Spine- Beloy Flashcards
The spinal nerves exit the
cervical spine above/below their corresponding vertebral body level?
above
For example, the C5 nerve root exits above C5 through the C4/5 neural foramen.
In the thoracic and lumbar spine it is above/below?
below
So the L5 nerve would come out below at the L5/S1 disc space.
Sensory distribution and muscle of C2
Radiates up the head & skull stabilizer
Sensory distribution and muscle of C3
Upper neck/jaw line & Nuchal muscles, Diaphragm
Sensory distribution and muscle of C4
Neck jaw line/superior shoulder & Nuchal muscles, Diaphragm
Sensory distribution and muscle of C5
Shoulder/Anterior arm & Deltoid, supraspinatus, infraspinatus
Sensory distribution and muscle of C6
Radial forearm into thumb & Biceps, brachioradialis, extensor carpi radialis, extensor pollicis
Sensory distribution and muscle of C7
Posterior arm into middle fingers & Triceps, lattisimus dorsi, pectoralis major
Sensory distribution and muscle of C8
Ulnar side, ring and pinky finger & Intrinsic hand muscles, finger extensors
Sensory distribution and muscle of T1
Same as C8. Ulnar side, ring and pinky finger & Intrinsic hand muscles, finger extensors
C3, C4, C5 are mostly sensory or motor?
sensory
Do thoracic n have motor fxn?
No only sensory so they are often cut in surgery with no repercussions
What is a muscle motor grading score of 5/5?
able to resist against the examiner resistance/full strength
What is a muscle motor grading score of 4/5?
able to move muscle group against gravity but only against minimal resistance/decreased strength
What is a muscle motor grading score of 3/5?
able to move muscle group against gravity but not against resistance
What is a muscle motor grading score of 2/5?
able to move muscle group but not against gravity
What is a muscle motor grading score of 1/5?
Muscle tone/contraction but not able to fully move muscle
What is a muscle motor grading score of 0/5?
muscle paralysis/flaccid tone
A straight leg raise can detect a problem with the _____ or ______ disc
L4/5 or L5/S1
These are what type of spine conditions?
- Disc herniation
- Facet joint osteoarthritis
- Spinal stenosis
- Degenerative disc disease
- Spondylolisthesis
Degenerative spine conditions
Inflamed facet joints cause _______ pain only
back
Cervicalgia AKA _____ pain is common due to _________
neck pain, poor posture
What symptoms will you get with cervical spine pain?
Muscle tightness, spasms, decreased ROM, headaches, radiculopathy (numbness, tingling)
For cervical spine pain, you decide to get a cervical spine work up. What do you order first?
Xray and need 4 views: AP/Lateral/Flexion/extension
Instability in the c-spine is > _______ mm of motion
2-3
First line tx for C-spine pain?
PT, activity modification (changing desk height, posture, chiro, time
When would you order an MRI for a patient with C-spine pain?
- Instability noted on xrays
- Weakness
- Signs/symptoms of cord compression
- No improvement with conservative care after 6-8 weeks
Spinal cord dysfunction that can lead to paralysis (a syndrome)
Myelopathy
What are some symptoms of myelopathy?
Gait instability, weakness, incoordination (can’t button shirt), bowel or bladder incontinence, burning in bilateral hands
Are symptoms of myleopathy reversible or irreversible?
Can be IRREVERSIBLE
If a patient has bowel or bladder incontinence, what test should urgently be ordered?
MRI
The thoracic spine has not a lot of degen and is hard to treat why?
- Tricky to treat as the spinal cord can not be manipulated
- Can not do surgery from the front as the lungs and heart are in the way.
- Common location for compression fractures, can lead to kyphosis
______ back pain lasts a short period of time and heals in a few days whereas _______ back pain lasts 3 months or more and causes a dull/aching pain
acute, chronic
Sciatica affects these dermatomes
L4, L5, S1
________ is a tear in the ligament that connects your vertebra to your disc.
Annular tear
How do you treat an annular tear?
- Response well to rest and NSAIDs
- Interventional injections can be helpful
- Does not require surgery
*also strengthening the muscles that support the joint
a fragment of the disc nucleus that is pushed out of the annulus, into the spinal canal through a tear or rupture in the annulus.
Herniated disc
The disc degenerates due to natural loss of elasticity and/or injury over years
A herniated disc occurs in _______ or ______
L4/L5 or L5/S1
A narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs.
Lumbar stenosis
Does not require surgery if there are no symptoms
What are signs of neurogenic claudication that can occur in lumbar stenosis?
- Buttock and leg pain when walking or standing
- May only be able to walk a few yards before legs get “tired”
- Relieved by sitting or bending over “shopping cart sign”
What is a positive shopping cart sign?
