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MSS: post-midterm > Spine clinical correlations > Flashcards

Spine clinical correlations Flashcards

1
Q

What is Lhermitte’s sign?

A
  • passive anterior cervical flexion elicits “electric” sensation down the spine or extremities
  • implies cervical spinal cord pathology
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2
Q

What is Spurling’s test?

A
  • cervical spine extension + rotation (towards affected side) + lateral flexion
  • pain/”electric” feeling upon compression implies cervical nerve root pathology
    • e.g. herniated disc
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3
Q

What is hoffmann’s sign?

A
  • flick the patient’s middle finger
  • positive= flexion-adduction of ipsilateral thumb and index finger
    • implies upper motor neuron process affecting cervical spine or brain
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4
Q

What is the straight leg raising (SLR) test?

A
  • also called Lasegue sign
  • positive test= leg pain reproduced at 30-70 degrees
    • implies lumbar nerve root pathology (L5 or S1)
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5
Q

What is the femoral nerve stretch test?

A
  • patient is placed in prone position with flexed knee and examiner lifts the leg (hip extension)
  • positive test= reproduction of patient’s pain in anterior thigh
    • implies upper lumbar nerve root pathology (L2-L4)
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6
Q

What are the common symptoms of an upper motor neuron injury?

A
  • spasticity/hypertonicity
  • increased reflexes
  • extensor plantar (+ babinski) response

**spinal cord injury, brain injury/stroke, myelopathy, CNS lesion

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7
Q

What are the common symptoms of a lower motor neuron injury?

A
  • flaccid weakness
  • loss of reflexes
  • muscle wasting/atrophy

**peripheral nerve entrapment or radiculopathy (nerve root problem)

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8
Q

What are 2 red flags for malignancy?

A
  1. history of cancer
  2. unexplained weight loss
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9
Q

What are 5 red flags for spinal fracture?

A
  1. major trauma
  2. minor trauma or strenuous lifting in an older individual
  3. prolonged corticosteroid use
  4. osteoporosis
  5. advanced age (>70 years)
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10
Q

What are 4 red flags for infection?

A
  1. constitutional symptoms (fever, chills)
  2. recent bacterial infection (UTI, skin infection, pneumonia)
  3. immunosuppression
  4. IV drug use
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11
Q

What are 4 red flags for cauda equina syndrome?

A
  1. acute onset of urinary incontinence/retention
  2. fecal incontinence, loss of anal sphincter tone
  3. saddle anesthesia
  4. global/progressive weakness in lower limbs
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12
Q

Define lumbar strain

A
  • muscle disruption from excessive stretch or tension
  • pain worse with movement, better at rest
    • localized muscle tenderness, reduced ROM, normal neuro exam
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13
Q

What makes the symptoms of a herniated disc better/worse?

A
  • worse
    • lumbar= sitting, bending, coughing/sneezing
    • cervical= ROM
  • better
    • lumbar= standing, walking
    • cervical= lying
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14
Q

What are the most common causes of radiculopathy?

A

**disc herniation (posterolateral herniation through the posterior longitudinal ligament)

  • cervical= C6, C7
  • lumbar= L5, S1
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15
Q

Describe the pathophysiology of radiculopathy

A
  • mechanical compression
    • neural ischemia/increased intraneural pressure
    • edema of nerve root/DRG
    • dura is mechanically sensitive
  • biochemical irritation
    • nucleus pulposis (inner core of the vertebral disc) contains cytokines, leukotrienes, Cox2, IL1, TNF alpha
    • can cause apoptosis of DRG cells
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16
Q

What is the sensation and pain radiation associated with C5?

A
  • sensation= lateral arm
  • radiation= shoulder blade, lateral arm
17
Q

What is the sensation and pain radiation associated with C6?

A
  • sensation= radial distal arm/forearm, thumb
  • radiation= shoulder blade, radial arm and forearm
18
Q

What is the sensation and pain radiation associated with C7?

A
  • sensation= posterior arm/dorsal forearm, middle finger
  • radiation= posterior arm and forearm
19
Q

What is the sensation and pain radiation associated with C8?

A
  • sensation= medial forearm, 4th/5th fingers
  • radiation= medial arm and forearm
20
Q

What is the sensation and pain radiation associated with L4?

A
  • sensation= anterior thigh, medial calf/foot
  • radiation= anterior thigh and kness, medial calf
21
Q

What is the sensation and pain radiation associated with L5?

A
  • sensation= lateral leg and dorsum of foot
  • radiation= buttocks, lateral thigh/calf, dorsal foot, great toe
22
Q

What is the sensation and pain radiation associated with S1?

A
  • sensation= posterior calf, lateral foot
  • radiation= posterior thigh/calf, lateral/plantar foot
23
Q

What is the reflex and motor weakness associated with C5?

A
  • reflex= biceps
  • weakness= shoulder flexion/abduction, elbow flexion
24
Q

What is the reflex and motor weakness associated with C6?

A
  • reflex= brachioradialis
  • weakness= elbow flexion, forearm pronation, wrist extension
25
Q

What is the reflex and motor weakness associated with C7?

A
  • reflex= triceps
  • weakness= elbow extension, wrist flexion
26
Q

What is the reflex and motor weakness associated with C8?

A
  • no associate reflex
  • weakness= finger flexion/abduction
27
Q

What is the reflex and motor weakness associated with L4?

A
  • reflex= patellar
  • weakness= knee extension, ankle dorsiflexion
28
Q

What is the reflex and motor weakness associated with L5?

A
  • reflex= medial hamstring
  • weakness= ankle dorsiflexion, great toe extension
29
Q

What is the reflex and motor weakness associated with S1?

A
  • reflex= achilles
  • weakness= ankle plantar flexion
30
Q

What is sacroilitis?

A

an inflammation of one or both of your sacroiliac (SI) joints

**common sign of ankylosing spondylitis

31
Q

What is spondylolysis?

A

a defect or stress fracture in the pars interarticularis of the vertebral arch

**aka scotty dog fracture

32
Q

What is spondylolisthesis?

A

A spinal disorder in which a bone (vertebra) slips forward onto the bone below it

33
Q

What are the early and late signs of ankylosing spondylitis?

A
  • early
    • widening of SI joints (with adjacent sclerosis)
    • posterior longitudinal ligament sclerosis L1-L3
  • late
    • fusion of both SI joints
    • bridging of vertebral bodies; “bamboo spine”
    • ossification of the anterior, posterior, and interspinous longitudinal ligaments

**also see systemic effect (upper lobe lung fibrosis, iritis, CV abnormalities)

34
Q

Define lumbar stenosis

A
  • narrowing of the spinal canal
    • disc (NOT herniation)
    • thickening of bone, facet joints, spondylolisthesis
    • thickening of ligamentum flavum
  • worse when standing/walking, relieved with lumbar flexion and sitting (temporarily opens canal; note disc herniations are worse with sitting)
35
Q

Describe cervical myelopathy

A
  • Compression of the cervical spinal cord (multifactorial)
  • subtle and varied presentation which required a high index of suspicion
    • loss of fine motor skills
    • gait disturbance/motor weakness
    • bladder/bowel dysfunction
    • LE numbness, weakness, pain
    • **Upper motor neuron findings

**treat with surgical laminectomy

MSS: post-midterm (26 decks)

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