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MSK > Spinal MSK > Flashcards

Spinal MSK Flashcards

1
Q

How many cervical nerve roots are there

A

8

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2
Q

Who gets wedge compression fractures

A

Old ladies (and men) with osteoporosis

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3
Q

Who gets burst fractures

A

We do! Those without osteoporosis

  • burst in vertebral body
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4
Q

What investigation would be best to identify damage to the posterior ligaments of the spine

A

MRI

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5
Q

What kind of fracture are the elderly more likely to sustain to the spine

A

Wedge compression fracture due to osteoporosis

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6
Q

Whiplash

A

Neck strain flexion extension injury

–> pain

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7
Q

Where is the most likely spot for a spinal fracture

A

Junction between thorax (fixed) and lumbar (free) vertebrae

–> L1 and T12

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8
Q

ALTS protocol

A

Advanced trauma life support protocol - ABC..

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9
Q

What percentage of spinal fractures will have another spinal injury elsewhere

A

10%

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10
Q

Neurogenic shock

A

Normal circulating volume but all extremities are dilated - blood pressure drops…

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11
Q

Spinal shock

A

Damage to spinal cord
–> flaccid paralysis then start to return

Need to assess neurologically after a few days

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12
Q

ASIA assessment

A

Grade A - compete spinal cord injury - no motor or sensory function

Grade E - normal where motor and sensory are normal

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13
Q

Anterior cord syndrome

A

Affects both motor and sensory pathways

Crude sensation, movement and fine sensation are lost

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14
Q

Central cord syndrome

A

Weakness and paralysis of arms and some sensory loss

Legs are less affected (sacral sparing)

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15
Q

Brown-sequard syndrome

A

Injury to half the cord

Movement and some sensory loss below injury

Pain and temperature loss on opposite side

Spinal concussion - complete or incomplete last few hours to days

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16
Q

How to children differ from adults regarding trauma to the spine

A

Children have a larger head relative to body

Can see ossification centres/growth plates

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17
Q

Tough outer layer of intervertebral disc

A

Annulus fibrosis

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18
Q

Gelatinous core of intervertebral disk

A

Nucleus polposus

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19
Q

Which movements cause IV discs to fail

A

Twisting movements

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20
Q

Management of nerve root pain

A

Physio

Strong analgesia

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21
Q

Disc problems

A

Disc bulge

Protrusion

Extrusion

Sequestration

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22
Q

Sensory loss of disk L5/S1

A

S1 nerve root

–> little toe and sole of foot

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23
Q

Motor weakness due to damage of S1

A

Plantar flexion of foot

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24
Q

Which nerve is affected by L4/5 disc prolapse

A

L5

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25
Q

Sensory loss from L5 lesion

A

Great toe and 1st dorsal web space

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26
Q

Motor weakness from L5 lesion

A

Extensor hallucis longus

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27
Q

Symptoms of L4 nerve root damage

A

Medial aspect of lower leg sensory loss

Quadricep weakness

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28
Q

Which regions of the spine are most commonly affected by degeneration

A

Cervical and thoracic

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29
Q

Effect of cauda equina compression - why is it an emergency

A

SURGICAL EMERGENCY

Sacral nerve root compression can result in permanent bladder and anal sphincter dysfunction and incontinence

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30
Q

Aetiology of cauda equina syndrome

A

Central lumbar disc prolaps (common)

Tumours

Trauma (to spine) or spinal stenosis

Infection - epidural abscess

Iatrogenic - spinal surgery or manipulation, an epidural injection 😱

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31
Q

Clinical features of cauda equina syndrome

A

Location of symptoms - bilateral buttock and leg pain and varying dyskinesia and weakness

Bowel or bladder dysfunction (urinary retention +/- overflow incontinence)

PR exam - saddle anaesthesia (perianal loss of sensation), loss of anal tone and anal reflex

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32
Q

Treatment of cauda equina syndrome

A

Operative - 48 hours❗️

Discectomy/route of problem

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33
Q

Spondylosis

A

Degenerative change

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34
Q

Effect of cervical and lumbar spondylosis

A

If severe can compress whole cord causing myelopathy

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35
Q

Movements permitted at the facet joints of the vertebrae at the lumbar spine

A

Flexion and extension

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36
Q

Name the ligament on the front of the vertebral bodies

A

Anterior longitudinal ligament

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37
Q

Name the ligament along the back of the vertebral bodies

A

Posterior longitudinal ligament

38
Q

Name the ligament between laminae

A

Ligamental flavum

39
Q

Symptoms of spinal claudication

A

Bilateral (usually)

