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MSK > Spinal Trauma and Nerve Disorders > Flashcards

Spinal Trauma and Nerve Disorders Flashcards

1
Q

What is the main cause of spinal cord trauma

A

Spinal fracture but most don’t end up

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2
Q

What is complete spinal cord trauma

A

No motor or sensory distal
No chance of recovery
ASIA grade A where E is normal

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3
Q

What is incomplete

A

Some function present

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4
Q

What can spinal cord trauma cause

A 
Tetraplegia
Paraplegia
Cord compression 
Central cord syndrome
Anterior cord syndrome
Brown-Sequard
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5
Q

Why can’t you determine extent of injury initially

A

May be in spinal shock

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6
Q

What is spinal shock

A

Transient depression of cord function below injury
Flaccid paralysis
Arreflexia
Can exist for several hours - days

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7
Q

What causes neurogenic shock

A

Injury above T6 disrupting sympathetic outflow

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8
Q

What does it cause

A

Hypotension
Bradycardia
Hypothermia

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9
Q

How do you Dx

A

X-ray
CT
MRI

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10
Q

How do you Rx

A

ABCDE
Surgical fixation if unstable
Spinal cord injury unit
Physio, OT, counselling

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11
Q

What does dorsal (posterior) column injury cause

A

Loss of vibration and proprioception

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12
Q

What causes

A

Tabes dorsalis
Subacute combined degernation of spinal cord (SACD)
Spinal infarction
Spinal stenosis

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13
Q

What does injury to spinothalamic tract cause

A

Loss of pain, sensation and temperature

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14
Q

What causes central cord paralysis and what does it cause

A

Narrow arthritic spinal canal
Flaccid paralysis of upper limb
Arms weaker than legs
Dorsal column affected

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15
Q

What does spinal cord infarction cause

A

Dorsal column signs

Loss of proprioception and fine discrimination

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16
Q

How does anterior cord present and what happens

A

Hyperflexion injury damaging anterior spinal artery
Affects spinothalammic and corticospinal tract
Touch and proprioception preserved
CAUSES WEAKNESS

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17
Q

What is Brown Squared

A

Hemisection of spinal cord - usually penetrating causing
Ipsilateral paralysis
Ipsilateral loss of proprioception / touch
Contralateral loss of pain and temp

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18
Q

What is Erb’s Palsy

A

Upper brachial plexus injury (C5+C6)

Musculocutaneous + axillary

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19
Q

What causes Erb’s palsy

A

Downward traction e..g shoulder dystocia
Trauma
Autoimmune
RT

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20
Q

What are the features of Erb’s palsy

A

Elbow extended and pronated
Medially rotated due to unopposed pec major and deltoid
Flexed wrist
Waiter tip position

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21
Q

What is Klumpke’s palsy

A

Lower brachial plexus injury
C8-T1
T1

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22
Q

What causes

A 
Upward traction e.g. breech birth / fall / pulled shoulder
Much rarer
Trauma
Autoimmune 
RT
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23
Q

What are the features

A

Small muscles of hand and flexors or wrist
Claw hand
May have associated Horner’s syndrome if T1 damaged

