanal sensation
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15
Q

How can you spot neurogenic shock (not spinal shock) in a SCI?

A

Following injury above T6 - if patient develops hypothermia, bradycardia and hypotension (due to symp outflow damage)

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16
Q

How can you differentiate spinal shock from the actual SCI?

A

Spinal shock is:

  • Transient (hrs to days)
  • Flaccid paralysis (vs spastic)
  • Areflexia (vs hyperreflexic)
17
Q

What’s the preferred method for fixing a spinal injury?

A

If it’s an unstable fracture –> Pedicle screw

18
Q

What can we provide long term for a SCI patient?

A
  • Transfer to SCI unit
  • Physio
  • OT
  • Psychological support
  • Urological & sexual counselling