Sensory dysaesthesiae

Possible weakness - drop foot

Takes several minutes to ease after stopping walking

WORSE ON WALKING DOWNHILL BECAUSE SPINAL CANAL BECOMES SMALLER IN EXTENSION

40
Q

Types of spinal stenosis

A

Lateral recess

Central

Foraminal

41
Q

Symptoms of spondylolysis

A

Low back pain

Occasionally radicular symptoms

Limits hyperextension activities/sports

Comon

42
Q

Stages of fracture healing

A

1) Inflammation - haematoma and fibrin clot, angiogenesis
2) Soft callus - until bony fragments are united by cartilage or fibrin tissue, continued increase in angiogenesis
3) Hard callus - secondary bone healing = obvious callous; rigid fixation no obvious callus = primary bone healing
4) Bone remodelling - conversion of woven bone to lamellar bone

43
Q

Delayed union of fracture could be caused by

A 
High energy injury 
Instability 
Infection 
Steroids/immune suppressants
Smoking 
Warfarin 
NSAID
44
Q

How may we help delayed healing

A

Different dixation
Dynamisation
Bone grafting - autogenous is best choice as allogenic has risk of disease transmission

45
Q

3 main functions of spine

A

Support axial skeleton

Movement of truck

Protect spinal cord

46
Q

Source of infection in acute osteomyelitis in infants

A

Infected umbilical cord

47
Q

Source of infection in acute osteomyelitis in children

A

Boils, tonsilitis, skin abrasions

48
Q

Source of infection in acute osteomyelitis in adults

A

UTI, arterial line

49
Q

What conditions may predispose to acute haematogenous osteomyelitis

A 
Diabetes
Rheumatoid arthritis 
Immune compromise
Long term steroid treatment 
Sickle cell
50
Q

Acute osteomyelitis infection organisms

A

Staph aureus most common all ages

Infants: e.coli
Older children: strep pyogenes, haemophilus influenzae

Adults: strep pyogenase, pseudomonas aeroginosa

51
Q

Responsible organism for acute osteomyelitis secondary to penetrating foot injury and IVDA

A

Pseudomonas aeroginosa

52
Q

Pathology of acute osteomyelitis

A

Starts at metaphysis

Vascular status - venous congestion and arterial thrombosis

Acute inflammation - increased pressure

Abscess (supuration)

Release of pressure

Necrosis of bone

New bone formation

Resolution (or chronic osteomyelitis if not)

53
Q

Clinical features of acute osteomyelitis in a child

A

Severe pain

Reluctant to move (neighbouring joints held flexed); not weight bearing

May be tender and inflamed

Fever and tachycardia

Malaise, fatigue, nausea, vomiting

Toxaemia

54
Q

Clinical features of acute osteomyelitis in an infant

A

May be minimal signs or be very ill

Possibly drowsy or irritable

Metaphyseal tenderness and swelling

Decreased ROM

Positional change

55
Q

Clinical features of acute osteomyelitis in an adult

A

Primary OM seen commonly in thoracolumbar spine fever
–> back ache

History of UTI or urological procedure

Old, diabetic, immunocompromised

Secondary often seen after open fracture, surgery

56
Q

Diagnosis of acute osteomyelitis

A

FBC and diff WBC - neutrophil leucocytosis

ESR CRP

Blood culture - take 3

U and E - ill and dehydrated

Xray (may be normal if early) or show metaphyseal destruction

Ultrasound
Aspiration into bone
Bone scan
MRI

57
Q

Define sequestrum

A

Osteonecrosis

58
Q

Define involucrum

A

New bone

59
Q

Differential diagnosis for acute osteomyelitis

A 
Soft tissue infection 
Acute septic arthritis 
Trauma 
Acute inflammatory arthritis 
Transient synovitis

Rare - sickle cell disease, haemophilia

60
Q

Treatment of acute osteomyelitis

A

Supportive for pain and dehydration

Rest and splintage

Antibiotics - empirical fluclox and benzylpen while waiting

Surgery - aspiration, drainage of abscess, debridement of dead/contaminated tissue

61
Q

Complications of acute osteomyelitis

A

Septicaemia, death

Metastatic infection

Pathological fracture

Septic arthritis

Altered bone growth

Chronic osteomyelitis

62
Q

Chronic osteomyelitis is…

A

Repeated breakdown of “healed” wounds

Chronically discharging sinus fixed to underlying bone

63
Q

Organisms responsible for chronic osteomyelitis

A

Staph aureus

E.coli

Strep. Pyogenes

Proteus

64
Q

Treatment of chronic osteomyelitis

A

Local - gentamycin cement/beads
Systemic

Eradicate bone infection surgically

Treat soft tissue problems

Correct deformity/reconstruct

Consider amputation

65
Q

Complications of chronic osteomyelitis

A

Ongoing metastatic infection - abscesses

Pathological fracture

Growth disturbance and deformities

Amyloidosis

66
Q

Route of infection in acute septic arthritis

A

Direct invasion via penetrating wound or intra-articular injury

Eruption of bone abscess

Haematogenous spread

67
Q

Organism in acute septic arthritis

A

Staph aureus

Haemophilus influenzae

Strep pyogenes

E.coli

68
Q

Presentation of acute septic arthritis in a neonate

A

Picture of septicaemia

  • irritability
  • resistant to movement
  • ill
69
Q

Presentation of acute septic arthritis in child

A

Acute pain in single large joint

  • reluctant to move
  • increase temp and pulse
  • increase tenderness
70
Q

Investigations for acute septic arthritis

A

FBC, WBC, ESR, CRP, blood cultures

Xray

Ultrasound

Aspiration

71
Q

Most common cause of acute septic arthritis in an adult

A

Infected joint replacement

72
Q

Differential diagnosis for septic arthritis symptoms

A

Acute osteomyelitis

Trauma

Irritable joint

Haemophilia

Rheumatic fever

Gout

73
Q

Treatment of acute septic arthritis

A

General supportive

Antibiotics

Surgical drainage and lavage

74
Q

Clinical features of tuberculosis

A

Insidious onset and general ill health

Contact with TB

Pain (esp. At night), swelling, loss of weight

Low grade pyrexia

Joint swelling

Decreased ROM

Ankylosis
Deformity

75
Q

Polymyalgia rheumatica is characterised by

A

Pain and stiffness in the shoulders, neck, hips and lumbar spine, which is worse in the morning

It is rare in the under 60s

76
Q

Most specific investigation for rheumatoid arthritis is

A

Anti-citrullinated peptide antibodies

However is not routinely performed before taking rheumatoid factor - send for anti-CCP if rf is negative or to judge course

77
Q

First line therapy for rheumatoid arthritis

A

Non steroidal anti inflammatory drugs

78
Q

Which joints of the hand are usually spared at the beginning of rheumatoid arthritis

A

Distal interpharyngeal joints

79
Q

When is the pain generally worse in osteoarthritis

A

The evenings

80
Q

Heberden’s and bouchard nodes are features of what

A

Osteoarthritis

Heb = DIP
Bouchard = PIP
81
Q

Main radiographical features of osteoarhritis are

A

Reduced joint space

Subchondral sclerosis

Bone cysts

Osteophytes

82
Q

Radiographical features of rheumatoid arthritis

A

Reduced joint space

Soft tissue swelling

Peri-articular osteopenia

Bony erosions

Joint subluxation

83
Q

Management of someone presenting to A&E with suspected septic arthritis

A

Aspiration and blood culture

Empirical antibiotic treatment IV - benzylpen and fluclox

Immobilise joint

Perform an Xray

Physio for follow up

84
Q

Clinical features of reactive arthritis

A

Acute assymetrical lower limb arthritis occurring 1-4 weeks following an infection (dysentery or urethritis)

Conjunctivitis

Enthesitis which may result in plantar fasciitis or archilles tendonitis

Ulceration of the glans penis

Nail dystrophy

Mouth ulcers

Aortic incompetence (rarely)

85
Q

Treatment of reactive arthritis

A

NSAIDs and local steroid injection for symptomatic control

86
Q

Psuedo-gout is caused by the presence of what crystals

A

Calcium pyrophosphate

87
Q

Which condition presents with rhomboidal, weakly positive bifringent crystals under polarised light microscopy of joint fluid

A

Pseudo-gout

88
Q

How does gout present under polarised light microscopy of joint fluid

A

Needle-shaped negatively birefringent crystals

89
Q

Why might someone with rheumatoid arthritis get pulmonary fibrosis

How would this present

A

Extra articular manifestations

And is a side effect of methotrexate (DMARD)

–> shortness of breath, fine basal inspiratory crepitations and dry cough

90
Q

Anti-phospholipid syndrome

A

Recurrent arterial or venous thrombosis with a history of miscarriages

Can occur secondary to SLE

MSK (12 decks)

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