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Summer FDTN Exam 4 > C-spine > Flashcards

C-spine Flashcards

1
Q

What are the bones of the vertebral column

A 
C: 7 vertebrae, 8 spinal nerves 
T: 12 vertebrae and nerves 
L: 5 vertebrae and nerves, cauda equina 
S: 5 fused, SI joints 
C: 5 fused
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2
Q

Briefly describe the anatomy of a vertebrae

A 
Vertebral body and arch 
pedicle, lamina 
Vertebral foramen (spinal cord passes through here) 
Spinous process 
Transverse processes 
Articular facets (T have costal facets)
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3
Q

How does the vertebral column move

A

lateral flexion
rotation
flexion extension

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4
Q

How are C1 and C different

A

There is no intervertebral disc between C1 and C2

Dens (C2) extends upwards to allow C1 to rotate

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5
Q

What are the intervertebral discs

A

between adjacent vertebrae from C2-Lumbosacral junction
Numbered as vertebral body above it
Has a fibrous ring around it (fibrocartilage), and a Pulpous nucleus in the center (high water content, slightly posterior, shape altered by movement)

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6
Q

What are examples of disc problems

A

Degeneration (+/- w/ osteophyte formation)
Bulging (prolapse)
Herniated (extrusion)
Sequestration (herniated and leaking away)
Thinning

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7
Q

What are the layers of the spinal column (SF to Deep)

A 
Epidural space 
Dura mater
Subdural space
Arachnoid mater 
Subarachnoid space 
Pia mater
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8
Q

What do different spinal nerve roots innervate

A

Ventral root: Myotomes
Dorsal root: Dermatomes
(C7 dermatome is the middle finger)
(S#-5 is perineal/genital area)

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9
Q

Briefly explain the brachial plexus

A

C5-T1 nerve roots lead into;
Superior, Middle, and Inferior trunks lead into;
3 anterior and 3 posterior divisions lead into;
Lateral, Posterior, and Medial cords lead into;
Musculocutaneous, Axillary, Radial, Median, and Ulnar nerves

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10
Q

What is the difference between a sprain and a strain

A

Sprain: Ligament injury (bone to bone)
Strain: Tendon injury (muscle to bone)

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11
Q

What is a cervical strain/sprain

A

Usually a combined injury of ligamentous structures and cervical musculature

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12
Q

Causes of a cervical strain/sprain are

A

forced movement past end range
sudden contraction
violent high velocity movement

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13
Q

How does a C-sprain/strain present

A

Non-radicular, non-focal neck pain anywhere from base of skull to cervicothoracic junction
Neck stiffness, limited ROM
+/- Cervicogenic HA pattern

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14
Q

On C-sprain/strain PE you may find

A

ttp over involved muscle, facet joint, or transverse process
NO pain w/ axial loading
usually normal neuro exam

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15
Q

In what non-trauma case would you order a C spine XR

A

50+ w/ new onset Sx
Constitutional Sx (fever, wt loss, chills)
mod-severe neck pain >6 wks
progressive neuro findings
infectious risk (IVDU, immunosuppressed)
Hx of malignancy

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16
Q

In what trauma cases would you order a C spine XR

A

can use Nexus low risk criteria, but Canadian C spine rules are preferred (for alert and stable trauma patients where C spine injury is a concern) 3 qualifying questions:

  1. High risk factors that mandate XR?
  2. No low risk factors that allow safe assessment of ROM?
  3. able to actively rotate neck 45” L&R?
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17
Q

Describe high risk factors present that would rule in C spine XR

A

65+
Dangerous mechanism of injury
Paresthesias in extremities

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18
Q

Describe low risk factors that would allow ROM testing and exclude need for XR

A 
Simple rear end MVC 
Sitting position in ED 
Walking at ay time 
Delayed onset neck pain 
NO midline C spine ttp 
(if they can rotate neck actively, do not need XR)
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19
Q

Why is delayed onset neck pain not a worry

A

BC s/p MVC, pain will be worse on Day 2 and 3 than Day of accident if the MOI is musculoskeletal
Fractures hurt the same day!

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20
Q

When viewing a C spine XR that shows the dens, what must you look out for

A

A straight line through the dens! This is normal, the bottom of the two front teeth, but most mistake it for a Fx
There are never straight lines in anatomy!

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21
Q

What type of pain points you to different C spine injury

A

Sharp pain: Muscle or ligament sprain

Tightness followed by pain: Muscle spasm

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22
Q

What type of pain points you to different C spine injury

A

Sharp pain: Muscle or ligament sprain

Tightness followed by pain: Muscle spasm

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23
Q

What levels are usually tested when assessing C sprain/strain

A

C5-T1 myotomes, dermatomes, and reflexes

24
Q

What is Spurling’s test

A

ROM test used to r/o neurologic involvement in a C spine injury (C strain/sprain, will be negative)
Helps Dx cervical herniation or spondylosis

