spine and spinal cord Flashcards
Paresthesia
Abnormal sensation- burning, pricking, tickling or tingling.
Dysesthesia
impairment of sensation of short anesthesia
Paresis,
decreased strength
plegia
complete loss of strength
Dermatome,
cutaneous area served by individual sensory root
Myotome
Muscles innervated by an individual motor root
Radiculopathy,
sensory and/or motor dysfunction due to injury to a nerve root
Myelopathy
disorder resulting in spinal cord dysfunction
spinothalamic/anterolateral tract - function and where it crosses
pain and temperature, crosses 2-3 segments above root entry level in anterior spinal cord
posterior columns function and where it crosses
vibration and position, crosses in medulla
corticospinal tract function and where it crosses
motor, crosses in lower medulla
Know where the nerve roots exit
C1, 2, 3, 4, 5, 6, 7 roots exit above same numbered vertebra (e.g. C7 above C7). C8 below C7 and all other roots exit below same numbered vertebra (e.g. T1 exits below T1).
Know the spinal cord level that each vertebral body overlies (C6 bone overlies C7 cord.)
Upper cervical: vertebra # overlies same cord segment # (C2 bone, C2 cord) o Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord) o Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)
o Lower thoracic/lumbar: vertebra # overlies cord
segment # +2- 3 (T 11bone, L1-2 cord) o Lower edge of the L1 vertebral body overlies the cord tip (conus medullaris)Upper cervical: vertebra # overlies same cord segment # (C2 bone, C2 cord) o Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord) o Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)
o Lower thoracic/lumbar: vertebra # overlies cord
segment # +2- 3 (T 11bone, L1-2 cord) o Lower edge of the L1 vertebral body overlies the cord tip (conus medullaris)Upper cervical: vertebra # overlies same cord segment # (C2 bone, C2 cord) o Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord) o Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)
o Lower thoracic/lumbar: vertebra # overlies cord
segment # +2- 3 (T 11bone, L1-2 cord) o Lower edge of the L1 vertebral body overlies the cord tip (conus medullaris)Upper cervical: vertebra # overlies same cord segment # (C2 bone, C2 cord) o Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord) o Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)
o Lower thoracic/lumbar: vertebra # overlies cord
segment # +2- 3 (T 11bone, L1-2 cord) o Lower edge of the L1 vertebral body overlies the cord tip (conus medullaris)
somatotopic organization of tracts
Posterior columns: sacral medial, arms lateral. Spinothalamic and corticospinal: sacral lateral, arms medial
blood supply to spinal cord
2 posterior spinal arteries supply posterior columns, 1 anterior spinal artery supplies spinothalamic and corticospinal tracts. Gray matter requires more blood than white matter
Recognize the symptoms of a radiculopathy and
radiculopathy: dz affecting nerve roots. Pain
Lhermitte’s sign, Spurling’s sign (+foraminal compression test), Lasegue’s sign (+straight leg raising test, SLR). Paresthesia (abnl sensations), Sensory loss (hypoesthesia, anesthesia), Weakness (paresis, plegia), loss of fine motor control, Disorders of Bowel, bladder, or sexual dysfunction, Gait problems LMN signs. Relieving factors rest, graded therapy, NSAIDs, muscle relaxants. radiculopathy: dz affecting nerve roots. Pain
Lhermitte’s sign, Spurling’s sign (+foraminal compression test), Lasegue’s sign (+straight leg raising test, SLR). Paresthesia (abnl sensations), Sensory loss (hypoesthesia, anesthesia), Weakness (paresis, plegia), loss of fine motor control, Disorders of Bowel, bladder, or sexual dysfunction, Gait problems LMN signs. Relieving factors rest, graded therapy, NSAIDs, muscle relaxants. radiculopathy: dz affecting nerve roots. Pain
Lhermitte’s sign, Spurling’s sign (+foraminal compression test), Lasegue’s sign (+straight leg raising test, SLR). Paresthesia (abnl sensations), Sensory loss (hypoesthesia, anesthesia), Weakness (paresis, plegia), loss of fine motor control, Disorders of Bowel, bladder, or sexual dysfunction, Gait problems LMN signs. Relieving factors rest, graded therapy, NSAIDs, muscle relaxants. radiculopathy: dz affecting nerve roots. Pain
Lhermitte’s sign, Spurling’s sign (+foraminal compression test), Lasegue’s sign (+straight leg raising test, SLR). Paresthesia (abnl sensations), Sensory loss (hypoesthesia, anesthesia), Weakness (paresis, plegia), loss of fine motor control, Disorders of Bowel, bladder, or sexual dysfunction, Gait problems LMN signs. Relieving factors rest, graded therapy, NSAIDs, muscle relaxants.
understand Lhermitte’s symptom.
Neck flexion results in “electric shock” sensation down the back and/or into arms. Attributed to posterior column disease (MS, disc, B12 def, mass).
spurlings sign
narrow foramen causes constriction of nerves exiting at that level
lasegues sign
straight leg sign- sretch sciatic nerve and shooting radicular pain occurs
Causes of radiculopathies
Common causes: Compression by degenerative joint disease (causing bony proliferation) or herniated disc near intervertebral foramen. Remember, discs can
herniate laterally. Posterior herniation would cause myelopathy. Less common causes: herpes zoster (shingles), carcinoma, lymphoma, sarcoidosis.Common causes: Compression by degenerative joint disease (causing bony proliferation) or herniated disc near intervertebral foramen. Remember, discs can
herniate laterally. Posterior herniation would cause myelopathy. Less common causes: herpes zoster (shingles), carcinoma, lymphoma, sarcoidosis.Common causes: Compression by degenerative joint disease (causing bony proliferation) or herniated disc near intervertebral foramen. Remember, discs can
herniate laterally. Posterior herniation would cause myelopathy. Less common causes: herpes zoster (shingles), carcinoma, lymphoma, sarcoidosis.
Know the neurologic signs used to distinguish lesions affecting the lower motor neurons versus those affecting the upper motor neurons.
LMN: atrophy, fasciculation, flaccidity, decreased DTRs and flexor plantar response. UMN: immediate muscle weakness and hypotonia, hyporeflexia followed by normal muscle bulk, no fasciculations, spasticity, increased DTRs, extensor or babinski plantar response
spinal shock
acute complete spinal cord transection. Has upper motor neuron damage signs. Acutely: Exam shows flaccid weakness, absent tone, absent DTR, & absent autonomic function (bladder, sweat). By 3-4 months: Exam shows UMN spastic weakness, hyperactive DTRs, Babinski sign.acute complete spinal cord transection. Has upper motor neuron damage signs. Acutely: Exam shows flaccid weakness, absent tone, absent DTR, & absent autonomic function (bladder, sweat). By 3-4 months: Exam shows UMN spastic weakness, hyperactive DTRs, Babinski sign.acute complete spinal cord transection. Has upper motor neuron damage signs. Acutely: Exam shows flaccid weakness, absent tone, absent DTR, & absent autonomic function (bladder, sweat). By 3-4 months: Exam shows UMN spastic weakness, hyperactive DTRs, Babinski sign.