Back + Upper Limb Clinical Correlates Flashcards
(137 cards)
1
Q
T/F the spinal cord segment that gives rise to a single spinal nerve does not always lie adjacent to the corresponding vertebral level:
A
TRUE
2
Q
What space is CSF obtained in a lumbar puncture?
A
subarachnoid space
3
Q
In adults, where is a lumbar puncture performed?
A
L3/L4 or L4/L5
4
Q
Risk of injury is decreased during a lumbar puncture below what vertebral level?
A
below L2
5
Q
How do you localize the L4 level for a lumbar puncture?
A
palpate the iliac crests and move to the midline
have pt flex forward in a sitting or side lying position
6
Q
Where is the needle inserted during a lumbar puncture to obtain a CSF sample?
A
through the supraspinous ligament and into the lumbar cistern
7
Q
What is another name for spinal anesthesia?
A
nerve block
8
Q
Spinal anesthesia is administered into the epidural space similar to a lumbar puncture, what does this cause?
A
loss of sensation inferior to the level of administration
9
Q
To affect sacral spinal nerves, where do you inject spinal anesthesia?
A
inject via sacral canal or posterior sacral foramina
10
Q
How does whiplash occur?
A
occurs with severe hyperextension of the neck
11
Q
What does whiplash damage?
A
damages paravertebral neck musculature and ligaments (anterior longitudinal)
12
Q
What is the mechanism of injury for whiplash?
A
- force applied posteriorly (rear-end motor vehicle accident)
- head is forced posteriorly (head-on football tackle, physical abuse)
causes neck to hyperextend
13
Q
Severe whiplash may also involve what?
A
anterior widening of intervertebral space at level of vertebral body as a result of disc tearing
14
Q
Rupture of the transverse ligament of the atlas can cause what?
A
partial dislocation (subluxation) or complete dislocation of atlantoaxial joint
15
Q
Complete dislocation of the atlantoaxial joint may result in what?
A
upper cervical spinal cord injury
(the dens may impinge posteriorly on cord or superiorly on brainstem)
16
Q
A severe upper cervical spinal cord injury can cause what?
A
quadriplegia, while brainstem injury can be fatal
17
Q
What is the most common health complaint?
A
lower back pain
18
Q
What are some sources of lower back pain?
A
- fibroskeletal (sprain), meningeal, synovial, muscular (strain), and nervous tissues
19
Q
What are some common causes of lower back pain?
A
- degenerative disc changes
- poor posture
- improper lifting technique
- abdominal muscle weakness/imbalance
20
Q
Sprains in the spine involve what?
A
ligament damage or damage at the osseoligament interface
21
Q
Pain associated with sprains in the spine can be reproduced how?
A
with end of range movements of the vertebral column
22
Q
Strains involve what?
A
overstretching or microtearing of back muscle fibers
23
Q
Strains in the spine most often occur where?
A
lumbar region, especially in postural muscles of erector spinae
24
Q
Pain associated with strains in the spine is often caused by what?
A
inflammation and subsequent muscle spasms, especially with movement
25
Spasms can lead to a physiologic muscle-holding pattern, which may cause what?
spinal malalignment and increased pain
26
Most cases of low back pain are caused by what?
muscle strain
27
Deviation from the normal primary and secondary spinal curvatures can cause what?
functional impairments
28
What excessive thoracic curvature appears more convex posteriorly and often occurs in the geriatric population as a result of degenerative changes in the spine and poor posture?
kyphosis
29
What excessive lumbar curvature appears more concave posteriorly and is associated with an anteriorly rotated pelvis and accompanying shortening of hip flexor muscles?
lordosis
30
What abnormal lateral curvature of the spine involves both lateral bending and rotation of the spine, creating a lateral concavity?
scoliosis
31
What curvature is often seen in adolescent girls and causes can be either postural/positional or congenital?
scoliosis
32
Spondylosis is the degeneration of what?
vertebral column
33
What region does spondylosis most often occur?
cervical region
34
What is most vulnerable to degenerative changes, leading to narrowing of disc space/weakening of annulus fibrosis, and bone spur formation?
