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Ortho > Spine > Flashcards

Spine Flashcards

1
Q

cervical radiculopathy in C4-C5

where is there pain, numbness, weakness, abnormalities

A

C5 nerve root

pain - base of neck, shoulder, and anterolateral arm

numbness in deltoid

weakness in deltoid

abnormal biceps reflex

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2
Q

cervical radiculopathy in C5-C6

where is there pain, describe sensations or, weakness, abnormalities

A

C6 nerve root

pain to neck, shoulder, lateral arm and radial aspect of forearm

sensation is abnormal to dorsolateral thumb and index finger

change in biceps and brachioradialis reflexes

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3
Q

cervical radiculopathy in C6-C7

where is there pain, describe sensations or, weakness, abnormalities

A

C7 nerve root

pain to neck, shoulder, lateral arms, and dorsum of forearm

sensation change to triceps and finger extensors

reflex altered to triceps

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4
Q

when would you further evaluate neck pain

A
  • traumatic event
  • radicular pain
  • continuous and persistent
  • associated with numbness, tingling, or head aches
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5
Q

Tx for neck pain

A

PT

Meds: NSAIDs, tylenol, muscle relaxants, prednisone, narcotics

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6
Q

L4 nerve involvement (L3-L4 disk)

test what?

A
  1. tibialis anterior weakness
  2. patellar tendon reflex
  3. sensation to medial aspect of food, shin, thigh
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7
Q

L5 nerve involvement (L4-L5 disk)

test what?

A

great toe extension (extensor hallucis longus) - weak?

sensation to dorsum of foot and first web space

pain in posterolateral thigh and calf?

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8
Q

S1 nerve involvement (L5-S1 disk)

test what?

A

gastronemius soleus complex (weak? toe-walk)

sensation to lateral foot

achilles tendon reflex

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9
Q

a back strain is an injury to what

A

paravertebral muscles

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10
Q

how long to lumbar strain symptoms usually last

A

< 1 month

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11
Q

where can pain radiate with a lumbar strain

A

buttocks or legs

also pain standing erect

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12
Q

chronic back pain criteria

A

low back pain lasting longer than 3 month

recurrent, episodic, persistent symptoms

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13
Q

how does a herniated disc occur

A

due to wear and tear or an injury

nucleus pulposus (soft center) pushes up against the annulus (tough outer ring) of the disc. The nucleus ruptures (herniates) and the soft central material is squeezed out

–> material inflames the spinal nerves –> pain, numbness, weakness

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14
Q

Risk factors for disk herniation

A
  • age: disk degeneration
  • Age 30-50
  • males
  • obesity
  • frequent driving
  • sedentary lifestyle
  • smoking
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15
Q

how do symptoms progress with a herniated disc

A

low back pain is first symptom - lasts for a few days

may progress onto leg pain, numbness, weakness

pain into the leg below the knee and into the foot and ankle

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16
Q

what workup or imaging would you do when suscpecting a herniated disc

A

PE: neurological

Imaging - xray, MRI

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17
Q

Tx for herniated nucleus pulposus

A

conservative

rest/activity modifications

PT

NSAIDs, tylenol, narcs?, prednisone?

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18
Q

idiopathic scoliosis characteristics

A
  • majority of cases
  • doesn’t usually cuase pain
  • runs in families
  • can occur in toddles and young children
  • most of the time is age 10 to skeletal maturity
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19
Q

what health issues can congenital scoliosis be associated with

A

heart

kidney

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20
Q

any condition that affects the nerves and muscles can lead to neuromuscular scoliosis - this is due to muscle weakness and/or imbalance.

what disorders/injuries could cause this

A

cerebral palsy

muscular dystrophy

spinal cord injury

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21
Q

large scoliosis curves can cause what

A

heart and lung problems

compress spinal cord

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22
Q

what is a normal cobb angle in weight-bearing x-rays for scoliosis

A

less than 10 degrees

23
Q

tx for scoliosis

A

initial: NSAIDs, exercise, PT

observation for curves <20

bracing - prevents worsening of curvature; worn until skeletal maturity

surgery for curves 45 degrees or greater - spinal fusion

24
Q

for postural kyphosis is it more common in males or females

A

females

25
Q

kyphosis that becomes apparent in teen years

usually thoracic spine but can affect lumbar spine

A

Scheuermann’s

26
Q

who is Scheuermann’s kyphosis most common in

A

boys

27
Q

Scheuermann’s kyphosis is diagnosed on xray; how do the vertebrae look?