25
How do you preform Spurling's test
Pt: Rotate and laterally flex neck to affected side PA: apply light downward (axial) pressure. If tolerated, apply cervical extension (tilt back) and reapply light axial compression
26
What do the moves in Spurling's test do
Narrow neural foramen and compress the nerve root | If pain is reproduced or there is an increase in radicular arm pain, the test is positive
27
How does whiplash occur
When vehicle gets struck from behind, head tilts back, torso rises up After impact, head snaps forward, and torso rebounds (forwards)
28
Cause of whiplash is
MC: stopped vehicle is rear ended | Acceleration-Deceleration of neck with rapid flexion/extension
29
Classic whiplash presentation is
Delayed onset C spine ttp and stiffness over 12-24 hours Pain peaks on day 3-5 Pain and stiffness w/ flexion/extension
30
PE findings for whiplash are
Limited ROM in all directions, mostly flexion extension NO pain w axial loading Neuro exam is usually normal
31
How do you treat whiplash
Soft C-collar NSAIDs Muscle relaxers (Flexaril, Skelaxin, Valium if bad) Cervical pillow to sleep (take C collar off) heat/ice PT if no improvement by day 5-7, or if improvement plateaus > day 10
32
What is cervical facet dysfunction
Shift in vertebral alignment leads to locking of facet joint | Caused by prolonged positional stress or traumatic injury
33
How does cervical facet dysfunction present
Insidious onset (when i woke up, I couldnt turn my head) Unilateral pain (sharp in C spine, achey in referral zone) Focal facet ttp ROM limitations: ipsilateral sharp pain w/ extension- contralateral tightness
34
How do you treat cervical facet dysfunction
Anti-inflammatories Muscle relaxers Early PT (stretch and strength), DC (adjustment), and DO (joint manipulations)
35
What are complications of cervical facet dysfunction
Cerebral artery occlusion/dissection | -cervical/suboccipital pain, dizzy, n/v, vision loss
36
What is cervical radiculopathy
neurogenic pain in distribution of cervical roots, w/ or w/o numbness, weakness, or loss of reflexes
37
Causes of cervical radiculopathy are
Traumatic stretching of nerve root/brachial plexus (birth, football) Cervical disc bulge/herniation Cervical foramen narrowing (old)
38
How does cervical radiculopathy present
``` Abrupt onset (if disc injury from trauma) or gradual onset (mostly older pts) *Cervical pain increased with extension, lateral flexion, and rotation to involved side* AKA spurling test is positive! ```
39
Neurologic deficits associated with Cervical radic. are
Burner-stinger syndrome (resolve in minutes) Bulge/hernia (gradual onset, need serial exams) Foraminal narrowing (increased risk for potential deficit)
40
What XR view lets you look at the foramen
Oblique
41
How do you grade muscle strength
0-5 0: no contraction 1: flicker of contraction 2. Moves w/o gravity (supine) 3: Moves against gravity 4: Moves against gravity and some resistance 5: Full, wo fatigue
42
How do you grade reflexes
``` 0-4+ 0: no response 1+: low normal 2+: normal 3+: brisker than average, can still be normal 4+: Hyperactive, clonus ```
43
What radiographs are good for evaluating cervical radiculopathy
5 views! | AP, lateral, odontoid, R & L obliques
44
How do you treat cervical radiculopathy
``` #1: Oral prednisone for 5-7 days, then mvoe to NSAIDs PT (cervical traction) ```
45
Why is slouching bad
It increases extension to C-spine
46
When would cervical radiculopathy require Neuro/PMR consult
Persistent/progressing neuro deficit | Persistent pain despite conservative Tx
47
What is in an epidural injection (can be used to Tx cervical radiculopathy)
Lidocaine and a steroid | This is to decrease inflammation
48
What is cervical spondylosis
Degenerative disease MC to C5-6 and C6-7 Characterized by osteophyte formation, Ligamentum flavum thickening, Disc space narrowing, and Vertebral subluxation (misalignment)
49
What happens to the vertebrae in C spondylosis
Degeneration due to arthritis
50
How does C spondylosis present
Progressive ROM loss/stiffness Intermittent pain at onset (can become chronic) Uni/bilat, deep aching neck, shoulder, and upper back pain Cervical crepitus focal/diffuse ttp along spinous processes and facet joints Loss of natural curve of C spine Facet joint arthrosis
51
How does C spondylosis present
Progressive ROM loss/stiffness Intermittent pain at onset (can become chronic) Uni/bilat, deep aching neck, shoulder, and upper back pain Cervical crepitus focal/diffuse ttp along spinous processes and facet joints Loss of natural curve of C spine Facet joint arthrosis
52
What is myelopathy (caused by osteophyte compressing spinal cord in C spondylosis)
``` Essentially, compression of spinal cord causing: Weak hands/muscle atrophy Leg weakness Unsteady gait Loss of bladder control Hyper-reflexia L'Hermitte's sign ```
53
What is L'Hermitte's sign
Electric shock sensation down centr of back following flexion of neck
54
How do you treat cervical spondylosis
NSAIDs (not steroids, bc this is chronic) Duloxetine (SNRI)- taper off VERY slowly Amitriptyline (SNRI)- for sleep, slow taper Gabapentin (neuropathic pain) cervical pillow PT +/- surgical fixation
55
What do you stay away from in C spondylosis
Opioids or narcotics Steroids -This is a chronic dz, you dont want them on those for a long time!

Summer FDTN Exam 4 (14 decks)

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