Vertebral discs and facet
35
Degenerative changes can also affect the which ligament, which increases the risk of spinal cord compression as a result of disc herniation?
adjacent posterior longitudinal ligament
36
What symptoms are a common drive for patients to seek medical attention?
myelopathy and radiculopahty
37
Tears in the what can lead to herniation or protrusion of the gelatinous inner nucleus pulposus into the vertebral canal
outer annulus fibrosus
38
Why does herniation most often occurs in a posterior or posterolateral direction?
because the posterior longitudinal ligament is weaker and narrower than its anterior counterpart
39
_____ herniation in the posterior direction can impinge on the spinal cord, whereas the more common ______ herniation impinges on spinal nerve roots.
disc; posterolateral
40
Disc herniation symptoms include what?
muscle weakness, and reflex changes
41
A herniation affecting the spinal nerve root at the level below L3/L4 would affect what spinal nerve root?
L4 spinal nerve root
42
What decreases with age?
disc health (structural integrity of intervertebral disc)
43
What changes decreases the mobility of the disc and increase risk of injury?
Disc dehydration with changes in nucleus pulposus
44
What is a laminectomy?
a surgical procedure that involves removal of a spinous process and associated laminae and pedicles at one or more vertebral levels
45
Why would a laminectomy be performed?
to create more space in the vertebral canal, relieving pressure on the spinal cord and spinal nerve roots
46
Pressure in the spinal cord is often caused by what?
spinal stenosis (narrowing of the canal) as a result of a space-occupying lesion, such as excess bony growth, tumor formation, or disc herniation
47
Vertebral dislocation without fracture most often occurs where? Why?
cervical region because of the horizontal orientation of articular facets
48
Pure dislocation in the thoracic and lumbar regions is less common and occurs in conjunction with additional factors, such as what?
fracture, pathology, or congenital malformation
49
Some examples of dislocations with fractures are:
- spondylolysis (Scottie dog fracture)
- spondylolisthesis
50
What is spondylolysis (Scottie dog fracture)?
racture of the pars interarticularis is most commonly observed in young athletes at the L4 or L5 level
51
What is spondylolisthesis?
Anterior displacement of the vertebral body
52
Where does spondylolisthesis typically occur
lumbosacral junction
53
What anterior compression fracture is accompanied by a transverse fracture through posterior vertebral structures?
chance fracture (seat-belt injury)
54
Where does a chance fracture (seat-belt injury) most commonly occur in the pediatric population?
T12/L1 interface
55
What the of fracture is a burst fracture of the C1 vertebra with at least two points of fracture is often associated with headfirst diving into shallow water?
Jefferson fracture
56
What fracture is a bilateral fracture through the vertebral arch of C2 (axis) often occurs just posterior to the articular facets when force is applied to a hyperextended neck and can result in C2 traumatic spondylolisthesis and spinal cord injury
Hangman fracture
57
What is a hyperflexion injury in the cervical spine is characterized by the avulsion of a triangular bony fragment from the anteroinferior region of the vertebral body
Teardrop fracture
58
Occlusion of the great anterior segmental medullary artery can eliminate blood supply to the what, causing paraplegia?
inferior two thirds of the spinal cord
59
When does the neural plate begin to fold?
week 4
60
What week does the neural tube close?
week 4
61
Where does the closure of the neural tube begin?
occipital/cervical region
62
The closure of the anterior end of the neural tube is called what?
anterior neuropore
63
The closure of the posterior end of the neural tube is called what?
posterior neuropore
64
If the anterior neuropore fails to close, upper neural tube defects occur. What is this called?
anencephaly
65
If the posterior neuropore fails to close, lower neural tube defects occur. What is this called?
spina bifida with myeloschisis
66
As the neural tube folds, some cells differentiate into what?
neural crest cells
67
The lumen of the neural tube gives rise to the ventricular system of the _____ and _____ _____ of the spinal cord.
brain; central canal
68
Where is blood pressure assessed at?
brachial artery
69
Where is the artery occluded by a blood pressure cuff?
occluded against the humeral shaft
70
Where are arterial sounds observed with a stethoscope?
over the brachial artery in the cubital fossa
71
What is used to measure systolic and diastolic pressures?
sphygmomanometer
72
What does the first absent sound represent in blood pressure
diastolic
73
Brachial pulse can be felt medial to which tendon?
bicipital tendon
74
What is normal blood pressure?
