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PM&R > Spine MSK/Pain > Flashcards

Spine MSK/Pain Flashcards

1
Q

Steroid that is more likely to cause tissue atrophy with injection of superficial structures?

A

Triamcinolone

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2
Q

What type of allergy can interfere with hyaluronic acid injections?

A

bird products (eggs, poultry, feathers)

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3
Q

What are the natural curves of the spine?

A
  • cervical lordosis
  • thoracic kyphosis
  • lumbar lordosis
  • sacral kyphosis
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4
Q

What is “transitional anatomy” in the lumbar spine?

A

some people have sacralization of the lumbar spine or lumbarization of the sacrum resulting in 4 or 6 lumbar vertebrae respectively.

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5
Q

Does having “transitional anatomy” in the lumbar spine necessarily cause pain or is it a normal varient?

A

normal varient

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6
Q

What does the nucleus pulposus consist of?

A

Type II collagen, water, and other materials

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7
Q

What type of collagen makes up the annulus fibrosis?

A

type I

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8
Q

What nerves innervate the C4-C5 facet joint?

A

C4 and C5 medial branches of dorsal rami

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9
Q

What nerves innervate the L3-L4 facet joint?

A

L2 and L3 medial branches of dorsal rami

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10
Q

What provides innervation to the nucleus pulposus?

A

nothing, it lacks innervation.

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11
Q

What provides innervation to the annulus fibrosus?

A
  • anterior: ventral rami
  • posterior: sinuvertebral nerves
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12
Q

What provides innervation to the vertebral body?

A

sinuvertebral nerves

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13
Q

When is surgery indicated for a vertebral body compression fracture?

A
  • greater than 25% loss of disc height
  • spine is unstable
  • significant neurologic deficits
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14
Q

What defines the middle column of the spine?

A

Posterior 1/3 of the vertebral body to the posterior longitudinal ligament

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15
Q

When is a spine unstable?

A

dammage to the middle column or any 2 columns

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16
Q

How does neurogenic claudication present?

A
  • leg or buttock pain/weakness
  • worse with prolonged standing
  • worse with spinal extension and relieved with flexion
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17
Q

How does vascular claudication present?

A
  • calf pain worse with activity (walking uphill, biking)
  • skin changes (thin, shiny, hairless)
  • diminished/absent pulses
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18
Q

Treatement for spinal stenosis

A

PT with directional preference assessment (flexion biased) or surgical decompression

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19
Q

Most common cause of spondylolisthesis?

A

Isthmic (Class II): fracture of pars interarticularis

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20
Q

How do you grade spondylolisthesis?

A
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21
Q

Treatment for spondylolisthesis?

A
  • Grade 1, 2, and asymptomatic grade 3: rest and PT
  • Symptomatic grade 3 or grade 4: surgery
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22
Q

What triggers SI joint pain?

A

transitional movements (sit to stand)

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23
Q

What does bilateral sacroiliitis indicate?

A

Ankylosing spondylitis

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24
Q

What type of radiculopathy will a L3-L4 central or posterolateral herniation cause?

A

L4

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25
Q

What type of radiculopathy will a L3-L4 lateral or neuroforaminal disc herniation cause?

A

L3

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26
Q

What type of radiculopathy will a C6/C7 disc herniation cause?

A

C7

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27
Q

What defines a disc bulge?

A

Disc tissue extending beyond the edges of the vertebral apophyses without displacement of disc material (nucleus)

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28
Q

What are the three types of disc herniation?

A

prolapse, extrusion, sequestration

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29
Q

What defines a disc protrusion?

A

displacement of disc material beyond the disc space with measure at base greater than apex

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30
Q

What defines a disc extrusion?

A

displacement of disc material beyond the disc space with measure at the apex greater than at the base

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31
Q

What defines a disc sequestration?

A

disc material has lost all connection with disc of origin

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32
Q

What is a schmorl node?

A
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33
Q

How are superior to inferior levels within a vertebral body defined?

A

In relation to the pedicle

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34
Q

How do we define the zones that a disc can herniate into?

A
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35
Q

What are the three types of annulus fissures?

A
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36
Q
A

`

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37
Q

What is the return to work expectation (%) for a patient who has missed six months due to low back pain?

A

50%

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38
Q

what is an uncovertebral joint (joint of Luschka)?

A

disc degeneration creates raised superior lateral vertebral body margins (uncinate processes) that approximate with the vertebra above

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39
Q

From what levels does the supraspinous ligament run?

A

L3 to C7, above that it becomes the ligamentum nuchae

40
Q

What is the cervical compression test?

A

reproduction of radicular symptoms with a downward compression on the top of the head

41
Q

What is a Chymopapain injection designed to do?

A

dissolve subligamentous herniations contained by the PLL

42
Q

What are some conditions on the differential for myelopathy?

A

tumors, MS, ALS, AV malformations, RA with subluxation, syringomyelia

43
Q

What is the definiton of radiographic instability of vertebral segments on flexion/extension XRs?

A
  • Cervical: greater than 3.5 mm translation
  • Thoracic or Lumbar: greater than 5mm translation
  • Rotation in sagittal plane more than 11 degree in the C-spine or 15 degrees in the L-spine
44
Q

When is surgery indicated for scoliosis?

A

Cobb angle > 40 degree (35 if neuromuscular)

45
Q

What is Scheuermann’s Disease?

A

an adolescent disorder of the vertebral endplates resulting in increased thoracic kyphosis

46
Q

What defines a stable vertebral body burst fracture?

A
  • Neurologically intact with posterior column intact
  • Less than 50% collapse of anterior vetebral body height
47
Q

Where does facet pain refer?

