Test 2 - cervical myelopathy Flashcards
what covers the medial posterior surface of the vertebral bodies and annular fibers of the discs
posterior longitudinal ligament
what decreases the posterior medial disc buldge/herniation
posterior longitudinal ligament
degeneration of the disc height from aging or trauma can lead to compression of the ________ decreasing perfusion of the spinal cord
anterior spinal artery
what artery serves as one for the dorsal column and dorsal horn
posterior spinal artery
what artery serves the anterior 2/3 of the spinal cord
anterior spinal artery
decreased blood flow to _____ decreases this tracts function, therefore could see UMN signs in the lower limbs
watershed zone: posterior lateral white matter where the lateral corticospinal tract is located
with spondylosis, ______ thickens, decreasing anterior and posterior diameter of the spinal canal
ligamentum flavum
what results in sliding of superior articular process over the inferior decreasing the vertical and anterior/posterior dimensions of the IVF
spondylosis
_____ of the neck and head may decrease signs and symptoms of myelopathy while increasing signs and symptoms of cervical radiculopathy
flexion: increases the a-p diameter of the cervical spinal canal, but stretches nerve roots
myelopathy sign: UMN signs of lower extremity (uni or bilaterally)
- spasticity in quads and triceps surae
- weakness in hamstrings and tib anterior
- hyperreflexia in patella and ankle
- clonus (repetitive contraction with stretch and hold of ankle)
- pathological reflex (extensor plantar response)
myelopathy signs: dorsal column dysfunction
dysequilibrium (decreased proprioception)
decreased touch and vibration
myelopathy sign: LMN signs in upper limb
- weakness
- atrophy
- twitches (fasciculations)
how to test for myelopathy
- touch and vibration with patients head in neutral pos
- test ankle reflex and plantar response
- patient extend their head and neck
- retest touch, vibration, ankle and plantar reflexes
- if normal in neutral and abnormal in extension, consider myelopathy
trauma causing cervical myelopathy
- sudden extreme extension
- severe whiplash
- extension of head with tooth extraction
- cervical manipulation
symptoms of cervical myelopathy
painful, stiff neck
shoulder arm pain
spastic weakness in legs (UMN)
what is the finger escape sign
unable to maintain full finger extension and adduction of the ulnar digits
symptoms of cord compression in LE
legs feel stiff and heavy
gives out quickly after exercise
toe scrapes floor during swing phase of gait
exam reveeals of cervical myelopathy in LE
spasticity more than weakness
increased muscle stretch reflexes
Pt may believe only onel leg is affected but is common to see extensor plantar response bilaterally
sensory changes in LE
numbness and/or tingling of soles of feet and around ankles
impaired vibration and position sense (dorsal columns)
asymmetrical
AP diameter of spinal canal less than ____ mm leaves insufficient room for the cord
9-10
diameter decrease does no correlate well with presence and degree of spinal cord injury
is there vision trouble in CM
no
what three tracts are affected by MS
DC - paresthesias in all limbs and with loss of JPS ataxia
CST - lesion spastic legs, ext plantar response
SPTT - deep achiness and pain and thermal loss
amyotrophic lateral sclerosis signs
LMN sings in UE
UMN signs in LE
preservation of reflexes in presence of weakness and atrophy
could be due to a B12 problem/deficiency
peripheral nn early with ataxia developing later d/t sensory loss
extensor plantar response with absent reflexes d/t loss of peripheral fibers
subacute combined degeneration
DC degeneration
CST degeneration