90–120/60–80 mm Hg
75
Where are the common sites for brachial plexus nerve block?
supraclavicular, axillary sheath, and interscalene
76
What bone is the most commonly fractured bone in the body?
the clavicle
77
Fractures typically occur between the _____ and _____ thirds from direct trauma to the shoulder or indirect force from falling on an outstretched upper limb
middle; lateral
78
The proximal clavicle (PC) is pulled superiorly by the _______
sternocleidomastoid
79
while the distal clavicle (DC) is depressed inferiorly because of the weight of the ____ ____
upper limb
80
What else is at risk in a clavicle fracture?
brachial plexus divisions and axillary vasculature are at risk of secondary injury
81
What can be injured in a surgical neck fracture?
axillary nerve and circumflex humeral vessels
82
What can be injured in a mid shaft fracture?
radial nerve and profunda brachii vessels
83
What can be injured in a supracondylar ridge fracture?
median nerve and brachial vessels
84
Fracture of the surgical neck is common in geriatric population with osteoporosis and may injure the _____ nerve and circumflex humeral vessels.
axillary
85
Midshaft or spiral groove fractures may injure the _____ nerve and profunda brachii vessels.
radial
86
Supraepicondylar ridge fractures may injure the _____ nerve and brachial vessels.
median
87
Medial epicondyle fractures may injure the _____ nerve and superior ulnar collateral vessels.
ulnar
88
What type of fracture is through the distal radius, resulting in the proximal segment moving anteriorly and the distal segment moving posteriorly, giving the distal forearm the appearance of a dinner fork.
Colles fracture (“dinner fork” deformity)
89
What is a fracture of the fifth metacarpal (or fourth) at the junction of the distal shaft and head (neck)?
Boxer fracture
90
What are common sites for IV placement?
superficial dorsal venous network and distal basilic or cephalic veins
91
What vein is easily accessible for blood sampling?
median cubital vein
92
______ occurs when lymph return from the extremities is interrupted, causing excessive swelling in the affected limb:
lymphedema
93
Removal of axillary lymph nodes in conjunction with a _______ is a common cause for upper limb lymphedema
mastectomy
94
Compression sleeves paired with frequent lymph massage may assist in moving the static lymph centrally and decrease _____.
edema
95
______ is an infection deep in the hand or forearm can result in inflammation of the associated lymphatic vessels.
lymphangitis
96
What is the first group affected because lymphatic vessels of the upper limb drain through this group before moving more centrally.
humeral (lateral) group
97
What disease is vasoconstriction of the digital arteries of idiopathic origin?
Raynaud disease
98
What is believed to be the cause vasoconstriction in Raynaud disease?
overactive postganglionic sympathetic fibers
99
Cold temperatures and emotional stimuli may trigger what ischemic event?
Raynaud disease
100
Surgical correction in the upper limb to correct Raynaud disease may include what?
presynaptic sympathectomy
101
Name two types of brachial plexus injuries:
1. upper trunk injury (Erb-Duchenne palsy)
2. lower trunk injury (Klumpke paralysis)
102
A patient presents with his or her upper limb in a “waiter’s tip” position, where the arm is adducted, extended and internally rotated, elbow extended, and forearm pronated because of the number of muscles paralyzed. What is this called?
upper trunk injury (Erb-Duchenne palsy)
103
A patient presents with “claw hand” mainly because of the paralysis of the medial lumbricals. What is this called?
lower trunk injury (Klumpke paralysis)
104
Lesions of the long thoracic nerve will paralyze what muscle? What will this result in?
