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MPT1 > Spine Two - starts with lateral stenosis > Flashcards

Spine Two - starts with lateral stenosis Flashcards

1
Q

lateral stenosis

A

narrowing of lateral neural foramen (can see bone spurs on imaging)

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2
Q

causes of lateral stenosis

A

degenerative changes
disk, posture

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3
Q

t or f, lateral stenosis can cause radicular symptoms

A

t

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4
Q

t or f, lateral stenosis is common in any age group

A

t

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5
Q

what reproduces signs and symptoms of lateral stenosis? what decreases them?

A

closing facets reproduces them (positive quadrant)
opening facets decreases symptoms

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6
Q

central stenosis

A

degeneration or narrowing of the spinal canal

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7
Q

what age is central stenosis most common in?

A

60+

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8
Q

what are some subjective findings with central stenosis

A
  • pain with standing and walking
  • possible numbness and tingling in lower extremities
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9
Q

“shopping cart sign” is common in

A

central stenosis

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10
Q

objective findings with central stenosis

A
  • closing spinal canal reproduces symptoms and opening decreases symptoms
  • limited AROM/PROM
  • positive slump test
  • possible UMN lesion
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11
Q

age group for radiculopathy

A

any

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12
Q

stenosis is the _______ and radiculopathy is the _______

A

diagnosis, symptom

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13
Q

can you have radiculopathy without stenosis

A

NO

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14
Q

can you have stenosis without radiculopathy

A

YES

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15
Q

radiculopathy is _______ in thoracic spine

A

rare

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16
Q

what can cause a nerve root impingment (3)

A

herniated nucleus pulposus
DDD/DJD
poor posture

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17
Q

subjective findings with radiculopathy

A
  • not usually relieved with rest
  • deep, burning, sharp pain (dermatomal pattern)
  • usually unilateral
  • possible report of weakness (drop things, drag toes)
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18
Q

objective findings with radiculopathy

A
  • positive neural tension
  • LMN lesion signs (hypo-)
  • reproduced with foramen narrowing
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19
Q

tests for cervical radiculopathy

A
  • decreased pain with traction (head pull)
  • positive spurling
  • ULNTT (ulnar, median, radial)
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20
Q

ULNTT

A

upper limb neural tension testing

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21
Q

causes of cervical radiculopathy

A

disc pathology, spondylosis, posture

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22
Q

tests for lumbar radiculopathy

A
  • decreased pain with traction (leg pull)
  • LLNTT (sciatic, femoral)
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23
Q

causes of lumbar radiculopathy

A

disc pathology, spondylosis, posture, spondylolisthesis

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24
Q

most common disk herniation? nerve root impingement?

A

C6/7
C7 nerve root

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25
Q

the likelihood of cervical radiculopathy _______ with age

A

decreases

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26
Q

two sets of rules ordering imaging is based on

A

1 - canadian c-spine rules (most common)
2 - american college of radiology suspected spine trauma appropriateness criteria
*applies to those over 14

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27
Q

What is the sensitivity and specificity of the canadian cervical spine rules

A

sensitive = 1
specificity - 0.43

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28
Q

canadian c spine rules

A

1 - over 65
2 - dangerous MOI
3 - paresthesia in extremeties
*if yes to any of these, they need an xray

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29
Q

canadian c spine low risk factors

A
  • able to sit in ED
  • simple rear end MVA
  • ambulatory at any time
  • delayed onset of neck pain
  • no midline c-spine tenderness
    *if any of these are present with no high risk factors you can safely asses ROM
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30
Q

t or f, if you cannot assess cspine ROM then they need a radiograph

A

t
also needed if less than 45 degrees of bilateral rotation

31
Q

how is the odontoid/transverse lig assessed in a plain film radiograph

A

open mouth view

32
Q

what could be compressed in thoracic outlet?

A

subclavian artery
subclavian vein
brachial plexus

33
Q

what is the compression in thoracic outlet usually coming from? what may it also involve?

A

1st rib
may also involve scalenes, clavical, pec minor

34
Q

what are some possible causes on TOS

A
  • head/neck/shoulder trauma
  • poor posture
  • hypertrophied scalenes (COPD, asthma, weightlifters)
35
Q

common demographic for TOS

A

middle aged women

36
Q

subjective findings for TOS

A
  • edema, skin tightness, cyanosis
  • pain and fatigue
  • heaviness
  • night pain
  • numbness and tingling (usually C8/T1)
37
Q

what should you rule out in TOS

A
  • cervical radic
  • systemic diseases (raynauds, lupus)
  • DVT (swelling with activity that doesn’t resolve)
38
Q

What TOS you should asses neural __________. what is the most common?

