18: Basic Exam for spine Flashcards Preview

MSS > 18: Basic Exam for spine > Flashcards

Flashcards in 18: Basic Exam for spine Deck (61)
1

History of cancer and/or Unexplained weight loss -

– r/o malignancy

2

Loss of bowel or bladder control – r/o

r/o myelopathy or stenosis

3

Significant weakness in spine r/o

– r/o myelopathy or radiculopathy

4

Saddle anesthesia – r/o

myelopathy or cauda equina syndrome

5

Chronic corticosteroid use – r/o

compression fracture

6

Pt that has Immunosuppression and or fever – r/o

infection

7

IV drug use and back pain – r/o

infection

8

Pt with back pain and Prior spine surgery – r/o

hardware failure, adjacent segment disease, recurrent disc
herniation

9

A patient has back Weakness and/or numbness –
we should be suspicious for

nerve involvement

10

Pt has Morning stiffness, improves with activity but not with rest (<40 yo) – suspicious for


spondyloarthropathy

11

fracture of the pars interarticularis

Spondylolysis

12

anterior displacement of one vertebrae on another

Spondylolisthesis

13

a. Hyoid bone –
b. Thyroid cartilage –
c. First cricoid ring –
d. Most prominent spinous process –

C3
C4-5
C6
C7

14

Top of iliac crest located at

L4-5

15

Posterior superior iliac spine located at

S2

16

Expected ROM of Cervicle spine
1. Rotation:
2. Flexion:
3. Extension:
4. Sidebending:

Cervical spine
1. Rotation – ~70°
2. Flexion – ~45° (chin to chest)
3. Extension – ~55°
4. Sidebending – ~40°

17

Lumbar spine
1. Flexion –
2. Extension –
3. Lateral bending
4. Rotation

Lumbar spine
1. Flexion – ~75°
2. Extension – ~30°
3.Lateral bending – ~35°
4. Rotation

18

passive rapid flexion of middle finger distal phalynx. Positive test is flexion of thumb, index finger

Hoffman – signs of Upper Motor Neuron Lesion

19

stroking sole of foot resulting in great toe extension and toe
spreading

Babinski-- signs of Upper Motor Neuron Lesion

20

Straight leg raise (SLR) – lying supine, leg is raised with knee extended. Positive test is

reproduction of radicular symptoms with hip flexed between 30-70°

21

Femoral stretch test – lying prone, knee is flexed to 90° and thigh elevated. Positive test is

reproduction of anterior thigh radicular symptoms

22

Spurling – reproduction of ipsilateral radicular symptoms with cervical spine extension, rotation, lateral sidebending This test suggests

cervical nerve root involvement

23

Lhermitte – electrical shock sensation in limbs with cervical flexion suggests

cervical cord involvement

24

Pt comes in with axial low back pain after acute injury, such as lifting or twisting

Lumbar strain

25

Causes of lumbar strain

muscle disruption from excessive stretch or tension

26

During exam, pt experiences localized muscle tenderness, reduced ROM in their spine

lumbar strain

27

What imaging would we get for suspected lumbar strain?

usually none.

28

Tx for Lumbar Strain

Relative rest, NSAIDs, muscle relaxant, physical
therapy

29

Pt complains axial low back pain, gradual onset (cervical: worse with cervical extension;
lumbar: worse standing/walking, better sitting/lying)

Osteoarthritis

30

Etiology of osteoarthritis

gradual degenerative changes/osteoarthritis to zygoapophyseal (facet)
joints; more common age > 55

31

Expected Exam findings in patient with osteoarthritis
worse with:
better with:

nonspecific, pain provoked with active extension, relieved with flexion

32

Treatment for OA–

NSAIDs, mild analgesics.
Physical therapy (flexion bias), possibly facet joint injections

33

What imaging would we want to order for expected OA?

Imaging: none or plain lumbar x-rays.

34

Patient experiences pain and possible numbness/weakness in limb > axial spine
Lumbar: worse sitting/flexion, better standing/extension

Radiculopathy

35

most common cause of radiculopathy

disc herniation

36

Expected exam findings of patient with radiculopathy?

SLR or Spurling positive, neurologic deficits (myotomal weakness, decreased reflex, dermatomal reduced sensation)

37

Imaging ordered for suspected radiculopathy:

MRI, possible EMG.

