Assessment of spine and spinal cord

Question 1

define paresthesia

Answer 1

abnormal sensation = burning, pricking, tingling tickling

Question 2

define dysesthesia

Answer 2

impairment of sensation short of anesthesia

Question 3

define paresis

Answer 3

partial loss of movement or impaired movement

Question 4

define dermatome

Answer 4

cutanoeus area served by individual sensory root

Question 5

define myotome

Answer 5

muscles innerv by individual motor root

Question 6

define radiculopathy

Answer 6

sensory and/or motor dysfunction due to injury to a nerve root from lateral herniation

Question 7

define myelopathy

Answer 7

disorder resulting in spinal cord dysfunction from central herniation

Question 8

spinothalamic tract
function
cross

Answer 8

function = pain and temp (cold/hot)

cross = 2-3 segments above root entry level in anterior cord

Question 9

posterior column
function
cross

Answer 9

function = vibration, position, 2-point discrim

cross = medulla (brain stem)

Question 10

corticospinal tract
function

cross

Answer 10

function = motor
cross = lower medulla (brain stem)

Question 11

where nerve roots exit

c1-7

Answer 11

exit above same numbered vertebra

c7 above c7

Question 12

where nerve roots exit

c8

Answer 12

c8 exits below c7 vertebra

t1 below t1

Question 13

where nerve roots exit

t1-s5

Answer 13

exit below same number vertebra

Question 14

know cord level each vertebral body overlies

upper cervical

Answer 14

vertebra number overlies cord segment of same number

Question 15

know cord level each vertebral body overlies

lower cervical

Answer 15

vertebra number overlies cord segment number + 1

c6 bone = c7 cord

Question 16

know cord level each vertebral body overlies

upper thoracic

Answer 16

vertebra number overlies cord segment number + 2

T4 bone = T6 cord

Question 17

know cord level each vertebral body overlies

lower thoracic/lumbar

Answer 17

vertebra number overlies cord segment number +2/3

t11 bone, L1-2 cord

Question 18

know cord level each vertebral body overlies

lower edge of l1 vertebral body

Answer 18

overlies cord tip (conus medullaris)

Question 19

where is conus medullaris

what does it supply

Answer 19

s2-s5 = supplies bladder, rectum, genitalia

Question 20

what happen if lesion conus medullaris

Answer 20

late pain in thighs and butt, pelvic floor weakness

symmetric saddle anesthesia
early bladder dysfunction, bowel, sex

Question 21

cauda equina formed by

what happens if lesion

Answer 21

Lumbar sacral roots within lumbosacral cistern

early root pain radiating to legs (conus = late), leg weakness, decr DTR, patchy, asymm “saddle

late bladder dysfunction (conus = early), bowel, sex dysfunction

Question 22

if lesion extramedullary (outside cord)

if lesion intramedullary (inside cord)

Answer 22

early pain
UMN signs

early bladder dysfunction

Question 23

extaspinal blood supply includes

Answer 23

paired posterior spinal arteries (supplies posterior column)

single anterior artery (supplies spinothal and corticospinal tracts and watershed T1-T4 or L1)

Question 24

intraspinal blood supply includes

Answer 24

gray matter require more blood than white

Question 25

define radiculopathy pain

Answer 25

variable- shooting, burning, tingling, numb radiates into dermatome or myotome

Question 26

exam for radiculopathy localization exercabation

Answer 26

possible LMN signs localization based on root of muscles/dermatome exacerbation by neck flex/ext/rot, shoulder movement, cough

Question 27

exam for radiculopathy | relieving factors

Answer 27

rest, immob, graded therapy, NSAIDs +/- muscle relaxant

Question 28

common causes of radiculopathy direction of herniated disc posterior herniation causes -->

Answer 28

compression by DJD --> bony prolif or herniated disc near intervertebral foramen other = herpes zoster, cancer, lymphoma discs herniated laterally posterior herniation --> myelopathy

Question 29

describe lhermitte's symptom due to

Answer 29

neck flxion --> "electric shock" sensation down back and/or arms due to posterior column disease (MS, disc, B12 deficiency, mass)

Question 30

LMN vs UMN signs

Answer 30

LMN = atrophy, fasciculations, decr tone, decr DTR UMN = spasticity, hyperreflexia, babinski

Question 31

voiding controlled by

Answer 31

higher cortical centers developing as continence and achieved in childhood

Question 32

define incontinence

Answer 32

neuro pathways that innerv bladder interrupted or when problem with pelvic floor/sphincter assoc with spinal cord damage

Question 33

bladder controlled by neurons terminate where?