A

tension

39
Q

special tests for TOS

A

adson’s, costoclavicular, hyperabduction, Roos

40
Q

7 common pathologies in thoracic and lumbar spine

A

1 - osteoporosis
2 - rib dysfunction
3 - scoliosis
4 - ankylosing spondylosis
5 - scheuermann’s disease
6 - HNP
7 - spondylolysis/spondylolisthesis

41
Q

t or f, males are at greater risk for osteoporosis

A

f, females 6:1

42
Q

osteoporosis is commonly _____ until fracture

A

asymptomatic (*may report limited thoracic extension)

43
Q

subjective findings with osteoporosis

A
  • family history of osteoporosis
  • early menopause (osteopenia)
  • decreased activity
  • low levels of calcium and vitamin D
  • WB activities most painful, improves with rest
44
Q

objective findings with osteoporosis

A
  • increased thoracic kyphosis and lumbar lordosis
  • localized pain if fracture is present
  • thin figure
  • may have decreased strength/proprioception
    ** be careful if you suspect osteoporosis
45
Q

what do you need to screen for in osteoporosis

A

balance because falls can cause a fracture

46
Q

T or F: osteoporosis is more common in obese pop

A

false, less common *more stress to bones promotes bone growth

47
Q

where is the most common place for a compression fracture?

A

thoracolumbar junction (T10-L2) * may refer to low back pain with or without radiculopathy

48
Q

what scan do you need to look at bone density

A

DEXA scan

49
Q

what imaging do you get to look for a fracture?

A

radiograph or CT, lateral view

50
Q

a compression fracture is common with traumatic falls but can also occur with what during ADLs?

A

forward bending (low trauma)

51
Q

3 possible MOIs for rib dysfunction/subluxation

A

1 - twisting or AP compression - typical ribs
2 - overuse of scalenes - 1st rib
3 - traumatic

52
Q

what is rib dysfunction commonly seen with?

A

chronic breathing pathologies (COPD, asthma)

53
Q

subjective findings with rib dysfunction

A
  • sharp pain with breathing/coughing/sneezing
  • possible sternal and/or thoracic pain
  • no neuro involvement unless 1st rib issue or TOS
54
Q

function non-structural scoliosis

A
  • no problems with vertebrae
  • spine adapts to postural deformities
  • can be reversed if cause is found
55
Q

what can cause functional non-structural scoliosis

A

SIJ dysfunction
leg length discrepancy
poor posture
hip contracture
nerve root irritation

56
Q

possible factors in idiopathic scoliosis

A

structural
musculature
metabolic/chemical
endocrine
CNS

57
Q

scoliosis can interfere with…

A

breathing
internal organ function
appearance

58
Q

what method is used with plain film imaging for scoliosis

A

cobb method
- ap film is used
- measures the curve and documents progression

59
Q

a spine curve of less than __________ does not need treatment and greater than ________ may need surgery

A

10, 40

60
Q

ankylosis spondylitis

A
  • ossification of joints and ligaments of entire spine
  • sounds like arthritis but has an earlier onset
61
Q

ankylosis spondylitis is a ______- disorder

A

rheumatoid
(patient will probably have an endocrinologist)

62
Q

what age is ankylosis spondylitis usually seen in? more common in males or females?

A

15-40, peaks in mid 20s, more common in males

63
Q

does ankylosing spondylitis affect the thoracic or lumbar vertebrae first?

A

thoracic

64
Q

subjective findings with ankylosing spondylitis

A
  • 1st symptom - stiff low back w/ or w/o pain
  • pain at night
  • intermittent pain during the day (spine, shoulders, and/or hips)
  • difficulty standing up striaght
65
Q

objective findings with ankylosing spondylitis

A
  • decreased active/passive trunk extension
  • restricted passive accessory with multiple segments
  • excessive flexed posture
  • hip/knees flexed posture
  • decreased shoulder elevation
  • decreased SB
  • restricted chest expansion
66
Q

imaging findings with ankylosing spondylitis

A
  • sacroilitis
  • squaring of vertebral bodies
  • apophyseal joints fused
  • ligamentous ossification
  • “bamboo spine” in more advanced cases
67
Q

etiology of scheuermann’s disease

A

congenital weakness in endplate increases flexion loading causing anterior wedging of vertebral body

68
Q

what can happen to the endplates with scheuermann’s disease

A

it can crack allowing nuclear material to migrate into vertebrae

69
Q

schmoral’s nodes

A

NP protrudes into endplate seen in scheuermann’s disease

70
Q

where is scheuermann’s disease most common

A

T10-L2

71
Q

what age is scheuermann’s disease most common in? more common in males or female

A

2nd decade of life
more common in males

72
Q

what kind of imaging do you need for scheuermann’s disease

A

MRI to detect disc/endplate involvement

73
Q

signs and symptoms of scheuermann’s disease

A

“growing pains”
stiffness/pain after rest
increased thoracic kyphosis
pain with axial loading and decreased pain with unloading

MPT1 (10 decks)

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