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MSK EXAM B > Week 6 Lecture (Cards Done) > Flashcards

Week 6 Lecture (Cards Done) Flashcards

1
Q

What are the two ways a traumatic spinal injury can occur?

A

Fractures & Dislocations

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2
Q

List the 6 types of atraumatic spinal cord injuries.

A
  • Spondylolisthesis
  • Disease
  • Pathalogic (eg. compression wedge due to osteoporosis)
  • NSLBP
  • Radicular Pain Syndrome
  • Radiculopathy
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3
Q

Describe the 3 pathophysiological features of a stable traumatic SCI.

A
  • Vertebral components will not be displaced by normal movements.
  • If neural elements undamaged little risk of being damaged
  • Often treated with support (collar/brace); pain managed (analgesia/RIB)
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4
Q

Describe the 2 pathophysiological features of an unstable traumatic SCI.

A
  • Significant risk of displacement and consequent further damage
  • Conservative treatment &/ Neurosurgery
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5
Q

Describe the pathomechanics of a traumatic SCI.

A

Traction - Resisted muscle effort
Direct - Penetrating injury
Indirect (most common) - Excessive mechanical stress/compression (eg. fall from height, MVA)

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6
Q

State the two major principles of acute care for SCI.

A
  • Avoid inappropriate movement & examination (assume an injury before being cleared & immediately use neck collar)
  • High index of suspicion (symptoms & signs may be minimal) (blunt injury above the clavicle, loss of consciousness)
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7
Q

State the 3 ways to assess the neck in acute SCI.

A
  • Supporting head with hands
  • Facial injuries
  • 5Ds - dizziness, diplopia, dysphagia, dysarthria, drop attacks
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8
Q

State the 4 ways to assess the back in acute SCI.

A
  • Log roll
  • Deformity
  • Signs of trauma
  • Cauda Equina Syndrome- bladder & bowel
    function, saddle paraesthesia/anaesthesia; ataxic gait; LBP; leg pain (uni/bi-lat)
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9
Q

What are the 4 components of a neurological examination?

A
  • Dermatomes
  • Myotomes
  • Reflexes
  • Babinski Reflex (extension of hallax indicates Upper motor neurone lesion and damage to corticospinal tract)
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10
Q

What are the 4 principles of management of SCI in acute care?

A
  • Preserve neurological function
  • Minimise threat of neurological examination
  • Stabilise spine
  • Rehabilitate patient
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11
Q

What are the 5Ds in assessment of neck after SCI?

A 
dizziness
diplopia (double vision)
dysphagia (difficulty swallowing)
dysarthria (speech problem)
drop attacks
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12
Q

What are 5 signs of Cauda Equina syndrome?

A
  • bladder & bowel disfunction
  • saddle paraesthesia (tingling)/anaesthesia
  • ataxic gait
  • LBP
  • leg pain (uni/bi-lat)
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13
Q

What are the clinical features of cervical whiplash?

A
  • Often pain onset 12-48 hours after injury
  • Pain diffuse and across neck and scapular
  • H/As, dizziness, blurring vision, paraesthesia (tingling) in arms, TMJ pain, tinnitus
  • Pain & restricted neck movement
  • Unremarkable neuro exam
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14
Q

What are the 3 elements in the management of cervical whiplash injury?

A
  • Support (soft collar, semi-rigid collar)
  • Education (positioning, rest, analgesia, return to work, prognosis, empathy)
  • Postural correction, ROM exercises, graded isometric and dynamic exercises
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15
Q

What percentage of patients recover fully from cervical whiplash in few weeks following injury?

A

50-60% of patients fully recover within a few weeks of cervical whiplash injury

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16
Q

How long for symptoms to diminish in most cases of cervical whiplash?

A

3 months (3/12)

17
Q

What percentage of patients report ongoing symptoms and loss of function after cervical whiplash?

A

2-5%

18
Q

What are the negative prognostic indicators for cervical whiplash?

A
  • older age
  • severity of injury at outset
  • longer lasting symptoms
  • pre-existing IV disc degeneration
19
Q

What are the 5 clinical features of Low Energy Insufficiency Thoracolumbar Wedge Compression?