paralyzes the serratus anterior muscle, resulting in a “winged” scapula
105
"Winged" scapula inhibits full abduction of the affected limb is impossible because the _____ _____ is unable to assist with upward scapular rotation.
serratus anterior
106
Which tendon is more commonly implicated in rotator cuff injuries?
supraspinatus tendon
107
Why is the supraspinatus tendon more commonly implicated in rotator cuff injury?
because of the small osseoligamentous path by which it travels to insert onto the greater tubercle
108
Pain associated with rotator cuff injury and bursitis is often exacerbated when patient is asked to abduct his or her arm above 50°, what is this called?
painful arc syndrome
109
The upper limb is vulnerable to what?
- tendonitis (inflammation of the tendon)
- tenosynovitis (inflammation of tendon and synovial sheath)
110
What type of injury radial nerve injury can result in full loss of elbow extension because of paralysis of the triceps brachii (proximal injury) and wrist drop or just wrist drop (at or distal to spiral groove) with elbow extension spared?
radial nerve injury
111
The wrist drop in a radial nerve injury occurs because of what?
paralysis of wrist and finger extensors
112
In a radial nerve injury, the deep branch of the radial nerve can also become impinged as it travels deep to what muscle?
supinator muscle
113
What muscle can entrap the deep radial nerve and cause downstream motor/sensory impairments of deep extensor forearm muscles and joints"?
supinator muscle
114
What type of contracture is a contracture of the medial half of the palmar deep fascia of genetic origin?
Dupuytren contracture
115
A pt who has Dupuytren contracture will see their digits to move into a flexed position. Why does this occur?
bands of the palmar aponeurosis associated with the fourth and fifth digits begin to shorten and fibrose
116
What digits does Dupuytren contracture involve?
4th and 5th digits
117
Carpal tunnel syndrome involves compression of the ____ nerve in the carpal tunnel:
median
118
Atrophy of the ____ eminence is present in carpal tunnel syndrome:
thenar
119
Clinically, a patient with what type of lesion at the elbow presents with the inability to flex digits one through three completely (“hand of benediction”)?
median nerve lesion
120
What two signs can present with a median nerve lesion?
- "hand of benediction" (atrophy of the thenar eminence)
- "OK" sign (unable to maintain flexion of the interphalangeal joints)
121
Dislocation of the what joint occurs most often in young athletes and in the anteroinferior direction?
glenohumeral
122
The axillary nerve and circumflex humeral vessels are vulnerable in what type of injury?
glenohumeral joint (shoulder) dislocation
123
In a shoulder separation injury, why is the shoulder less rounded and squarer appearance?
the weight of the upper limb pulls it inferiorly, accentuating the point of the acromion through the lateral shoulder skin
124
Dislocation of the humeroradial joint (“nursemaid’s elbow”) can occur when the ____ ligament is partially or completely torn.
anular ligament
125
In nursemaids' elbow, what becomes dislocated and appears as a palpable mass in the cubital fossa?
the radial head
126
Why does the radial head become dislocated and appears as a palpable mass in the cubital fossa?
the biceps brachii pulls the radial head anteriorly and superiorly once dislocated
127
What is the pain in nursemaid's elbow believed to be?
anular ligament being pinched in the joint
128
When the ulnar collateral ligament is torn—common in baseball pitchers—surgical repair involves harvesting a tendon of what muscle?
palmaris longus
129
Ulnar collateral ligament reconstruction is also called what?
Tommy John surgery
130
Congenital anomalies of the limbs fall into how many general categories?
4
131
What congenital limb anomaly category does missing part of a limb or entire limb fall into?
1 (reduction defects)
132
What congenital limb anomaly category does extra digits fall into?
2 (duplication defects)
133
What congenital limb anomaly category does fusion of digits fall into?
3 (dysplasia defects)
134
What congenital limb anomaly category does physical forces damage the developing limb fall into?
4 (deformation defects)
135
Limb development occurs over a 5 week period, from week __ to week __
week 4 to week 8
136
When does the upper limb bud?
day 24
137
When does the lower limb bud?
day 28
