Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CMT-dos > Spine 1 > Flashcards

Spine 1 Flashcards

1
Q

Lower Spine Vertebral Column

A

Lumbar
5 vertebral bodies (occasionally 6)
L1 to L5

Sacrum
5 segments (usually fused without discs)
Sacrum sits above Coccyx
3-4 segments (fused)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ligaments of spine

A

Anterior Longitudinal Ligament
Connects vertebral bodies anteriorly

Posterior Longitudinal Ligament
Connects vertebral bodies posteriorly

Ligamentum Flavum (Yellow Ligament)
Connects lamina posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lumbar Discs

general

A

Purpose
Cushioning between vertebral bodies
Named by Vertebral Body above and below
L4-5 disc is located between the L4 and L5 vertebral bodies

Annulus Fibrosis
Fibrous outer ring of the disc

Nucleous Pulposus
Soft inside of the disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Spinal Cord

general

A

Purpose is to transmit information to and from the rest of the body

Begins at craniocervical junction and usually ends between T12-L2

End of spinal cord is called conus medullaris (conus)

At end of the conus there are spinal nerves that go to lower extremities and bowel/bladder
Cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A

Notice that the nerve root exits at the top of the foramen
Notice that the disc is below the nerve root

Cervical - nerve roots exiting are named based on vertebral body below foramen
Except C8 which exits in C7-T1 foramen

Thoracic to Sacral- Named for vertebral body above foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

spine pain

Pathophysiology

neck, back, thoracic

A

Neck and lumbar pain more common than thoracic

Neck Pain multifactorial
Chronic stress/strains of muscle (most common) due to overuse or repetitive injuries, poor posture, acceleration/deceleration injuries, radicular pain, occupational (prolonged sitting)

Back Pain multifactorial
Lumbar strain (muscular), HNP, SS, other

Thoracic pain less common
Trauma/fracture, tumor, infection, HNP, DJD, spasm

Majority of LBP that presents to PCP is non-specific in etiology, primarily musculoskeletal in origin
Resolves with conservative measures within a few weeks
Less than 1% will have serious systemic condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cervical Spine

Spurling Test

A

to diagnosis cervical HNP or spondylosis
Patient seated, laterally flex head, apply slight pressure downward to increase axial load

+ if numbness, tingling, it pain down ipsilateral side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cervical Spine

Hoffman Reflex

A

to test for long tract spinal cord involvement in neck

Pathological reflex, indicates abnormality within the cervical spinal cord or higher (UMN lesion or pyramidal sign) ALS, MS, spinal cord compression

(+) reflex is flexion and adduction of the thumb/index finger after flicking of the middle finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

lumbar

Tests

A

Gait (barefoot) look at Trendelenburg (pelvis level on one foot = normal hip abductor)

Heel and toe walking (tests L4-5, S1 innervated muscles)

Calf and thigh circumference? atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Special Testing

Seated SLR, supine SLR, slump test

A

Seated SLR - + test causes patient to lean back

Supine SLR (Lesegue) - + test is radicular pain in leg, not back (HNP or compression) symptoms at 20 degrees or less is suggestive of symptom amplification

Slump test – seated, hands behind back, then slump in relaxed position, chin to chest. Extend leg, dorsiflex fully. Examiner gives slight pressure to back of head. + test is impingement on dura, spinal cord or nerve roots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

back pain

PE

A

Additional Components of Examination

Should include:
Deep Tendon Reflex Examination of patella, ankle, ? Clonus, ? Babinski

Sensory Examination (light touch/pin prick) to help identify/localize a lesion and determine extent of deficit

Evaluation of gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Back pain

red flags

A

Fever, chills, weight loss
History of IV drug abuse
History of malignancy
Progressive weakness
Bowel or bladder dysfunction
Trauma
Increasing pain not controlled by simple analgesia
Saddle anesthesia
Distended/palpable bladder
Paraparesis
Unexplained Neurological deficit
Decreasing pain in the face of increasing deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Myelopathy

A

Injury/ compression of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Radiculopathy

A

Injury/ compression of the nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stenosis

A

Narrowing of passage for spinal cord or nerve root

17
Q

Acute LBP-Sprain or Strain

general

A

LBP is a symptom, not a diagnosis

Strain implies injury to paravertebral spinal muscles

Sprain describes ligamentous injuries +/- involving facet joints or annulus fibrosis (without HNP- herniation of …)

Patients give history of repeated lifting, twisting, or operation of vibrating equipment

Risk factors include poor fitness, smoking, job dissatisfaction, psychosocial factors

18
Q

LBP Sprain or Strain

Clinical Symptoms and red flags

A

Acute onset of symptoms, often trivial event such as lifting, leaning

Pain can radiate to buttocks, difficulty standing erect

Red flags –Neurologic deficits, fever/other constitutional symptoms (weight loss, B/B dysfunction), unresponsive pain syndromes, trauma, pain at rest,