A
  • Osteoporosis (cortical and trabecular bone loss)
  • Flexion & axial compression (max stress at anterior cortical shell)
  • Pain (local and due to pain in Sacroiliac joint
  • Reduced function and mobility
  • Increased thoracic kyphosis, decreased lumbar lordosis
20
Q

What are some non-operative treatments for Low Energy Insufficiency Thoracolumbar Wedge Compression?

A
  • Heat, massage, analgesia, brace
  • Anti-osteoporotic medication; Vit D
  • Ex program to increase axial strength
  • Resisted exercise
  • Weight-bearing to prevent reduction in bone density
21
Q

What are some of the clinical features of acute LBP (7 in total)?

A
  • 8th most common condition managed by GPs
  • Mechanism = unguarded flexion + rotation
  • History of LBP
  • Forward flexed posture and/or pelvic shift
  • Leg pain (uni/bi)
  • Neurological symptoms
  • Pain DB/C/Sneeze
22
Q

What are the prognoses for acute LBP?

A
  • Most patients improve in 4-6/52
  • Pain & disability may persist for months
  • Small % remain severely disabled
  • Recurrence is common in first 12 months in people with unresolved symptoms
23
Q

What techniques are recommended for diagnosis of LBP?

A
  • Diagnostic triage (NSLBP, serious pathology)
  • Screen for serious pathology (red flags)
  • Neuro screening (incl SLR test)
  • Psychosocial factors (yellow flags) if no improvement
  • Routine imaging not needed for NSLBP
24
Q

What are the 5 common recommendations for treatment of LBP?

A
  • Reassure patients that prognosis is usually good
  • Advise to stay active
  • Prescribe meds if needed (paracetamol > NSAIDs > opiods)
  • Discourage bed rest
  • DO NOT advise supervised exercise program
25
Q

What are the stages in the model of care for LBP?

A
  1. Assessment
  2. Triage
  3. No imaging in NSLBP
  4. Personalised education
  5. Evidence-based management
  6. Plan follow-up
26
Q

What are the clinical features spondylolisthesis?

A
  • Ithmus defect
  • USU due to degen changes of z jts & disc
  • Often asymptomatic
  • Pathogenesis (genetic & mechanical features)
  • LBP
  • Neural involvement
27
Q

What are the types of pathogenesis in spondylolisthesis?

A
  • Degenerative
  • Congenital
  • Traumatic
  • Pathogenic
28
Q

How is neuro function affected by spondylolisthesis?

A
  1. Cauda equina syndrome (spinal claudication)

2. Radiculopathy (nerve root impingement)

29
Q

What type of imaging should you do for spondylolisthesis?

A
  • Radiographs - AP, lateral, 30 degrees oblique

- CT/MRI

30
Q

State ways to manage spondylolisthesis?

A
  • Flexion exercises
  • Braces/supports
  • RIB
  • Restriction of activities
  • NSAIDs
  • Analgesics
  • Surgery
31
Q

What are the 3 mechanisms of pelvic fracture?

A
  1. AP compression (e.g. front on collision of car vs human)
  2. Lateral compression (e.g. side on impact MVA)
  3. Vertical shear (e.g. fall from height onto one leg)
32
Q

What are the clinical features of pelvic fracture?

A
  • Usually 1 fracture
  • 2 fractures if pelvis rigid
  • 2nd fracture may be hard to see
  • Can be stable/unstable
33
Q

What are features of STABLE pelvic fracture?

A
  • pain on attempted walking
  • localised tenderness
  • rarely any visceral injury
34
Q

What are features of UNSTABLE pelvic fracture?

A
  • Unable to stand due to pain & shock
35
Q

What is the treatment for pelvic fracture?

A
  • RIB 4-6 weeks or mobilisation (WBAT)
  • Prophylaxis of thromboembolus
  • Bed exs & mobility - promote healing of # and prevent disuse atrophy/joint stiffness

MSK EXAM B (3 decks)

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