The pain usually decreases when bending forward or sitting. This is often referred to as the “shopping cart sign”; patients with lumbar spinal stenosis often feel relief from their symptoms when leaning forward over the shopping cart while shopping at a grocery store.
What type of spine changes are these called? Scoliosis and spoldylolisthesis
Deformity
Spondylolysis vs spondylolisthesis
Spondylolysis is a crack or stress fracture in one of the vertebrae, the small bones that make up the spinal column. Whereas spondylolisthesis is when the stress fracture weakens the bone so much that it is unable to maintain its proper position in the spine—and the vertebra starts to shift or slip out of place.
What is a good muscle relaxer to use for treatment of spondylolysis or spondylolisthesis?
methocarbamol
Treatment for spondylolysis or spondylolisthesis?
Pt, activity modification (it it hurts, don’t do it), chiropractic care, inversion/decompresison, tylenol, NSAIDS, steroids, muscle relaxers,, physiatry for interventional injections
When should you order an MRI?
Instability on xray, no improvement after 6-8 wks, cauda equina symptoms
**Pain with palpation of the lumbar spine
What symptom is a straight up emergency?
Bladder incontinence!!! (Cauda equina), saddle anesthesia & numbness in groin
MUST CHECK RECTAL TONE
These symptoms can cause what condition?
- Persistent fever
- History of IV drug use
- Current or recent UTI, respiratory or other infection such as dental abscess
Discitis/Osteomyelitis
Slow loss of bone mass affecting 28 million americans
osteoporosis
the DEXA scan assesses what bones in the body?
Lumbar vertebrae femur, bones in forearm
A DEXA score of < -1 =
normal
A DEXA score of -1 to 2.4 =
osteopenia
osteopenia the bone loss is not as severe as in osteoporosis.
A DEXA score of > 2.4 =
osteoporosis
Medical management of osteoporosis?
- Calcium/Vit D
- Bisphosphonates (boniva, “dronate meds”)
Class A spinal cord injury =
Class B spinal cord injury=
Class E spinal cord injury=
A- complete: no motor or sensory function preserved in sacral segments
B- incomplete: sensory, but no motor function preserved below the neurological level
E- sensory and motor function normal
- Effects hand and arms. Its major injury to
the central grey matter of the spinal cord. - Weakness and burning in hands
Complete cord syndrome
- Weakness on one side of the body
- Loss of sensation (hemianesthesia) on the
opposite side
Brown sequard syndrome
-Motor loss below lesion, but intact sensation
anterior cord syndrome (can’t move foot but can feel it)
______ or anterior compression fractures account for 50-70% of all T/L fractures
Wedge
An anterior/wedge fracture is stable if
the posterior ligament complex is not disrupted
An anterior/wedge fracture is unstable if
- Severe compression: > 50% of vertebral height
- Significant fracture kyphosis: > 30°
- Rotational component to the injury
- Fractures at multiple levels
a descriptive term for an injury to the spine in which the vertebral body is severely compressed
burst fracture
Tx of a burst fracture
- neuro checks
- raise MAPs if neuro deficit
- steroids
- bracing
- surgical stabilization
- PT/OT
- pain management
55y/o male with no pmHX present to clinic with low back pain and right posterior calf pain that started after mowing the lawn 5 days ago.
Exam: He has a positive straight leg raise on the right.
L4/L4/S1 = herniated disc
Xray, PT, NSAIDS
82 y/o female presents with thoracic spine after falling in her garden yesterday. She states she has had a dull back pain but this is more stabbing in nature. She has also noticed some numbness along her nipple line for the last 6 months.
Exam: Normal, except tenderness to palpation along her mid thoracic spine
T4 affected (ask if bilateral because this could be a sign of shingles)
Compression fracture
Get xray
24 y/o female who was recently treated for a UTI presents to your office has new low back pain and low-grade fever.
She has pain into her bilateral anterior thigh down her medial calf.
Exam: Her strength in normal.
L4/L5
Osteomyelitis
MRI with contrast, ESR, CRP
62 y/o male with neck pain with bilateral hand numbness
but has noticed worsening imbalance and has been having a hard \ time putting on his watch.
Normal except he has a positive Hoffman’s sign
C6-C8
Cervical spine stenosis
Xray and MRI
25 y/o female with right arm pain
She has pain in her posterior scapula and middle finger
Exam: Normal except her right triceps is a 4/5
C7
Herniated disc
Xray, PT, possible MRI
A hoffman’s test tests disturbance in UMN pathways and problems with which part of the spine?
C-spine
This test is used to determine whether your fingers or thumbs flex involuntarily in response to certain triggers.
Hoffman’s
Hoffman’s, clonus and babinski test for ________
Hyperflexion
Internal and external rotation tests which L spines?
L3/L4