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24
Q

What are roots of musculocutaneous

A

C5,6,7

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25
What does it supply and what does it do
Biceps brachii | Elbow flexion and supination
26
What are roots of axillary nerve
C5,6
27
How is axillary commonly injured
Fracture humeral neck | Shoulder dislocation
28
What is associated features
Loss of shoulder abduction as supplies deltoid / teres minor Sensory deficit in badge area
29
What are roots of radial nerve
C5-T1 | Posterior cord
30
When is radial nerve injures
Fracture humeral shaft Entrapment / compression Supracondylar fracture
31
What does radial nerve injury cause
Loss of elbow extension if axillary damage (triceps) Loss of wrist and finger extension = wrist and finger drop 1st web space sensation loss (snuff box)
32
What are roots of median nerve
C5-T1
33
What causes damage to median nerve
Compression Wrist laceration Radial / ulnar or supracondylar fracture
34
What does median nerve damage cause
``` Carpal tunnel syndrome Tinel and Phalen +Ve Thenar wasting Loss of sensation - over 3.5 radial fingers Loss of pronation of forearm Loss of thumb abduction - ok sign ```
35
What are nerve roots of long thoracic
C5-C7
36
What does it supply and what does damage cause
Serrtus anterior Damage during sport e.g. rib blow or mastectomy Winged scapula
37
What are nerve roots of ulnar nerve and what is role
C8-T1 Medial cord No branches in the arm Wrist flexion
38
When is ulnar injured
Damage to medial epicondule Humeral fracture Supracndylar, radial and ulnar fracture Wrist laceration
39
What does damage at wrist cause
``` Claw hand Wasting intrinsic muscles + hypothenar Weak ring and little finger Thumb adduction Sensory loss to medial 1-1.5 fingers ```
40
What causes claw hand
Hyperextension MTP | Flexion of DIP and PIP
41
What does damage at elbow cause
As above Clawing less severe - paradox Proximal lesions = less severe Radial deviation
42
What are nerve roots of femoral nerve and role
``` L2-L4 Branch of lumbar plexus Pass through psoas muscle into femoral triangle Supplies quadriceps Thigh flexion - iliopsoas Knee extension - quads Patella reflex Sensory to anterior and medial thigh ```
43
What damages femoral
Hip and pelvic fracture | Gunshot + stabs
44
What are nerve roots of sciatic nerve and what does it supply / what happens if damaged
``` L4-S3 All muscles below knee Sensory loss to below knee and foot Largest nerve in body Knee flexion Foot movement Pain and numbness from glutes to ankle Pain in distribution ```
45
What does sciatic split into
Tibial - L4-S3 | Common fibular - L4-s1
46
When is sciatic at risk
Pelvic tumour / fracture Dislocation Injection into non-safe part of buttock Surgery
47
What does tibial supply
Weak plantar flexion and inversion | Sensory to sole of foot
48
Injury to tibial
Not common as deep | Popliteal laceration
49
What are nerve roots of common fibular and what does it supply
``` L4-S2 More lateral branch of sciatica Wraps around neck of fibula Splits into deep and superficial Tends to be injured at knee ``` Deep supplies anterior compartment EHL so foot dorsiflexion and eversion Superficial supplies sensory to dorsum of foot
50
What does injury cause
Foot drop Weak ankle dorsiflexion and eversion Sensory loss lateral side of foot and below knee
51
What is obturator nerve involved in
Adduction of thigh | Sensory to medial aspect
52
When is it damaged
Anterior hip dislocation
53
What does superior gluteal nerve
Hip abduction | Gluteus medias and minibus
54
If damaged what occurs
+ve trendelenbig
55
When is it damaged
Hip / pelvic fracture Hip surgery Posterior hip dislocation Misplaced injection
56
What does inferior gluteal nerve do
Hip extension | Lateral rotation
57
If damage what happens
Can't rise from seat | Associated with sciatic nerve injury
58
What is Meralgia Paraethetica
Paresthesia or anaesthesia in distribution of lower femoral cutaneous nerve L2/L3
59
What causes
Idiopathic Iatrogenic Neuroma
60
What are the symptoms
``` Burning, tingling, cold or shooting pain Upper lateral aspect Deep muscle ache Aggravated standing No motor Sx ```
61
Who is at risk
``` Obesity Pregnancy DM Tense ascites Trauma Surgery ```
62
How do you Rx
Pelvic compression test at ASIS - makes worse | Nerve conuction
63
How do you Rx
Inject nerve with LA
64
What is tetraplegia and what is usual cause
Loss of all 4 limbs Resp failure due to loss of diaphragm above C7 Usually due to cervical segment injury
65
What is paraplegia
Loss of LL | Bladder and bowel affected
66
How do you treat spinal injury
``` Can't determine extent as may be in spinal shock ABCDE Immobilise X-ray MRI if child Surgical fixation Spinal cord unit Physio / OT Psych counselling ```
67
What is Leriche Syndrome
Atherosclerosis disorder involving aorta / iliac Claudication buttock / thigh Impotence - L1 Atrophy
68
How do you Dx
Angiography
69
How do you Rx
Address CVS RF
70
What do you get if L2-L4 damaged / femoral
Sensory loss over anterior thigh and knee Weak quads so impaired thigh flexion Reduced knee reflex and knee extension +ve femoral stretch
71
What is femoral stretch
Flex knee whilst hip extended | If pain in anterior thigh = +Ve
72
What does L5 compression cause
Sensory loss dorsum of foot / 1st set space Wekness foot Weakness big toe dorsiflexion Weakness inversion and eversion - Differentiate from common fibular palsy Reflex intact +Ve sciatic stretch
73
What does S1 compression cause
Sensory loss leg and lateral foot Weakness plantar flexion of foot Reduced ankle reflex +VE sciatic stretch
74
What causes a foot drop
L5 Sciatic nerve Common fibular
75
What are reflexes
``` Biceps = C5/6 Triceps = C6/7 Knee = L3/4 Ankle = S1/2 ```
76
What is eversion and inversion
``` Opp to what you think Eversion - tax evaders go into valley - foot in Inversion - space invaders on hill - so up and out ```
77
How do you investigate nerve disorders
MRI - More useful if think radiculopathy e.g. L5 Nerve conduction - More useful if individual nerve e.g. common perineal
78
When do you refer for sciatica
Red flag Sx - bladder / saddle anaesthesia etc | If chronic >6 months

MSK (21 decks)

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