A

Irregular and wedge-shaped

not passively correctable

28
Q

kyphosis in adulthood is called this

it increases with age

A

Dowagers hump

29
Q

when is there the greatest change in angle in dowager’s hump kyphosis

A

50-59

30
Q

tx for kyphosis

A

NSAIDs
exercise
bracing (if pt still growing)

surgical: if degree >75
- straighten and fuse abnormal segments

31
Q

narrowing of the spinal canal causing pressure on the spinal cord and spinal nerve roots

A

spinal stenosis

32
Q

Sx of spinal stenosis

A

pain, numbness and weakness in legs

33
Q

is spinal stenosis more common in males or females?

A

equal

34
Q

most common cuase of spinal stenosis

A

Arthritis

>60 y/o most often

35
Q

in elderly spinal stenosis is due to 1

in younger pts spinal stenosis is due to a 2 process or from some disorder with s/sx in 3 (age)

A
  1. degeneration
  2. congenital
  3. 20s or 30s
36
Q

symptoms of spinal stenosis

A

gradual or sudden

  1. burning pain in buttocks that can radiate into legs and feet
  2. numbness or tingling in buttocks and/or lower extremities
  3. weakness in one or both legs or “food drop”
  4. Sx progress proximally to distally
  5. pain improves with leaning foward (increase space for nerves to travel)
  6. pain worsened with walking or standing
  7. pain experienced at night
37
Q

imaging for spinal stenosis

A

xrays
MRI
Myelogram - insert dye to better visualize nerves and look for compression

38
Q

tx for spinal stenosis

A

non-surgical: alleviate pain and restore fxn - NSAIDs, PT, ESI

Surgical: patients with low quality of life - laminectomy, spinal fusion

39
Q

what is seronegative spondyloarthropathy a group of conditions for?

A

RA, PsA, and arthritis associated with IBD

40
Q

what is ankylosing spondylitis negative for?

what common genetic factor is there with seronegative spondyloarthropathy?

A

RF and ANA

HLA-B27

41
Q

ankylosing spondylitis is a chronic inflammatory disorder affecting 1 and 2, causing stiffness and pain

A
  1. low back

2. pelvis

42
Q

what disorder shows a bamboo spine in xray

A

ankylosing sponydlitis

43
Q

ankylosing spondylitis:

typically develops in 1 (age)

There are fibrous and bony bridging of the joints in the spine and discs

2 and 3 involvement

4 arthritis

Can also involve the 5, 6 and 7 (dactylitis)

A
  1. young adults (20-30)
  2. spinal
  3. sacroiliac
  4. peripheral (30-50%)
  5. hips
  6. shoulders
  7. digits
44
Q

extraarticular manifestations of ankylosing spondylitis

A

IBD

Psoriasis

UVEITIS - most common

45
Q

these are all symptoms for what

  • back pain
  • PAIN IMPROVES WITH EXERCISE
  • no improvement with rest
  • pain at night that improves upon waking
  • neck pain
  • buttock pain
  • fever/sweating during flares
A

ankylosing spondylitis

46
Q

ankylosisng spondylitis tx

A

NSAIDs

exercise

47
Q

what nerve roots are especially vulnerable with cauda equina

A

ones that control bladder and bowel

48
Q

what may cause cauda equina

A
  • herniated disc
  • trauma
  • infection
  • tumor
  • any narrowing of spinal canal
49
Q

Sx of cauda equina

A
  • radicular pain and numbness in LE
  • perineal numbness (“SADDLE” distribution)
  • leg weakness (stumbling gait, symmetric foot drop)
  • trouble voiding or loss of urinary and anal sphincter control
50
Q

PE for cauda equina

A
  • watch gait
  • heel and toe walk
  • anal spincter tone
  • “saddle” anesthesia present?
51
Q

imaging for cauda equina

A

xray
MRI
CT myelogram

52
Q

labs for cauda equina

A

WBC
CRP
ESR

to help look for infection

53
Q

tx for cauda equina

A

EMERGENCY

surgical decompression

Ortho (9 decks)

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