spine injury Flashcards
How long does it typically take for back pain due to muscular injury to resolve?
90% resolves within 6 wks regardless of treatment
What are GI/GU causes of back pain?
kidney stones, AAA, pancreatitis, peptic ulcer disease
What are the basic distinguishing features based on history between disc herniation and spinal stenosis?
disc herniation is worse with exertion
spinal stenosis is worse when walking or standing, and improves when the patient bends at the waist
What should you consider in a patient with radiating back pain that improves with activity and worsens with rest?
consider ankylosing spondylitis
What maneuvers worsen the disc herniation?
straight leg raises and valsalva maneuvers
Where are the motor and sensory deficits with compression of L4 nerve root?
patellar reflex, foot dorsiflexion, medial leg
Where the the motor and sensory deficits with compression of the L5 nerve root?
first toe dorsiflexion and lateral lower leg, first web space
What are the motor and sensory deficits with compression of the S1 nerve root?
foot eversion and plantarflexion; lateral foot sensory changes
What are the interosseous muscles, what do they do, what is their innervation?
palmar adduct, dorsal abduct. controlled by the deep branch of the ulnar nerve
What is Erb-Duchenne palsy?
superior trunk dysfunction due to lateral traction on the neck (think birth or shoulder dystocia). this causes “waiter’s tip” posture
What is klumpke palsy?
weak lumbricals due to damage to the lower trunk (C8-T1 roots). remember that the lumbricals are innervated by the median and ulnar nerves. this is caused by grabbing a tree branch to break a fall or upward force on arm during delivery
similar presentation if there is lower trunk compression due to pancoast tumor or cervical rib injury
What causes wrist drop?
weakness of the radial nerve, often due to humerus fracture. could also be due to a posterior cord lesion
What causes deltoid paralysis?
anterior shoulder dislocation can cause axillary nerve impingement or stretching
What is an ulnar claw?
due to distal ulnar loss. you’ve lost the lumbricals, so the opposite movements are exaggerated- looks like the pope’s blessing at rest. due to epiphyseal separation of the medial epicondyle of the humerus (basically need to know that the ulnar nerve is near the medial epicondyle)
