Spine Flashcards
What are red flags in a pt’s hx for spinal issues?
Bowel or bladder dysfunction Fever/fatigue (constitutional) Wt loss Saddle paresthesia Progressive neuro decline Trauma
Sensory testing for C1-C2
Front of face
Motor testing for C1-C2
Neck flexion
Sensory testing for C3
Lateral face and skull
Motor testing for C3
Lateral flexion
Sensory testing for C4
Supraclavicular
Motor testing for C4
Shoulder shrug
Sensory testing for C5
Lateral shoulder/upper arm
Motor testing for C5
Shoulder abduction
Reflex testing for C5
Bicipital (musculocutaneous)
Sensory testing for C6
Lateral lower arm and hand (thumb and index finger)
Motor testing for C6
Elbow flexion and wrist extension
Reflex testing for C6
Brachialradial (musculocutaneous)
Sensory testing for C7
Palmar aspect of hand- middle 3 fingers
Motor testing for C7
Elbow extension and wrist flexion
Reflex testing for C7
Triceps (radial)
Sensory testing for C8
Medial lower arm and hand
Motor testing for C8
Finger flexion and thumb extension
Sensory testing for T1
Medial elbow and upper arm
Motor testing for T1
Finger abduction
Kyphosis
Exaggerated rounding of back
Causes of kyphosis
Usually after osteoporosis/disc degeneration weakens the spine
Birth malformations
Tx of kyphosis
Maintain good bone quality with diet exercise osteoporosis meds Bracing in children Exercises Spinal fusion is last resort
What are signs of scoliosis?
Uneven shoulders
Curve in spine
Uneven hips (ASIS should be even in nl presentation)
What is considered mild scoliosis?
Cobb angle of 10-20 degrees
What is considered moderate scoliosis?
Cobb angle 21-40 degrees
What is considered severe scoliosis?
Cobb angle >40 degrees
How is a Cobb angle taken?
Find which one is bent most, then find one turned the most opposite way
Find the intersection
What should tx be for a Cobb angle of >20?
Monitor
What should tx be for a Cobb angle of 20-29?
Braced according to risk
What should tx be for a Cobb angle of >30?
Braced
What are the general components of low back pain?
80% of people with back pain Most <3 mos Hx of lifting/twisting Nl neuro exam Pain with ROM Generalized diffuse pain
How should one proceed in an exam and dx of low back pain?
Clinical dx
No imaging needed
R/o red flags
When should one image in low back pain?
Neuro signs Bony pain Stepoff Saddle anesthesia Bowel/bladder sx
Myelopathy
Something pressing on the spinal cord itself
A functional disturbance or pathological change in the spinal cord
Usually progressive
Upper motor neuron signs of myelopathy
Weakness Spasticity Altered tonus Hyperreflexia Hoffman's sign
Hoffman’s test
Relax pt
Flick middle finger
Nl: only middle finger should move
Abnl: Index finger moves as well
Lower motor neuron signs of myelopathy
Weakness Atrophy Hyporeflexia Flaccidity Fasciculations Bowel/bladder dysfunctions
Radiculopathy
Motor/sensory disturbance due to specific nerve root compression
S/sx of radiculopathy
Pain Weakness Numbness Sensory loss Reflex changes
What is considered an acute case?
<6 wks
What is considered a chronic case?
> 12 wks
What is considered radicular pain?
Radiating, tingling/numb/shock
Spondylosis
Disc space narrowing
S/Sx of spondylosis
Neck pain Dec ROM Muscle spasms Trouble sleeping Antalgic gait
Spondylolysis
Sometimes neck of Scotty dog is broken- pars defect or pars fx
Get oblique spine views
Cause of spondylolysis
Trauma cause
Tumbling, other sports that have high impact on the legs
Spondylolysthesis
One vertebral body is shucked on the other- concern for pars defect
S/sx of spondylolisthesis
Back pain
Worse with activity (bending/lifting)
Trouble with lumbar flexion
Muscle spasms
Grade I spondylolisthesis
1-25% slip
Grade II spondylolisthesis
26-50% slip
Grade III spondylolisthesis
51-75% slip
Grade IV spondylolisthesis
76-100% slip
Tx for spondylolisthesis
Stable can be left alone
Can tell when unstable when back pain is increasing
Most are gradual
Fusion
Causes of radicular pain
Young-herniated disc
Older-foraminal narrowing
S/sx of cervical radiculopathy
Numbness Paresthesias Muscle spasms Weakness Dec coordination
PE of cervical radiculopathy
Decreased or painful ROM Sensory changes Muscle weakness Decreased reflexes Pos Spurlings maneuver
Conservative tx for cervical radiculopathy
Spontaneous resolution in 6-12 wks NSAIDs Steroids PT Traction Refer if failure of tx, atrophy, weakness, myelopathy
What is the MC cause of sciatica?
Bulging or herniated disc
Test for sciatica
Straight leg test
Pain at 30-70 degrees radiates below the knee
Tx for sciatica
Most will resolve Heat or cold NSAIDs/steroids/muscle relaxants Injections PT Surgery
Cervical sprain/strain components
Usually caused by whip lash through an MVA Muscles and/or ligaments Decreased ROM, TTP Nl neuro exam Could take 6 mos to resolve RICE is mainstay of tx
Compression fx
Wedge-shaped vertebra Osteoporosis Midline pain Kyphosis Look for the vertebra that's different
Tx for compression fxs
Pain control
Brace
Surgery referral
Kyphoplasty
What is a risk of a kyphoplasty?
Could get more fxs above and below d/t weak structures
Jefferson fracture
Fracture to C-1 (atlas)
Dx of Jefferson fx
Open mouth view
Cause of hangman fx
Spinous process is broken
Hangman fracture
Fracture to C-2 (axis)
Spinal stenosis
Narrowing of canal
Compression of nerve roots
Older pts
Usually degenerative in nature
S/sx of spinal stenosis
Neurogenic claudication Radiculopathy Worse with walking/prolonged standing Better with rest/laying down Relief with stooping Back pain that shoots downward Worse with extension
Spinal stenosis tx
NSAIDs
Therapy
Epidural injections
Surgery/fusion
Causes of cauda equina syndrome
Disc herniation Epidural abscess Epidural hematoma Trauma Burst fxs
Tx for cauda equina syndrome
Surgical emergency
Must decompress ASAP
NPO
What differentiates a spinal epidural abscess?
Fever
S/sx of spinal epidural abscess
Severe back pain "Shocking" or "shooting" Sensory changes Motor weakness B/b dysfunction Fever/malaise
What are the most common cancers to metastasize to the spine?
Breast Lung Thyroid Kidney Prostate
