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MSK > Spinal Symposium - Pt 1 > Flashcards

Spinal Symposium - Pt 1 Flashcards

1
Q

What is a dermatome?

A

Area of skin that is mainly supplied by a single spinal nerve

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2
Q

What is a myotome?

A

Group of muscles that a single spinal nerve innervates

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3
Q

What are the myotomes of the upper limb?

A

C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extensors
C8 - long finger flexors
T1 - finger abduction

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4
Q

What are the myotomes of the lower limbs?

A

L2 - hip flexion
L3,4 - knee extension
L4 - ankle dorsiflexion
L5 - big toe extension
S1 - ankle plantar flexion

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5
Q

How man people with a fracture/ dislocation have a SCI (spinal cord injury)?

A

15%
Majority of people with a SCI will have an accompanying column injury

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6
Q

What is the incidence of spinal cord injuries?

A

1000 SCI/ year in the UK
Males > females
Peak is 20-29 years old

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7
Q

What are the most common causes of spinal cord injury?

A

Road traffic accidents, sport + recreational activities and falls

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8
Q

What is a complete SCI?

A

No motor or sensory function distal to lesion
No anal squeeze and sacral sensation
ASIA grade A
No chance of recovery

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9
Q

What is an incomplete SCI?

A

Some function is present below site of injury
More favourable prognosis overall

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10
Q

What is ASIA classification?

A

A - complete
B - incomplete. Sensory but not motor is preserved.
C - incomplete. Motor function preserved with key muscle grade under 3
D - incomplete. Motor function preserved with key muscle grade over 3
E - normal motor and sensory function

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11
Q

Describe tetraplegia

A

Quadriplegia
Partial or total loss of use of all four limbs and the trunk
Loss of motor/ sensory function in cervical segments of spinal cord

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12
Q

What causes tetraplegia?

A

Cervical fracture - resp. failure due to loss of innervation of diaphragm from phrenic nerve
Spasticity

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13
Q

What is spasticity?

A

Increased muscle tone
UMN lesion
Spinal cord and above
Injuries above L1

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14
Q

What is paraplegia?

A

Partial or total loss of use of lower limbs
Arm function spared
Possible impairment of function of trunk
Impairment or loss of motor/ sensory function in thorax, lumbar or sacral regions

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15
Q

What causes paraplegia?

A

Thoracic/ lumbar fractures
Associated with chest or abdominal injuries

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16
Q

What is the symptoms with paraplegia?

A

Spasticity if injury of spinal cord
Bladder/ bowel function affected

17
Q

What are some partial cord syndromes?

A

Central cord syndrome
Anterior cord syndrome
Brown-Sequard syndrome

18
Q

What is the signs of central cord syndrome?

A

Central tracts more involved
Weakness of arms > legs
Perianal sensation and lower extremity power preserved

19
Q

What is central cord syndrome causes?

A

Hyperextension injury
Older patients - arthritic neck

20
Q

Describe Brown-Sequard Syndrome

A

Hemi-section of the cord
Penetrating injuries
Paralysis on affected side, loss of proprioception and fine discrimination, and pain + temp. loss on oppisite side

21
Q

What is the key to management of SCI?

A

Prevent secondary insult - particularly in patients with an incomplete injury
ABCD and ATLS

22
Q

What is a secondary injury of SCI?

A

Acute pathophysiologic processes
Neuroprotective interventions - stabilisation, ATLS resus, pharmacological agents and surgical care

23
Q

What is ABCD of management?

A

Airway
Breathing
Circulation - IV fluids and consider neurogenic shock
Disability - assess neurological function

24
Q

What is spinal shock?

A

Transient depression of cord function below level of injury
Flaccid paralysis, areflexia and lasts several hours to days after injury

25
Q

What is neurogenic shock?

A

Hypotension, bradycardia and hypothermia
Injuries above T6
Secondary to disruption of sympathetic outflow

26
Q

What imaging is required for SCI?

A

X-rays
CT scanning - bony anatomy
MRI - neurological deficit or children

27
Q

Describe surgical fixation

A

For unstable fractures
Vast majority fixed from posterior
Pedicle screws preferred method

28
Q

What is the long term management of SCI?

A

Spinal cord injury unit
Physio
Occupational therapy
Psychological support
Urological/ sexual counselling

MSK (39 decks)

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