Spine Injuries + Myotomes Of Upper Limb Ses 7 msk Flashcards
Cervical spondylosis
chronic degenerative osteoarthritis affecting the intervertebral joints in the cervical spine.
Can be due to age- related disc degeneration marginal osteophytosis (osteophyte formation adjacent to the end plates of the vertebral bodies) or facet joint osteoarthritis.
Symptoms:
narrowing of the intervertebral foramina = pressure on the spinal nerves = radiculopathy = paraesthesia in the dermatome, pain, motor weakness.
narrowing of the spinal canal = myelopathy = gait dysfunction, loss of balance, loss of bowel and bladder control.
Fractures of the atlas (C1 vertebra) notion
What is it:
Fracture of the anterior and posterior arches of the atlas
Causes:
The mechanism of injury is axial loading e.g. diving into shallow water, impacting the head against the roof of a vehicle, or falling from playground equipment.
Symptoms:
bursting open of bone fragments reduces risk of impingement on the spinal cord = no neurological signs.
Damage to arteries at base of skull secondary neuro eg ataxia, stroke etc.
Fractures of the axis - 2 notion
What is it:
Hangman’s fracture - C2 is fractured through the pars interarticularis.
Tends to expand spinal canal.
Cause:
The mechanism of injury is forcible hyperextension of the head on the neck
What is it:
Fracture of odontoid
Cause:
Flexion or extension. most common is elderly patient with osteoporosis falling forwards and impacting their forehead on the pavement.
Can also be hyperextension of cervical spine.
Also blow to back of head causing hyperflexion injury.
Scan:
open mouth’ AP X-ray or a CT of the cervical spine.
Whiplash injury
What is it:
forceful hyperextension-hyperflexion injury of the cervical spine so tearing of cervical muscles and ligaments.
Symptoms:
Secondary oedema, haemorrhage and inflammation
Muscle spasm
Pain and stiffness
arm pain and paraesthesia as a result of injury to the spinal nerve
Lower back pain.
Chronic myofascial pain syndrome can sometimes develop as a secondary tissue response to disc or facet-joint injury.
injury to the cervical cord due to movement of mobile vertebrae.
Cervical intervertebral disc prolapse
Who:
30 to 50 year-old
Cause:
tear develops in the annulus fibrosus of the disc, and the nucleus pulposus protrudes from the disc, with impingement onto an adjacent nerve root or the spinal cord.
sequestration can occur where the segment of nucleus pulposus enters the spinal canal and gets resorbed.
may be spontaneous in origin or may be related to trauma and neck injury.
Symptoms:
Paracentral prolapse may impinge on a spinal nerve = radiculopathy.
Canal-filling prolapse = acute spinal cord compression.
EXITING NERVE ROOT COMPRESSED eg in C5/6 prolapse C6 spinal nerve compressed.
In lumbar + thoracic it’s traversing nerve root.
Cervical myelopathy what are long tracts?
What is it:
Narrowing of spinal canal
Cause:
degenerative stenosis of the spinal canal caused by cervical spondylosis - 50 to 80yrs - includes ligamentum flavum hypertrophy or buckling, facet joint hypertrophy, disc protrusion and osteophyte formation.
Congenital stenosis
Cervical disc herniation
Spondylolisthesis
Trauma
Tumour
RA
Symptoms:
loss of balance with poor coordination, decreased dexterity, weakness, numbness and in severe cases paralysis, pain.
dysdiadochokinesia
L’Hermitte’s phenomenon is the sensation of intermittent electric shocks in the limbs, exacerbated by neck flexion.
Diagnosis:
Hoffman’s test - holds the patient’s middle finger at the middle phalanx and flicks the finger nail. If the index finger and thumb move, the patient has a positive Hoffman’s sign (abnormal).
Babinski sign - lateral side of the sole of the foot is stroked from heel to toes. If hallux dorsiflexes and toes fan out - damage to long tracts.
Treatment:
Surgical decompression or there is sphincter dysfunction and quadriplegia.
Thoracic cord compression notion
Cause:
vertebral fractures so bony fragments in spinal canal
Tumours in spinal canal - most common cancers that arise from solid organs and spread to bone are breast, lung, thyroid, kidney and prostate.
Symptoms:
in the lower thoracic spine and in the lumbar spine, the neural segments do not line up with their respective vertebral segments because the spinal cord is much shorter than the vertebral column.
Pain at site of lesion, spastic paralysis, paraesthesia in the dermatomes distal to the site.
Vertebral osteomyelitis, discitis and epidural abscess
Cause:
Pathogens reach by 3 ways:
Haematogenous - arterial (segmental artery) or retrograde venous to v bodies
Direct inoculation eg during lumbar puncture
Spread from adjacent soft tissue infection
bony ischaemia and infarction - Necrosis of the bone - direct spread of organisms into the adjacent disc space, epidural space and adjacent vertebral bodies.
Staphylococcus aureus (50%), and Gram -ve bacilli such as Escherichia coli (up to 30%). Following invasive spinal procedures, Staph epidermidis (up to 30%).
Infection with more unusual organisms = injecting drug users.
Who:
Immunocompromised patients - HIV, diabetes, steroids
Symptoms:
Neurological damage due to:
Septic thrombosis leading to ischaemia
Compression of neural elements by abscess / inflammatory tissue
Mechanical collapse of bone leading to instability, particularly in chronic infections
Myotomes Upper Limb
C5: shoulder abduction and external rotation
C6: elbow flexion + wrist extension + supination (internal rotation of shoulder )
C7: elbow extension + wrist flexion + pronation
C8: finger flexion + finger extension (thumb extension, wrist ulnar deviation )
T1: finger abduction and adduction
Axillary Lymphadenopathy
Axillary lymphadenopathy refers to enlargement of the axillary lymph nodes.
Causes include:
Axillary Lymph Node Removal - staging of breast cancers - lymphoedema due to accumulated lymph in the subcutaneous tissue - painful swelling of the upper limb.
Infection of the upper limb - red, warm, tender streaks are visible in the skin
Infections of the pectoral region and breast
Metastases from breast cancer
Leukaemia or lymphoma
Metastases from malignant melanoma (type of skin cancer) in the upper limb
