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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
Q

Cobb Angles of 50 degrees or more

A

surgery should be discussed

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26
Q

How many curvatures of the spine

A

4; cervical, thoracic, lumbar, pelvic

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27
Q

cervical curvature

A

concave, least pronounced

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28
Q

thoracic curvature

A

convex

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29
Q

lumbar curvature

A

concave

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30
Q

pelvic curvature

A

concave, forward and downward

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31
Q

Lordosis

A

accentuated lumbar curvature
-counterbalances a protuberant abdomen (pregnancy or obesity)
-infants

32
Q

Kyphosis

A

accentuated thoracic curvature “hunchback”
-faulty posture
-elderly (senile kyphosis secondary to osteoporosis)
-smooth curvature of spine
-common especially in women

33
Q

Frequency of Low Back Pain

A

2nd most common reason for seeking medical attention from primary care

34
Q

Prevalence of Low Back Pain

A

between 20-50 yrs old: 60-80%

35
Q

*Back pain is the most common reason for disability and lost productivity in adults younger than 45

A
36
Q

Regardless of treatment for back pain ….

A

60-70% will recover from pain in 6 weeks

80% will recover form pain in 12 weeks

37
Q

Primary Care Clinician’s Responsibility

A

Differentiate between life threatening and non life threatening diseases

38
Q

common cause of back pain

A

muscle strain

39
Q

life threatening causes of back pain

A

-myocardial infarction
-aortic diseases
-kidney issues
-ectopic pregnancy

40
Q

What percent of back pain is caused by muscle strain

A

95%

41
Q

what percent of back pain is caused by herniated discs

A

5%

42
Q

Muscle Strain

A

THE MOST COMMON CAUSE OF BACK PAIN

43
Q

Pathophysiology of Muscle Strain

A

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
Q

Signs and Symptoms of Muscle Strain

A

-pain with movement, relieved with rest
-pain above knee
-no numbness/tingling
-spasms
pain in muscle not the spinous process

45
Q

Physical Exam findings for Muscle Strain

A

-pain worse with extension (patient will walk legs up legs to stand up)
-neurovascular within normal limits

46
Q

Tests for Muscle Strain

A

none

47
Q

Treatment for Muscle strain

A

-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
Q

Elements of physical therapy for Muscle Strain

A

-abdominal and paraspinal muscle strengthening
-spinal and hamstring flexibility
-awareness of posture
-lifting techniques

49
Q

Pharmacological Treatment for Muscle Strain

A

-NSAIDS
-Tylenol (Acetaminophen)

50
Q

Tylenol (Acetaminophen)

A

-relieves pain
-reduced fever
-only works in the central nervous system

-bad for kidneys

51
Q

Advil and Motrin (Ibuprofen)

A

-NSAIDs (nonsteroidal anti inflammatory drugs)
-reduce inflammation
-Also reduces pain and fever

-can cause gastric and duodenal ulcers

-bad for stomach

52
Q

Pathophysiology of a Herniated Disc

A

nucleus pulposus protrudes into the annulus fibrosus and impinges a spinal nerve exiting the spinal column

53
Q

Prevalence of Herniated Disc

A

only 2-5% of those experiencing back pain

54
Q

How long does a herniated disc take to resolve on its own

A

usually within 6 weeks

55
Q

Where in the Spine do Herniated discs commonly occur

A

lumbar spine

56
Q

herniated discs are more common as we age because of

A

degenerative changes of the discs

57
Q

Symptoms of Herniated discs

A

-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
Q

PE Herniated Disc

A

-Anal sphincter is tight and closed
-positive neurological findings that are dermatomal (decreased reflexes,, strength, and sensation)
-electric shock down one leg
-GATES

59
Q

GATES

A

L5 nerve- unable to heel walk

S1 Nerve- Unable to toe walk

60
Q

Herniated Disc Treatment

A

-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
Q

Cauda Equina Syndrome

A

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
Q

What is the Cauda Equina

A

formed by nerve roots caudal to the level of spinal cord termination

63
Q

Cauda Equina Syndrome General Information

A

-rare
-comprises 0.2-2% of herniated discs
-potentially devastating consequences

64
Q

Pathophysiology of CES

A

Central Disc Protrusion that pushes on spinal cord
-massive herniation

65
Q

Classic Presentation of CES

A

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
Q

if there is lax anal sphincter tone

A

the S2 spinal nerve is involved

67
Q

Treatment of CES

A

immediate surgical referral!!!

-delay in decompression ca lead to permanent loss of bowel and bladder control, and sensory abnormalities

68
Q

Scoliosis

A

from the Greek word crookedness

curvature of the spinal greater than 10 degrees

69
Q

scoliosis onset

A

infancy, early childhood, adolescence

70
Q

Cause of Adolescent Idiopathic Scoliosis

A

Idiopathic=unknown origin

heredity?

71
Q

Prevalence of Adolescent Idiopathic Scoliosis

A

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
Q

Structural change of scoliosis

A

-vertebral bodies rotate towards convexity
-spinous processes rotate towards concavity

-ribs also move as they are attached to spine

73
Q

Symptoms of Scoliosis

A

USUALLY ASYMPTOMATIC
rotation does not cause pain

-can restrict pulmonary function (rare before 100 degrees)

74
Q

Scoliosis PE findings

A

-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
Q

Scoliosis Diagnosis

A

Cobb Angle- measures degree of curvature

76
Q

Scoliosis Treatment

A

determined by cobb angle and age of patient

Anatomy Chapter 13 (5 decks)

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