Neurological

Question 1

What is the MOI for spinal cord injury?

Answer 1

Compression (vertebrae slip back into spinal cord)
Contusion (bam)
Distraction (tensile load through spinal cord)
*usually don’t see spinal cord laceration/transection, more so tissue damage

Question 2

What will dictate which deficits will happen when looking at motor and sensory consequences of SCI?

Answer 2

The level of injury (ex. Cervical/thoracic/lumbar)

Question 3

We have a spinal cord classification, consisting of

Answer 3

Different levels of injury and function (partial or more complete loss of sensory and motor function)

Question 4

Most of our spinal cord injuries will be in which part of the spine? Why is this a problem?

Answer 4

Cervical, dangerous because it’s the highest cervical level
If you mess it up it impacts a lot of areas

Question 5

Damaging the dorsal roots would mean what?

Answer 5

More sensory issues, afferent

Question 6

If we injury ventral roots, what does this mean

Answer 6

Efferent, can anticipate motor deficits if the injury focused here

Question 7

Whats the SCI example krista gave in class? Ie MOI

Answer 7

Tackled, head in ground
- axial / compressive load going through spine
- might go into extreme flexion or extension of cervical spine near head
- excessive cervical flexion

Question 8

What could happen with vertebrae from an SCI MOI

Answer 8

• vertebrae might not line up
• dislocation of ZA joint in cervical spine
• if you move vertebrae forward you might get spinal cord issues
• can also have fracture of vertebrae, if you fracture the point the other part could go into spinal cord
• fracture/dislocation + issue at spinal cord level

Question 9

What injury mimics fhe signs and symptoms of a cervical SCI but is transient/short lived in nature?

Answer 9

Cervical cord neuropraxia

Question 10

What might a cervical cord neuropraxia look like

Answer 10

• mimics full spinal cord injury
• crushes, damages, person can’t feel limbs
• reverses in short period of time (miracle!)
• on the surface looks super severe
• could be a minute/24/48 hours/2 weeks but these effects are temporary, no actual damage to spinal cord

Question 11

Cervical cord neuropraxia could also be referred to as

Answer 11

Spinal cord concussion
- mimics some physiological impacts
- similar metabolic dysfunction

Question 12

What are the types of spinal cord injury? In order from least to most severe

Answer 12

Neuropraxia, axonotmesis, neurotmesis

Question 13

Describe neuropraxia in terms of severity

Answer 13

• axons are fully intact
• the epineurial layer has some level of disruption
• has been stressed in some way but connectivity is still fully there
• that’s why we get this function back, did jot actually break up communication piece
• temporary

Question 14

Describe the severity of axonotmesis

Answer 14

• have some disruption in connectivity of the axon
• will have longer recovery time, could be as long as 3 months
• structural disruption in axon

Question 15

Describe the severity of neurotmesis

Answer 15

• disruption all the way through axon and epineurial layer

Question 16

What condition presents a higher risk for CCN?

Answer 16

Congenital spinal stenosis

Question 17

Define stenosis and how it would be applied to the spinal cord

Answer 17

Narrowing of pathway/hole (in this case spinal canal)
- less space for spinal cord to fit in
- when comparing anterior posterior dimensions of vertebral body and canal, should be roughly equal in healthy people (in stenosis this canal is 80% width)

Question 18

Given the structure of the spinal cord, why might stenosis be an issue in certain sections?

Answer 18

• spinal cord doesn’t have a consistent cross sectional area
• bottom in lumbar is more narrow cause less nerve innervation
• cervical spine hs the largest cross sectional area
• if we have a smaller spinal canal this could be an issue

Question 19

What is the MOI for brachial plexus neuropraxia?

Answer 19

1. Traction mechanism (pull apart)
2. Compression mechanism (compressing nerve roots thst build the brachioplexus right aa they branch out of SC, happens in opposite direction of flexion)
   - compression of lateral flexion and extension will, close down on nerve roots
   - nerve exits intervertebral foramen (check)
3. Direct blow (to brachioplexus)
   - exposed, just a thin muscle layer on top, window between muscles leaves a weak spot

Question 20

What happens to the head to pull the brachioplexus apart?

Answer 20

Head is pulled away from shoulder in some way
- sometimes falling, sometimes pulling
- lateral flexion of cervical spine pulls it apart
*review anatomy, nerve origins between c5 and t1

Question 21

What lay terminology describes brachial plexus neuropraxia?

Answer 21

Burner or a stinger

Question 22

Which spinal nerves are typically affected in brachial plexus neuropraxia?

Answer 22

Even though we can think of whole brachioplexus as available for damage, usually it’s upper part (c5, c6 nerve roots)
- c5 and c6 are more superficial and vulnerable

Question 23

Describe the clinical presentation of brachialplexus neuropraxia

Answer 23

• unilateral issue, shows up in one arm only
• reduction in cervical spine ROM and pain
• have function below the site of injury (difference between sci and this)
• injury location is anything fed by brachioplexus
• neurological symptoms can dissolve

Question 24

Most people will return to play in how many hrs after brachial plexus neuropraxia? Why?

Answer 24

24
- doesn’t rip apart axons/communication structure, therefore transient

Question 25

What other condition is brachial plexus neuropraxia associated with?

Answer 25

Congenital spine stenosis

Question 26

When we’re in a field setting and one of these happens, we will look at

Answer 26

Broader neurological testing

Question 27

Define a dermatome

Answer 27

The area of skin that a specific spinal nerve collects sensory information from
- mapped area on surface of body that matches up with spinal nerve

Question 28

Describe dermatome testing

Answer 28

• most neural structures will have motor and sensory components
• sensation is where we will test dermatome
• a specific part of body is sped by specific spinal nerve
• to test function of spinal level, we can test their ability to detect sharp stimuli or soft dull stimulus (don’t poke the skin, just poking or brushing something along it)

Question 29

What area corresponds to c5

Answer 29

Lateral side of elbow and upper arm

Question 30

What area corresponds to c6

Answer 30

Finger 1 and 2, radial side of forearm

Question 31

What area corresponds with c7

Answer 31

Finger 3

Question 32

What area corresponds with c8

Answer 32

Finger 4 and 5

Question 33

What area corresponds with t1?

Answer 33

Ulnar side of elbow and forearm

Question 34

Tingling in pinky could mean what?

Answer 34

Issue with c8

Question 35

Define myotome

Answer 35

A joint action (or actions) produced by a group lf muscles that rely heavily on the motor messages traveling along that spinal nerve *motor output

• every action is driven by partnerships of different spinal nerves
• we can kook at global function and say it’s generally influenced by l2 for example
• of you want to test l2, you can ask person to do hip flexion

Question 36

How can we test myotomes?

Answer 36

Can do resisted strength tests and see what they can do

• can provide hints that it’s a neurological injury
• resistance test (grade out of 5), isometric with rom tables

Question 37

What myotome area corresponds to c5

Answer 37

Elbow flexion

Question 38

What movement corresponds with c6

Answer 38

Wrist extension

Question 39

What movement corresponds with c8?

Answer 39

Finger flexion

Question 40

What movement corresponds with t1?

Answer 40

Finger abduction