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MSK > Trauma ortho 1 > Flashcards

Trauma ortho 1 Flashcards

Shoulder problems Elbow problems Spinal problems Back pain problems

1
Q

Name 5 categories of LBP causes

A
  1. Spondylogenic - originating in the spine
  2. Neurogenic
  3. Viscerogenic
  4. Vascular
  5. Psychogenic
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2
Q

Mechanical back pain is managed in ______.

Investigations:
should you offer lumbar spine x-ray?
When should you offer MRI?

A

Mechanical back pain is managed in primary health care
Investigation: lumbar spine x-ray should not be offered
Offer an MRI only if result likely to change management or sinister causes are suspected

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3
Q

Mechanical back pain: first-line treatment approach (3)

A
  1. Reassurance, explanation
  2. NSAIDs (+PPI over 45)
  3. Avoid bed rest, keep active, early return to work
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4
Q

Mechanical back pain: second-line treatment approach

A

If fails to settle, physiotherapy

Alternative therapies e.g. facet joint injections, acupuncture

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5
Q

Persistent mechanical back pain: third line treatment approach

A

Rehabilitation programmes

Pain clinics

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6
Q

Prolapsed intervertebral disc
What can happen to the…
Annulus
Nucleus pulposus

A

Annulus can tear
Nucleus can prolapse
Resulting in cord/nerve root compression

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7
Q

Prolapsed intervertebral disc

Which ligaments are involved

A

Anterior longitudinal ligament

Posterior long ligament

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8
Q

Prolapsed intervertebral disc
Disc changes in normal aging - name 4
Physiological and on imaging

A
  1. Decreased water content of discs
  2. Disc space narrowing
  3. Degenerative x-ray changes
  4. Degenerative changes in facet joints
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9
Q

Prolapsed intervertebral disc

What social factor can aggravate this?

A

Normal degenerative disc changes can be aggravated by smoking

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10
Q

Prolapsed intervertebral disc

Pathological disc changes 6

A

Tearing of annulus fibrosis, prolapse of nucleus
Osteophytes causing nerve root compression
Central spinal stenosis
Abnormal movement - trauma
Spondylosis
Spondylolisthesis

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11
Q

Nerve root pain

  • distribution of pain
  • progression/prognosis
  • 2 modalities of treatment
  • when to refer
A 
Distribution of pain - radicular, along nerve root
Prognosis: usually settles in 3 months
2 modalities of treatment:
- Physiotherapy
- Strong analgesia
Refer after 12 weeks and do MRI
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12
Q

4 types of disc problems
Which one is the most common, asymptomatic?
Which one involves desiccated disc material free in canal?
Which one is caused by weakened but intact annulus?

A

Bulge - common, asymptomatic
Protrusion - weakened annulus but intact
Herniation - through annulus but still in continuity
Sequestration - desiccated disc material free in canal

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13
Q

Cervical disc prolapse

Which nerve roots

A

C5-6

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14
Q

Thoracic disc prolapse

Which nerve roots

A

T11-12

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15
Q

Lumbar disc prolapse

Most common nerve root involvement

A

L4/5

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16
Q

Lumbar disc prolapse

Which ligament weakening causes posterolateral lumbar disc prolapse?

A

PLL

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17
Q

3 types of thoracic disc prolapse and herniations

A

Central
Posterolateral
Lateral

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18
Q

Cauda Equina Syndrome (CES)
Name 6 causes
Which is the most common cause

A
  1. Central lumbar herniated disc
  2. Tumours
  3. Trauma
  4. Spinal stenosis
  5. Epidural abscess
  6. Iatrogenic
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19
Q

Name 3 iatrogenic causes of CES

A

Spinal manipulation
Spinal epidural
Spinal surgery

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20
Q

Name 4 clinical features of Cauda Equina Syndrome (CES)

Investigation of choice
If this is contraindicated, what investigative modalities are used? (2)

A
  1. Injury or precipitating event
  2. Location of symptoms
    - Bilateral buttock and leg pain, varying dyasthesia and weakness
  3. Bowel and bladder dysfunction
    - urinary retention, incontinence
  4. Saddle anaesthesia - loss of anal tone, loss of anal reflex

Investigation of choice - MRI
If contraindicated, use CT or pyelogram

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21
Q

Cauda Equina Syndrome (CES)
Treatment
Prognosis after surgery

A

Treatment - surgery outcome good if surgery within 48 hours

Prognosis after surgery - third will not regain function of bladder/sensory/motor deficit

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22
Q

Degenerative cervical spondylosis

Why might a patient lose consciousness in this situation

A

Osteoarthritis

Vertebral artery passing through foramina transversarium may get occluded in cervical spondylosis

23
Q

Degenerative cervical spondylosis
Name 5 clinical features excluding referred pain
What are the 3 areas of referred pain?
Complications [2]

A 
Cervical pain worsened by movement
Retro-orbital or temporal pain
Numbness, paresthesia of upper limbs
Limited ROM of cervical spine
Poorly localized tenderness
Referred pain
- occiput
- between shoulder blades
- upper limb

Complications include radiculopathy and myelopathy.

