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Anatomy Chapter 13 > Back and Spine > Flashcards

Back and Spine Flashcards

1
Q

vertebrae

A

protect the spinal cord

-a series of small bones forming the backbone

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2
Q

How many vertebrae

A

33

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3
Q

How many cervical vertebrae

A

7

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4
Q

How many thoracic vertebrae

A

12

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5
Q

How many lumbar vertebrae

A

5

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6
Q

sacrum

A

5 fused sacral vertebrae

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7
Q

coccyx

A

3-5 fused coccygeal vertebrae

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8
Q

Causes of Bone Pain

A

-Fracture
-osteoporosis/medications
-cancer
-IV drug use

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9
Q

Cancer

A

-Primary carcinoma
-secondary carcinoma
-multiple myeloma

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10
Q

Primary carcinoma

A

starts in the back

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11
Q

Secondary carcinoma

A

starts somewhere else and metastasizes to the back

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12
Q

Multiple myeloma

A

spinal cancer

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13
Q

LEAD KETTLE

A

-Can metastasize to bone
-PB KTL
(prostate, breast, kidney, thyroid, lung)

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14
Q

Spinal nerves

A

exit through intervertebral foramen which is the space between two discs

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15
Q

Dermatomes

A

area on the surface of the body innervated by afferent fibers from one spinal root

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16
Q

Signa of Carcinoma

A

-fever with no origin
-weight loss
-night sweats

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17
Q

Intervertebral disc

A

-cushion like pad
-act as shock absorbers during running, walking, and jumping
-allow spine to flex and extend and to a lesser extent bend laterally
-over time they loose flexibility and compressibility

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18
Q

Intervertebral disc composed of

A

nucleus pulposus and annulus fibrosis

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19
Q

nucleus pulposus

A

inner semifluid which gives disc elasticity and compressibility

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20
Q

annulus fibrosis

A

strong outer ring of fibrocartilage which contains the nucleus pulposus and limits its expansion

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21
Q

Radiographic Assessments of the Back

A

-Spinal Radiographs
-MRI

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22
Q

Spinal Radiographs

A

High radiation load!

-gives information regarding BONE disease

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23
Q

MRI

A

Diagnostic Test of Choice!

-evaluates herniated discs
-evaluates nerve impingement
-imaging modality of choice to evaluate a herniated nucleus pulposus

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24
Q

Treatment Options are driven by

A

-degree of curvature as measured by Cobb Angle
-Skeletal maturity or non-skeletal maturity status

