Spine Flashcards
Features of back pain history
Axial vs radiating (e.g. shooting into leg)
Improved with rest?
Any sensation loss (radiculopathy)
Any gait instability (myelopathy)
Any red flags?
Spinal history red flags
Night pain, weight loss, Hx of cancer
Recent trauma
Saddle anaesthesia, bladder/bowel control loss, gait disturbance
Thoracic spine
Age <20 or >55
Management of spinal radiculopathy
Analgesia, physiotherapy
Laminectomy for resistant cases
Management of cauda equina
PR, full neuro exam
Post-voiding bladder ultrasound
Urgent MRI
Surgical decompression
Differential for glove/stocking distribution of sensory loss
DAMAGE
Diabetes
Alcohol
Metabolic
Autoimmune/vasculitis
Guillaine-Barre
Positive prognostic marker for cauda equina
Incomplete saddle anaesthesia (only half affected)
Spondylolysis vs spondylolisthesis
Spondylolysis: Fracture of vertebral isthmus (commonly L5), often asymptomatic and self-limiting
Spondylolisthesis: Slippage of vertebra on one below of intervertebral disc (15% progresssion from spondylolysis in young people, common with degeneratve change in elderly)
Spinal stenosis (i.e. neurogenic claudication) vs vascular claudication
Pathophysiology of spinal stenosiS
Degeneration of spine –> osteophyte formation –> reduction in canal space
Soft tissue/ligamentum flavum hypertrophy
What should bilateral carpal tunnel symptoms alert you to?
Cervical myelopathy!
Nexus guidelines for C-spine clearance
DC TIN
Distracting injury?
Altered consciousness?
Tenderness?
Intoxication?
Focal neurology?
Common organisms associated with MSK infection
Staph aureus, streptococcus, N. gonnorhoea for septic arthritis
Presentation of MSK infection
Joint pain +/- pseudoparalysis
Warmth, redness, swelling
Systemic response e.g. fever (swinging in abscess formation)
Elevated WCC, CRP, ESR
Aetiology of septic arthritis
Staph aureus, N. gonorrhoea
Haematogenous, direct, or osseous spread (from osteomyelitis)
Management of septic arthritis
Blood cultures
IV Abx (fluclox, cephalosporin)
Joint aspiration + lavage with saline (may require surgery in hip or if septation has occured)
Complications of septic arthritis
Cartilage damage –> early osteoarthritis
Septic shock
Copmlications of osteomyelitis
Commonly a disease of children –. growth arrest due to permanent bone damage
May be first presentation of diabetes –> check blood glucose!
Management of osteomyelitis
Blood cultures + blood glucose
IV abx
Surgical drainage if chronic/periosteal pus formation
Amputation if resistant to previous measures (chronic)
Lateral vs posterolateral disc herniation
Lateral: Nerve root above (e.g. L4 in L4-5 disc)
Posterolateral: Nerve root below (e.g. L5 in L4-L5 disc)
C5 dermatome
Regiment badge
C6 dermatome
Thumb
C7 dermatome
Middle finger
C8 dermatome
Little finger
T1 dermatome
Medial elbow
T5 dermatome
Nipple
T10 dermatome
Umbilicus
L3 dermatome
Medial thigh/knee
L4 dermatome
Medial leg
L5 dermatome
Dorsal surface of toes
S1 dermatome
Plantar surface of heel
C5 myotome
Shoulder abduction
Elbow flexion root
C5-C6
Elbow extension nerve root
C7
Wrist extension nerve root
C6
Finger extension nerve root
C7
Finger flexion nerve root
C8 (median + ulnar)
Finger abduction enrve root
T1
Hip extension nerve root
L5/S1
Hip flexion nerve root
L1-L2
Knee flexion nerve root
S1
Knee extension nerve root
L3/4
Ankle dorsiflexion nerve root
L4-5
Ankle plantarflexion nerve root
S1/S2
Great toe extension
L5
Ankle inversion nerve root
L4-L5
Ankle eversion nerve root
L5/S1