19
Q

LBP Sprain or Strain

exam and imaging

A

Exam: Diffuse tenderness low back or SIJ, reduced ROM, Intact MMST and reflexes

Imaging: x-rays not helpful, MRI not indicated
Defer x-rays first 2-6 weeks

20
Q

LBP strain/sprain

Tx phases

A

LBP without radicular features and no focal neurological deficits:

Phase 1: Focus on symptomatic relief
Avoid intense physical activity
Pain management (NSAIDS, acetaminophen, etc.), topical treatments (heat, massage, acupuncture). Avoid muscle relaxants, steroids, narcotics
80-90% of LBP episodes resolve within 2-6 weeks

Phase 2: After acute pain resolves help patient return to full activity
Return to work issues
PT for exercise program, aerobic activity

Refer to specialist for symptoms >4 weeks

21
Q

Degenerative Disc Disease

general

A

Age or activity related breakdown of disc material; leads to reduction of fluid within the disc and thinning of the disc which then leads to osteophyte formation

Common complaints/ symptoms:
May be nothing or may be pain, numbness, tingling, etc
Depends on what other problem the DDD causes
Pain worsens with sitting

Aging, obesity, smoking, and excessive axial loads can accelerate the degeneration

22
Q

Degenerative Disc Disease

imaging

A

Tests:
x-rays will show disc space narrowing and possibly osteophyte formation

MRI is needed if patient has symptoms of nerve involvement

Will also show disc desiccation and osteophytes

23
Q

Degenerative Disc Disease

Tx

A

Nothing if there is no pain

Reduce accelerators

Treat the pain with NSAIDs, bracing * and PT for core strengthening

Surgical intervention should be reserved for cases with severe pain or nerve impingement (usually spinal fusion)

24
Q

Disc Bulge/ Disc Herniation

general

extrusion and sequestration

A

Bulge: large amount of annulus creeps out of its normal space

Herniation: smaller but more intense amount of annulus creeps out of its normal space
Extrusion: annulus tears because of degeneration and what is left of the nucleus leaks out
Sequestration: extrusion that is completely severed

25
Q

Disc Bulge/ Disc Herniation

S/Sx

A

Pain
Numbness or tingling
Weakness
Typically worse symptoms with herniation

26
Q

Disc Bulge/ Disc Herniation

PE and imaging

A

(+) Straight leg raise
DTRs- normal or limitted if nerve involvement ( would only be unilateral)
AROM- normal or limitted if nerve involvement ( would only be unilateral)

Tests:
X-rays can be unremarkable
MRI is test of choice and will typically show posterolateral bulge or herniation

27
Q

Disc Bulge/ Disc Herniation

Tx

A

Bulge: NSAIDs, bracing, PT, steroid injections

Herniation: surgery to remove portion of disc that is causing nerve compression

bulge will often resolve on its own within a few months but herniation needs surgery to repair fairly quickly to try to prevent permanent nerve damage

28
Q

Cauda Equina Syndrome

general

A

Posterior compression of nerve tissue (cauda equine) and not posterolateral compression of nerve roots (can come from fracture fragments, disc herniation, hematoma, abscess)

29
Q

Cauda Equina Syndrome

symptoms

A
30
Q

Cauda Equina Syndrome

PE and imaging

A

bowel and/or bladder dysfunction
decreased rectal tone
saddle anesthesia (sensory deficit over the perineum, buttocks, and inner thighs)
variable motor and sensory loss in the lower extremities
decreased lower extremity reflexes
sciatica

Tests:
MRI (of entire spine if concern that it is related to metastasis, there is a chance of another mass)

ONE OF THE FEW TIMES IN LIFE THAT MRI IS ALLOWED TO BE ORDERED STAT/ EMERGENTLY

31
Q

Cauda Equina Syndrome

Tx

A

Treatment:
Steroids FAST; dexamethasone 10mg IV
Consult neurosurgery ASAP

Misc:
Often with this disease, once a symptom presents, it is unlikely to resolve with surgery… you are just trying to prevent more problems and hoping to slightly improve current symptoms

32
Q

Facet Arthritis

general

A

Degenerative changes of the facet joints related to aging and overuse

33
Q

facet arthritis

Common complaints/ symptoms:

A

Same as all other OA
Pain
Stiffness
Can also have numbness and other radicular symptoms

34
Q

facet arthritis

PE and imaging

A

PE:
Improved pain with forward flexion
Worsening of pain with extension and hyperextension

Tests:
Might see on x-rays but difficult
Easiest to see on MRI or CT

35
Q
A

CMT-dos (95 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions