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Year 2- MSK > Spinal Symposium: Spinal Anatomy and Injury > Flashcards

Spinal Symposium: Spinal Anatomy and Injury Flashcards

1
Q

RECAP- does the vertebral foramen, where the spinal cord passes down, increase with size going downwards or decrease?

A

Decreases with size as moves inferiorly

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2
Q

RECAP- which section of the vertebral column has a foramen for the vertebral artery?

A

Cervical region

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3
Q

RECAP- to which section of the vertebral column do ribs attach?

A

Thoracic region

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4
Q

RECAP-curvature of spine at cervical and lumbar regions?

A

Lordosis

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5
Q

RECAP- curvature of the spine at the thoracic and sacral regions?

A

Kyphosis

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6
Q

Where does the C1 nerve arise in relation to the C1 vertebra?

A

Above the C1 vertebra

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7
Q

Where does the C8 nerve root emerge?

A

Between vertebrae of C7 and T1

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8
Q

Where does the C5 nerve root emerge in relation to the C5 vertebra?

A

Between C4 and C5

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9
Q

Where does the L3 nerve root emerge in relation to the L3 vertebra?

A

Between L3 and L4

->so cervical is the vertebrae before and the actual vertebrae and lumbar is the actual vertebrae and one below if that makes sense

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10
Q

Dermatome?

A

An area of skin supplied by a single spinal nerve

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11
Q

Myotome?

A

Group of muscles innervated by a single spinal nerve

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12
Q

Where is the C7 dermatome?

A

Middle finger

->C5 badge area, C6 thumb, C8 little finger, etc

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13
Q

Where is T10 dermatome?

A

Around umbilical area

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14
Q

Which dermatomes supply the groin area?

A

T12 and L1

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15
Q

In terms of myotomes- which muscle does C5 innervate and what is the associated action?

A

Deltoid muscle- shoulder abduction

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16
Q

In terms of myotomes- which muscle does C6 innervate and what is the associated action?

A

Biceps- elbow flexion and wrist extension

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17
Q

In terms of myotomes- which muscle does C7 innervate and what is the associated action?

A

Triceps- elbow extensors

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18
Q

In terms of myotomes- which muscle does C8 innervate and what is the associated action?

A

Flexor digitorum supericialis and profundus- finger flexors

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19
Q

In terms of myotomes- which muscle does T1 innervate and what is the associated action?

A

Interossei- finger abduction

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20
Q

In terms of myotomes- which muscle does L2 innervate and what is the associated action?

A

Iliopsoas- hip flexion

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21
Q

In terms of myotomes- which muscle does L3/4 innervate and what is the associated action?

A

Quadriceps- knee extension

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22
Q

In terms of myotomes- which muscle does L5 innervate and what is the associated action?

A

Extensor hallicus longus- big toe extensor

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23
Q

In terms of myotomes- which muscle does S1 innervate and what is the associated action?

A

Gastroc- ankle planarflexor

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24
Q

Who tends to get spinal cord injuries?

A

Male > female
Peak 20-29 years

->young men in RTA or falling from buildings x

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25
Q

What are the most common causes of spinal cord injuries?

A

Falls
RTAs
Sport
Knocked over/collision
Trauma
Sharp trauma/assault

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26
Q

Two main groups of spinal cord injuries?

A

Complete and incomplete

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27
Q

Difference between incomplete and complete spinal cord injuries?

A

Complete- no motor or sensory function distal to lesion. No chance of recovery.

Incomplete- some function present, more favourable prognosis

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28
Q

List the features of a complete spinal cord injury.

A

No motor or sensory function distal to the lesion
No anal tone
No sacral sensation

29
Q

Why can’t a complete/incomplete spinal cord injury be determined acutely?

A

Patient may be in spinal shock meaning the spinal cord does not work so examination initially unreliable

30
Q

Which classification is used for the severity of spinal cord injuries?

A

ASIA classification

-> A-E, A most severe (complete SCI) to E (normal motor and sensory function)

31
Q

Are ASIA classified SCI’s complete or incomplete?

A

All three incomplete

32
Q

Tetraplegia/quadraplegia?

A

Partial or total loss of use of all four limbs and the trunk

33
Q

Paraplegia?

A

Affects lower limbs predominantly suggesting that injury level is below innovation of arms

34
Q

In tetraplegia/quadriplegia, what kind of motor/sensory loss is there?