38

Tx for patient with radiculopathy

Relative rest, physical therapy, surgical
discectomy if progressive/severe weakness or unresponsive to conservative care. For
pain, NSAIDs, oral or epidural corticosteroids, limited opioids, neuromodulators

39

Pt comes in with slowly progressive back and unilateral or bilateral leg pain. It is worse when standing, and better when sitting. Positive for shopping cart sign (bc flexes spinal canal)

Lumbar stenosis

40

You suspect your patient to have lumbar stenosis, what are the key DDx?

Differentiate from vascular claudication (must sit
or bend to relieve symptoms)

41

Causes of Lumbar Stenosis

narrowing of the spinal canal (due to disc herniation/ protrusion, ligamentum flavum thickening, osseous thickening of bone/facet joint, spondylolisthesis)

42

Imaging ordered for suspected Lumbar Stenosis

Imaging: MRI, possibly CT or EMG.

43

Treatment for Lumbar Stenosis

NSAIDs, neuromodulators, physical therapy (flexion bias), use of walker, epidural steroids, surgery for lumbar decompression

44

Patient comes in with back pain, numbness, weakness in arms and/or legs; balance and gait difficulties;
bowel/bladder dysfunction

cervical myelopathy

45

Etiology for suspected cervical myelopathy

cervical canal stenosis with spinal cord compression

46

On exam, patient has arm and/or leg weakness, upper motor neuron signs-- hyperreflexia, Hoffman/Babinski, ataxia, and increased tone

Cervical myelopathy

47

Treatment options for Cervical Myelopathy

Surgical decompression. No role for nonoperative
treatment

48

What imaging would you order for suspected cervical myelopathy?

MRI

49

Old patient comes in with sudden thoracic (or lumbar) pain with no history of trauma. On exam they are tender over spinous processes, paraspinals. Worse: lumbar flexion. Better: lumbar extension.
Normal neuro exam (unless nerve root affected)

Compression fracture

50

Causes of Compression fracture in spine

ii. Etiology – majority related to osteoporosis, older patients; anterior vertebral body
wedge fracture. T10, T11, T12, L1 most commonly. In younger patients w/o clear
etiology, consider malignancy, multiple myeloma. 1/3 are asymptomatic

51

Patient comes in with suspected comression fracture of spine. What imaging do you order?

plain x-rays, possibly MRI or CT; DEXA scan to eval for
osteoporosis.
If malignancy considered: CBC, SPEP, alkaline phosphatase, sed rate (malignancy for our younger pts)

52

Tx options for

NSAIDs, acetaminophen, calcitonin, mild opioids. Consider bracing for 6 weeks.
Physical therapy. Symptoms usually improve in 3 months.
Vertebroplasty/kyphoplasty a consideration, evidence of efficacy limited

53

Pt comes in with onset of low back pain < age 40, insidious, better with exercise, pain at
night and on waking, not improved with rest

Ankylosing spondylitis

54

Suspected etiology of Ankylosing spondylitis

inflammatory spondyloarthropathy, usually sacroiliitis initially. Can be associated with uveitis, inflammatory bowel disease, psoriasis among other features

55

On exam, patient i has reduced

Reduced lumbar ROM, often tender to palpation over sacroiliac joints with
positive joint provocative tests (FABER, Gaenslen).

56

You suspect a patient of having ankylosing spondylitis. What imaging would you order?
Early?
Late?
Labs?

plain x-rays – earliest finding sacroiliitis.
Later syndesmophytes can progress to “bamboo spine”. Labs: HLAB27, C-reactive protein, sed rate.

57

Tx options for patient with ankylosing spondylitis?

NSAIDs – typically marked relief. Consider anti-TNF agents.
Physical therapy, emphasis on spine extension

58

Pt comes in and complains of leg pain, numbness, weakness; saddle anesthesia; bowel/bladder
dysfunction (urinary retention most common; urinary or stool incontinence). Dx?

Cauda equina syndrome

59

Etiology of patient with cauda equina syndrome

large herniated disc compressing cauda equina most common (also epidural tumor, abscess, or hematoma)

60

What exam findings would you expect to see in someone with cauda equina syndrome?

reduced or absent reflexes, weakness, decreased rectal tone

61

Tx for cauda equina syndrome?

Surgical emergency