24
Q

Degenerative cervical spondylosis
Investigation largely dependent on clinical or imaging
What can imaging show to confirm dx (2)

A

Largely clinical diagnosis but x-ray can show osteophytes and narrowing disc space with
encroachment of intervertebral foramina

25
Q

What will be an indication of MRI at early stage of investigation (4)

A

Neurological symptoms:
Progressive myelopathy
Radiculopathy
Intractable pain

26
Q

What is Lhermitte’s sign

A

Neck flexion causing electric shock like sensation radiating down spine

27
Q 
Degenerative cervical spondylosis
Treatment approaches (3)
A

Wait and see
Avoid bed rest, keep active
Physiotherapy - after 4-12 weeks of not resolving pain

28
Q

Spinal stenosis/claudication

Presentation (4)

A

Bilateral - usually
Sensory dyasthesiae
Weakness - foot drop
Takes several minutes to ease after stopping walking (mimicking claudication)

29
Q

Spinal stenosis/claudication

Which factors improve/worsen symptoms

A

Worse walking down hills - extension

Better walking uphill, riding bicycle - flexion

30
Q

Spinal stenosis/claudication - Lateral recess stenosis

Tx (4)

A

Non-operative measures
Nerve root injection
Epidural steroid injection
Surgery

31
Q

Spinal stenosis/claudication - Central stenosis

Tx (3)

A

Non-operative measures
Epidural steroid injection
Surgery

32
Q

Spinal stenosis/claudication - foramina stenosis

Tx (4)

A

Non-operative measures
Nerve root injection
Epidural injection
Surgery

33
Q

Spondylosis definition (1)

A

defect of pars interarticularis

34
Q

Spondylolisthesis definition (1)

A

anterior displacement of vertebral body

35
Q

Spondylosis

2 symptoms

A
  1. LBP

2. Radicular symptoms occasionally

36
Q

Spondylosis
Investigations - 4
Treatment - 3 modalities

A 
X-rays
CT
MRI
Bone scan
Treatment
- Non-operative measures
- Injection therapy
- Surgery
37
Q

Spondylolisthesis

Wiltse Classification 5 categories

A 
Congenital
Isthmic
Degenerative
Traumatic
Pathologic
38
Q 
Spondylolisthesis
Surgical indications (2)
A

Indicated in persistent pain and/or nerve root entrapment

39
Q

According to ASIA classification of SCI, which grade has completely no chance of recovery

A

ASIA Grade A

40
Q

What fracture causes tetraplegia or quadriplegia

A

Cervical fracture

41
Q

In tetraplegia/quadriplegia, respiratory failure is due to loss of innervation of what? What nerve is this and state nerve roots

A

In tetraplegia/quadriplegia, respiratory failure is due to loss of innervation of diaphragm
Phrenic nerve C3-5

42
Q

Paraplegia definition (1)

A

Partial or total loss of use of the lower limbs

43
Q

What is spared in paraplegia

A

Arm function spared

44
Q

What are 2 partial cord syndromes

A

Central cord syndrome

Anterior cord syndrome

45
Q

Which patients and which type of injuries are typically affected in central cord syndrome

A

Elderly patients with arthritic neck with hyperextension injury (low velocity)

46
Q

What injury can cause central cord syndrome

A

Hyperexentension injury

47
Q

Clinical features of central cord syndrome

What is typically preserved? (2)

A

Weakness of arms > legs
Dyasthesias
Perianal sensation and lower extremity power preserved

48
Q 
Anterior cord syndrome
Presentation
What type of injury causes this (2)
Damage to what causes this?
What is preserved
A

Profound weakness
Type of injury causing this - hyperextension injury, anterior compression fracture
Damage to anterior spinal artery
Fine touch and proprioception preservaed

49
Q

Management of SCI

A

Prevent secondary insult/further damage

ABCD management

50
Q

What is ABCD management

A

Airway and c-spine
Breathing
Circulation
Disability - PR, peri-anal sensation

51
Q 
Spinal shock definition
Clinical features (2)
A

Transient depression of cord function below level of injury lasting several hours-days after injury
Clinical features
Flaccid paralysis
Areflexia

52
Q

Neurogenic shock
Cause (2)
3 clinical signs

A 
2 causes of neurogenic shock:
- Injuries above T6
- Secondary to disruption of sympathetic outflow leading to loss of sympathetic tone
3 Clinical signs
- Hypotension
- Bradycardia
- Hypothermia
53
Q

How to differentiate radiculopathy and named nerve pathology like ulnar nerve palsy?

A

Radiculopthy follows a dermatomal distribution, unlike named nerve pathology. The pattern of sensory loss cannot be explained by a single named nerve.

MSK (28 decks)

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