Week 6 Lecture (Cards Done) Flashcards
What are the two ways a traumatic spinal injury can occur?
Fractures & Dislocations
List the 6 types of atraumatic spinal cord injuries.
- Spondylolisthesis
- Disease
- Pathalogic (eg. compression wedge due to osteoporosis)
- NSLBP
- Radicular Pain Syndrome
- Radiculopathy
Describe the 3 pathophysiological features of a stable traumatic SCI.
- 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)
Describe the 2 pathophysiological features of an unstable traumatic SCI.
- Significant risk of displacement and consequent further damage
- Conservative treatment &/ Neurosurgery
Describe the pathomechanics of a traumatic SCI.
Traction - Resisted muscle effort
Direct - Penetrating injury
Indirect (most common) - Excessive mechanical stress/compression (eg. fall from height, MVA)
State the two major principles of acute care for SCI.
- 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)
State the 3 ways to assess the neck in acute SCI.
- Supporting head with hands
- Facial injuries
- 5Ds - dizziness, diplopia, dysphagia, dysarthria, drop attacks
State the 4 ways to assess the back in acute SCI.
- Log roll
- Deformity
- Signs of trauma
- Cauda Equina Syndrome- bladder & bowel
function, saddle paraesthesia/anaesthesia; ataxic gait; LBP; leg pain (uni/bi-lat)
What are the 4 components of a neurological examination?
- Dermatomes
- Myotomes
- Reflexes
- Babinski Reflex (extension of hallax indicates Upper motor neurone lesion and damage to corticospinal tract)
What are the 4 principles of management of SCI in acute care?
- Preserve neurological function
- Minimise threat of neurological examination
- Stabilise spine
- Rehabilitate patient
What are the 5Ds in assessment of neck after SCI?
dizziness diplopia (double vision) dysphagia (difficulty swallowing) dysarthria (speech problem) drop attacks
What are 5 signs of Cauda Equina syndrome?
- bladder & bowel disfunction
- saddle paraesthesia (tingling)/anaesthesia
- ataxic gait
- LBP
- leg pain (uni/bi-lat)
What are the clinical features of cervical whiplash?
- 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
What are the 3 elements in the management of cervical whiplash injury?
- Support (soft collar, semi-rigid collar)
- Education (positioning, rest, analgesia, return to work, prognosis, empathy)
- Postural correction, ROM exercises, graded isometric and dynamic exercises
What percentage of patients recover fully from cervical whiplash in few weeks following injury?
50-60% of patients fully recover within a few weeks of cervical whiplash injury
How long for symptoms to diminish in most cases of cervical whiplash?
3 months (3/12)
What percentage of patients report ongoing symptoms and loss of function after cervical whiplash?
2-5%
What are the negative prognostic indicators for cervical whiplash?
- older age
- severity of injury at outset
- longer lasting symptoms
- pre-existing IV disc degeneration
What are the 5 clinical features of Low Energy Insufficiency Thoracolumbar Wedge Compression?
- 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
What are some non-operative treatments for Low Energy Insufficiency Thoracolumbar Wedge Compression?
- 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
What are some of the clinical features of acute LBP (7 in total)?
- 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
What are the prognoses for acute LBP?
- 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
What techniques are recommended for diagnosis of LBP?
- 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
What are the 5 common recommendations for treatment of LBP?
- 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
What are the stages in the model of care for LBP?
- Assessment
- Triage
- No imaging in NSLBP
- Personalised education
- Evidence-based management
- Plan follow-up
What are the clinical features spondylolisthesis?
- Ithmus defect
- USU due to degen changes of z jts & disc
- Often asymptomatic
- Pathogenesis (genetic & mechanical features)
- LBP
- Neural involvement
What are the types of pathogenesis in spondylolisthesis?
- Degenerative
- Congenital
- Traumatic
- Pathogenic
How is neuro function affected by spondylolisthesis?
- Cauda equina syndrome (spinal claudication)
2. Radiculopathy (nerve root impingement)
What type of imaging should you do for spondylolisthesis?
- Radiographs - AP, lateral, 30 degrees oblique
- CT/MRI
State ways to manage spondylolisthesis?
- Flexion exercises
- Braces/supports
- RIB
- Restriction of activities
- NSAIDs
- Analgesics
- Surgery
What are the 3 mechanisms of pelvic fracture?
- AP compression (e.g. front on collision of car vs human)
- Lateral compression (e.g. side on impact MVA)
- Vertical shear (e.g. fall from height onto one leg)
What are the clinical features of pelvic fracture?
- Usually 1 fracture
- 2 fractures if pelvis rigid
- 2nd fracture may be hard to see
- Can be stable/unstable
What are features of STABLE pelvic fracture?
- pain on attempted walking
- localised tenderness
- rarely any visceral injury
What are features of UNSTABLE pelvic fracture?
- Unable to stand due to pain & shock
What is the treatment for pelvic fracture?
- RIB 4-6 weeks or mobilisation (WBAT)
- Prophylaxis of thromboembolus
- Bed exs & mobility - promote healing of # and prevent disuse atrophy/joint stiffness