48
Q

gold standard for diagnosis of facet pain?

A

double diagnostic medial branch blocks

49
Q

What is the FABRE (Patrick’s) Test?

A

Contralateral SI joint pain with flexion, abduction, external rotation, and extension of the ipsilateral hip

50
Q

What is the Gaenslen’s Test?

A

SI joint pain with extension of involved leg off the table while the contalateral hip is held in flexion.

51
Q

What is the Iliac compression test?

A

SI joint pain with downward force on iliac crest with patient lying on their side

52
Q

What is the Yeoman’s test?

A

SI joint pain with hip extension and ilium rotation

53
Q

What is Gillet’s Test?

A

Failure of PSIS to rotate down on raised leg side due to SI joint restriction

54
Q

What is the seated flexion test?

A

Asymmetric cephalad motion of the PSIS with forward flexion when seated. Abnormal side distinguished with standing flexion test.

55
Q

most common location for spine infection?

A

thoracic spine

56
Q

Mneumonic for Waddell’s signs?

A

DO ReST

  • Distraction: lack of consistency between seated and supine straight leg testing
  • Overraction: disproportionate reactions to a request
  • Regionalization: abnormalities without anatomic basis
  • Simulation: pain with light axial load or log rolling
  • Tenderness: exaggerated sensitivity to touch
57
Q

What are the two main nerve fibers that synapse onto wide dynamic range neurons in the dorsal horn?

A
  • Large myelinated A Beta fibers carrying light touch and pressure
  • Small unmyelinated C fibers carrying pain
58
Q

What is the difference between CRPS I and II?

A

CRPS II is due to a know nerve injury (causalgia)

60
Q

How long does the acute and dystrophic stages of CRPS last?

A

each stage last 3 - 6 months

61
Q

Gold standard diagnostic test for CRPS?

A

stellate ganglion block

62
Q

Early Tx for CRPS?

A

Prednisone 1mg/kg daily x 2 weeks

63
Q

Three medications used to abort migrane headaches?

A

triptans, NSAIDs, acetaminophen

64
Q

sensory distribution of nerves to the groin?

65
Q

What is a trigger point?

A

hyperirritable band of tight muscle and fascia that causes pain and sensory changes

66
Q

Where can you find the greater occipital nerve?

A

1/3 of the way from the occipital protuberance to the mastoid process

67
Q

Where do you inject for a shoulder joint injection?

A

2 fingerbreadths medial and 2 fingerbreadts inferior to the posterior acromion aiming towards the coracoid process

68
Q

type of collagen seen with tendonosis

69
Q

Target for medial branch block?

A

junction of superior articular process and transverse process

70
Q

target for stellate ganglion block?

A

transverse process of C6, anterior tubercle

71
Q

What is the difference between vertebroplasty and kyphoplasty?

A

kyphoplasty introduces cement indirectly with use of a balloon and has additional goal of restoration of vertebral body height

72
Q

Hyperesthesia

A

increased sensitivity to a stimulus

73
Q

Hyperalgesia

A

Exaggerated pain response from a stimulus that normally elicitis pain

74
Q

allodynia

A

pain elicited from a nonpainful stimulus

75
Q

Where do C fibers terminate?

A

dorsal horn laminae I and II

76
Q

Where are wide dynamic range neurons?

A

dorsal horn laminae III - V

77
Q

What fibers inhibit pain responses in Gate Control Theory?

78
Q

Which opioid receptors cause respiratory depression?

A

Kappa, Mu2

79
Q

What are the two metabolites of codine?

A

hydrocodone and morphine

80
Q

Which opiate can contribute to serotonin syndrome? Why?

A

Tramadol because it is a weak NE/5HT reuptake inhibitor

81
Q

Mechanism of action of buprenorphine?

A
  • partial mu and kappa agonist
  • delta antagonist
82
Q

Two NSAIDs that are selective for COX-2?

A

Meloxicam and Celecoxib

83
Q

Why should prescribing TCA’s in conjunction with SSRIs be avoided?

A

They are both metabolized by P450 in the liver, this can cause increased plasma levels of TCAs.

84
Q

Where do lyrica and gabapentin act?

A

alpha 2 delta subunit of L-type calcium channels

85
Q

What is a cordotomy?

A

ablation of the spinothalamic tract used to treat cancer pain

86
Q

How is interstitial cystitis diagnosed?

A

potassium sensitivity test

87
Q

Root levels of ilioinguinal and iliohypogastric nerves?

88
Q

How do the different Modic changes show up on MRI?

A
  • Type I: Bright on T2, dark on T1 due to serum/edema taking place of marrow
  • Type II: Bright on both due to fat taking place of marrow
  • Type III: Dark on both due to bony sclerosis
89
Q

What are two mechanisms by which corticosteroids reduce pain?

A
  • inhibit C-fiber excitation
  • induce synthesis of phospholipase A2 inhibitor
90
Q

How are alcohol and phenol related to CSF?

A

alcohol is hypobaric and phenol is hyperbaric

91
Q

What are the borders of the “safe triangle” for transforaminal injections?

A
  • Superior: horizontal line just under the superior pedicle
  • Lateral: lateral edge of vertebral body
  • Hypotneuse: spinal nerve root
92
Q

Which type of epidural injection has the least risk for dural puncture?

A

caudal approach

93
Q

What type of block is used to treat upper abdominal pain?

A

celiac plexus block

94
Q

What type of block can treat pelvic pain from cancer?

A

superior hypogastric plexus block

95
Q

Where is the hypogastric plexus located?

A

lower third of L5 vertebral body, anterolateral border bilaterally

PM&R (21 decks)

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