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25
Cobb Angles of 50 degrees or more
surgery should be discussed
26
How many curvatures of the spine
4; cervical, thoracic, lumbar, pelvic
27
cervical curvature
concave, least pronounced
28
thoracic curvature
convex
29
lumbar curvature
concave
30
pelvic curvature
concave, forward and downward
31
Lordosis
accentuated lumbar curvature -counterbalances a protuberant abdomen (pregnancy or obesity) -infants
32
Kyphosis
accentuated thoracic curvature "hunchback" -faulty posture -elderly (senile kyphosis secondary to osteoporosis) -smooth curvature of spine -common especially in women
33
Frequency of Low Back Pain
2nd most common reason for seeking medical attention from primary care
34
Prevalence of Low Back Pain
between 20-50 yrs old: 60-80%
35
*Back pain is the most common reason for disability and lost productivity in adults younger than 45
36
Regardless of treatment for back pain ....
60-70% will recover from pain in 6 weeks 80% will recover form pain in 12 weeks
37
Primary Care Clinician's Responsibility
Differentiate between life threatening and non life threatening diseases
38
common cause of back pain
muscle strain
39
life threatening causes of back pain
-myocardial infarction -aortic diseases -kidney issues -ectopic pregnancy
40
What percent of back pain is caused by muscle strain
95%
41
what percent of back pain is caused by herniated discs
5%
42
Muscle Strain
THE MOST COMMON CAUSE OF BACK PAIN
43
Pathophysiology of Muscle Strain
a paraspinal muscle is strained -often poor muscle tone -can be caused by repeated movements such as twisting, sleeping, lifting -often occurs doing the simplest of movements
44
Signs and Symptoms of Muscle Strain
-pain with movement, relieved with rest -pain above knee -no numbness/tingling -spasms pain in muscle not the spinous process
45
Physical Exam findings for Muscle Strain
-pain worse with extension (patient will walk legs up legs to stand up) -neurovascular within normal limits
46
Tests for Muscle Strain
none
47
Treatment for Muscle strain
-education on proper posture and back exercises -teach how to protect back by properly lifting using the legs -bed rest no longer than two days -ice 20 min with deep massage -physical therapy for acute simple back pain
48
Elements of physical therapy for Muscle Strain
-abdominal and paraspinal muscle strengthening -spinal and hamstring flexibility -awareness of posture -lifting techniques
49
Pharmacological Treatment for Muscle Strain
-NSAIDS -Tylenol (Acetaminophen)
50
Tylenol (Acetaminophen)
-relieves pain -reduced fever -only works in the central nervous system -bad for kidneys
51
Advil and Motrin (Ibuprofen)
-NSAIDs (nonsteroidal anti inflammatory drugs) -reduce inflammation -Also reduces pain and fever -can cause gastric and duodenal ulcers -bad for stomach
52
Pathophysiology of a Herniated Disc
nucleus pulposus protrudes into the annulus fibrosus and impinges a spinal nerve exiting the spinal column
53
Prevalence of Herniated Disc
only 2-5% of those experiencing back pain
54
How long does a herniated disc take to resolve on its own
usually within 6 weeks
55
Where in the Spine do Herniated discs commonly occur
lumbar spine
56
herniated discs are more common as we age because of
degenerative changes of the discs
57
Symptoms of Herniated discs
-severe pain following a nerve dermatome -pain often worse in leg than in the back -difficulty performong tasks such as standing, walking, sitting -NO DISRUPTION TO BOWEL OR BLADDER -may complain of weakness
58
PE Herniated Disc
-Anal sphincter is tight and closed -positive neurological findings that are dermatomal (decreased reflexes,, strength, and sensation) -electric shock down one leg -GATES
59
GATES
L5 nerve- unable to heel walk S1 Nerve- Unable to toe walk
60
Herniated Disc Treatment
-NSAIDs -Decreased activity for 1-2 days -narcotic medication no longer than 7 days -epidural steroid injections (up to 3 in 6 month period) -oral corticosteroids to reduce inflammation (prednisone) *no quick surgical fix available
61
Cauda Equina Syndrome
A TRUE BACK EMERGENCY -results from a sudden reduction in the volume of the lumbar spinal canal that causes compression of multiple nerve root and leads to muscle paralysis -sacral roots that control the bladder and anal sphincter are midline and particularly vulnerable (S2 to S4)
62
What is the Cauda Equina
formed by nerve roots caudal to the level of spinal cord termination
63
Cauda Equina Syndrome General Information
-rare -comprises 0.2-2% of herniated discs -potentially devastating consequences
64
Pathophysiology of CES
Central Disc Protrusion that pushes on spinal cord -massive herniation
65
Classic Presentation of CES
The Triad -severe bilateral leg pain involving weakness and sensory loss; difficulty standing from chair without using hands - loss of sensation in anal, perianal, and genital region (Do you feel different when you wipe) -bladder retention or incontinence
66
if there is lax anal sphincter tone
the S2 spinal nerve is involved
67
Treatment of CES
immediate surgical referral!!! -delay in decompression ca lead to permanent loss of bowel and bladder control, and sensory abnormalities
68
Scoliosis
from the Greek word crookedness curvature of the spinal greater than 10 degrees
69
scoliosis onset
infancy, early childhood, adolescence
70
Cause of Adolescent Idiopathic Scoliosis
Idiopathic=unknown origin heredity?
71
Prevalence of Adolescent Idiopathic Scoliosis
accounts for up to 85% of scoliosis cases more females than males (females more likely to require treatment as well) age 10-16 (often seen during puberty)
72
Structural change of scoliosis
-vertebral bodies rotate towards convexity -spinous processes rotate towards concavity -ribs also move as they are attached to spine
73
Symptoms of Scoliosis
USUALLY ASYMPTOMATIC rotation does not cause pain -can restrict pulmonary function (rare before 100 degrees)
74
Scoliosis PE findings
-shoulder height assymetry -unilateral scapula prominence -waistline asymmetry -distance between elbow and flank is asymmetric -with patients leaning forward with legs and palms together: -rib hump -intercostal space discrepancy
75
Scoliosis Diagnosis
Cobb Angle- measures degree of curvature
76
Scoliosis Treatment
determined by cobb angle and age of patient

Anatomy Chapter 13 (5 decks)

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