Answer 33

1) areas of brain/brainstem sending axons down cord medial to LCST 2) terminate on preganglionic parasympathetic at S2-S4 3) synapse on postgangl parasymp near bladder 4) innerv detrusor (smooth muscle) for voiding

Question 34

muscle spindles, nociceptors, and receptors in detrusor and bladder wall have cell bodies where? involved in what?

Answer 34

DRG at S2-S4 involved in reflex arc and ascend nervous system via AL path and dorsal column

Question 35

what happens when bladder fills?

Answer 35

1) muscle spindle of detrusor/bladder stretched 2) incr firing --> incr neuronal firing of symp preganglionic neurons in IML cell column from T11-L1 3) constriction of internal urethral sphincter decr firing of pregangl symp at S2-S4 to inhib contract of detrusor 4) then activates higher centers in bain 5) inhib of symp tone and activ of parasymp contraction of detrusor

Question 36

if PNS LMNs injured if sensory afferents affect if intact sensory with damaged motor

Answer 36

weakness, atrophy, hyporeflexia bladder does not contract = overflow incontinence no sensation of full bladder urge to void but detrusor can't contract

Question 37

where can LMN injury occur

Answer 37

preganglionic neuron at S2-S4 sacral root of cauda equina, pelvic nerve pelvic plexus 2ndary postgangl, parasymp neuron innerv detrusor

Question 38

if UMN lesions injuured

Answer 38

to affect bladder, must be bilateral detrusor flaccid --> urinary retention --> flaccid bladder over time, get spasticity and bladder hyper contracts causing freq and urgency (activ parasymp motor neuron with little stretch and cause spastic bladder)

Question 39

c5 sensory motor reflex

Answer 39

``` sensory = shoulder, upper lat arm motor = deltoid, infraspinatus, bicep ``` reflex = biceps

Question 40

c6 sensory motor reflex

Answer 40

``` sensory = 1st and 2nd digits of hand motor = wrist extension, biceps ``` reflex = biceps, brachioradialis

Question 41

c7 sensory motor reflex

Answer 41

``` sensory = 3rd digit motor = triceps reflex = triceps ```

Question 42

L4 sensory motor reflex

Answer 42

``` sensory = knee, medial leg motor = psoas, quad reflex = patellar ```

Question 43

L5 sensory motor reflex

Answer 43

``` sensory = dorsal foot, great toe motor = foot dorsiflex, big toe ext, foot eversion/inversion ``` reflex = none

Question 44

S1 sensory motor reflex

Answer 44

sensory = lat foot, small toe, sole of foot ``` motor = foot plantarfelx reflex = achilles ```

Question 45

dermatomes for nipple line xyphoid umbilicus

Answer 45

``` nipple = T4 xyphoid = T6 umbilicus = T10 ```

Question 46

Lhermitte's sign

Answer 46

with cervical stonosis and flex head —> shock extend down spine and compression of spinal cord acutely (cervical myelopathy)

Question 47

spurling's sign

Answer 47

turn head towards nerve root (foramen narrows) —> shock sensation along the tract of nerve root

Question 48

Lasegue's sign

Answer 48

in lumbosacral spine, narrowed neural foramen and raise leg and dorsiflex ankle —> stretch sciatic nerve, shooting pain in distrib of nerve root of sciatic nerve

Question 49

dysestheia vs paresthesia

Answer 49

dysesthesia is more unpleasant