A

Loss of motor/sensory function in cervical segments of the spinal cord

35
Q

RECAP- nerve supply to diaphragm?

A

Phrenic nerve- C3,4,5 keeps the diaphragm alive :)

36
Q

Spasticity?

A

Increased muscle tone

37
Q

Is spasticity seen in UML or LML?

A

Upper motor lesions

38
Q

Features of paraplegia?

A

Arm function spared
Possible impairment of trunk function

39
Q

In paraplegia, what kind of motor/sensory loss is there?

A

Impairment or loss of motor/sensory function in the thoracic, lumbar or sacral region

40
Q

What happens to bowel and bladder function in paraplegia and quadriplegia?

A

Impaired in both

41
Q

What are the three partial cord syndromes?

A

Central cord syndrome
Anterior cord syndrome
Brwon-Sequard syndrome

42
Q

Which age group tends to get central cord syndrome?

A

Elderly

43
Q

When movement usually causes central cord syndrome?

A

Hyperextension

44
Q

Features of central cord syndrome?

A

Weakness of arms > legs
Power normal
Perianal sensation and lower extremity power presevered

45
Q

When movement usually causes anterior cord syndrome?

A

Hyperflexion

46
Q

Features of anterior cord syndrome?

A

Loss of sensation and pain
Fine touch and proprioception preserved

47
Q

Brown-Sequard syndrome?

A

Hemi-section of the cord

48
Q

What tends to cause Brown-Sequard syndrome?

A

Penetrating injuries e.g. stabbing

49
Q

Features of Brown-Sequard syndrome?

A

Paralysis on affected side
Loss of proprioception and fine touch
Pain and temperature loss on opposite side below lesion

50
Q

What are the principles of management for any patient with a SCI?

A

Want to minimise secondary damage
Involves ABCD management- A before B before C before D

51
Q

A for ABCD management of spinal cord injuries?

A

Airways- cervical spine control using spinal cord immobilisation collar. Intubation and oxygen.

52
Q

B for ABCD management of spinal cord injuries?

A

Breathing- ventilation and oxygenation
Management of any chest injuries to maximise oxygenation of blood

53
Q

C for ABCD management of spinal cord injuries?

A

Circulation- IV fluids

Consider Neurogenic shock (low BP and HR, loss of sympathetic tone)

Sometimes vasopressors given to maximise blood supply and improve circulation

54
Q

When can spinal shock occur?

A

After SCI and can last several hours to days after an injury

55
Q

What is spinal shock?

A

Transient depression of cord function below the level of injury

56
Q

When does neurogenic shock occur?

A

Secondary to the disruption of sympathetic outflow

57
Q

Features of neurogenic shock?

A

Hypotension
Bradycardia
Hypothermia

58
Q

Above what level of the spinal cord do injuries cause neurogenic shock?

A

Above T6

59
Q

If examining a patient with spinal shock, what would be noted?

A

Flaccid paralysis
Absence of reflexes

60
Q

D for ABCD management of spinal cord injuries?

A

Disability- using GCS to assess cognition
Assessing neurological function, including PR and perianal sensation

61
Q

What is meant by log rolling a paient?

A

Using at least four members of staff to roll the patient while keeping them immobilised until the injury can be evaluated clinically and radiologically
Allows for inspection of vertebrae and assessment of PR and perianal sensation

62
Q

Imaging for SCI?

A

X-rays
CT- for bony anatomy
MRI- if neurological deficit or children

63
Q

Okay so which investigation if there is neurological deficit as a result of SCI?

A

MRI

64
Q

Which SCIs are managed via surgery?

A

Unstable fractures

65
Q

How are SCIs usually treated using operation?

A

Surgical fixation, usually with pedicle screws

66
Q

Long term management of SCI?

A

Spinal cord Injury Unit- team of specialists for advice and help
Physiotherapist
Occupational therapist
Psychological support
Urological/sexual counselling

67
Q

Differences between neurogenic claudication and vascular claudication?

A

Neurogenic- patient should be able to walk up hills, cycle a bike or push a trolley but may have problems coming down a hill or lying flat. May be complaints of backache too. Pain can take a while to go.

Vascular- struggling walking uphill, pain goes after rest

68
Q

Which type of claudication is often bilateral?

A

Neurogenic

69
Q
A

Year 2- MSK (36 decks)

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