Cervical & Thoracic Spine

Question 1

What sections of the spine are mobile?

Answer 1

Cervical

Lumbar

Question 2

Where are pain fibers located?

Answer 2

Annulus fibrosis
Joint: uncovertebral, facet
Ligaments
Periosteum
Muscle/Fascia

Question 3

Radicular Pain

Answer 3

Nerve root mediated
Dermatomal pain, numbness, paresthesia
Associated with weakness, hyporeflexia

Question 4

Reasons for Radicular Pain

Answer 4

Compression
Chemical
Inflammatory

Question 5

Define Referred Pain

Answer 5

Axial or external pain localized to a site remote from location of nocioceptors

Question 6

Describe Referred Pain

Answer 6

Dull, achy, non-dermatomal pain

Associated with axial pain

Question 7

How do intervertebral discs get their nutrition?

Answer 7

Childhood: annular arteries
Adolescence: diffusion

Question 8

Normal Aging of Discs

Answer 8

Occurs at different rates
Disc dehydration, narrowing
Increase strain on annulus: diffuse bulging, annular tears, focal disc herniation
Stress transfers to uncovertebral & facet joints

Question 9

Causes of Axial Pain

Answer 9

Facet, uncovertebral joint arthritis
Loss of lordosis (muscular)
Instability

Question 10

Define Radiculopathy

Answer 10

Pressure related nerve root dysfunction

Question 11

Causes of Radiculopathy

Answer 11

Disc herniation

Uncovertebral, facet joint spurs

Question 12

Define Myelopathy

Answer 12

Pressure related spinal cord dysfunction

Question 13

Causes of Myelopathy

Answer 13

Large disc herniation
Spurs
Congenitally narrow canal

Question 14

Describe Structural Axial Pain

Answer 14

Dull
Achy
Paraspinal

Question 15

Describe Referred Axial Pain

Answer 15

Sharp
Stabbing
Intrascapular

Question 16

Describe Radicular Extremity Pain

Answer 16

Dermatomal
Sharp
Temperature
Wet/dry

Question 17

Describe Appendicular Extremity Pain

Answer 17

Non-dermatomal

Joint/bone/muscle localized

Question 18

Muscles to Check for C5

Answer 18

Deltoid

External rotators

Question 19

Muscles to Check for C6

Answer 19

Wrist extension
Pronator teres
Biceps

Question 20

Muscles to Check for C7

Answer 20

Triceps

Question 21

Muscles to Check for C8

Answer 21

Finger flexors

Question 22

How to Test for Sensory

Answer 22

Light touch
Pin prick
Temperature

Question 23

DTR for C5

Answer 23

Biceps

Question 24

DTR for C6

Answer 24

Brachioradialis

Question 25

DTR for C7

Answer 25

Triceps

Question 26

Reason for Hyporeflexia

Answer 26

Radiculopathy

Question 27

Reason for Hyperreflexia

Answer 27

Myelopathy

Question 28

C5 Motor, Reflex, Sensation

Answer 28

M: deltoid, biceps R: biceps S: Lateral upper arm

Question 29

C6 Motor, Reflex, Sensation

Answer 29

M: wrist extensors, pronator teres R: brachioradialis S: lateral forearm, digit 1 & 2

Question 30

C7 Motor, Reflex, Sensation

Answer 30

M: triceps, finger extensors, wrist flexors R: triceps S: middle finger, back of upper arm

Question 31

C8 Motor, Reflex, Sensation

Answer 31

M: finger flexion, interossei muscles R: none S: medial forearm, digits 4 & 5

Question 32

T1 Motor, Reflex, Sensation

Answer 32

M: interossei muscles R: none Sensation: distal, medial upper arm

Question 33

Long Tract Signs

Answer 33

``` Hyperreflexia Clonus Increased resting tone Gait, coordination, rectal tone Hoffmans (UE) Babinski (LE) ```

Question 34

Provocative Tests for the Cervical Spine

Answer 34

Spurling's Reverse Spurling's L'Hermitte

Question 35

Differential Diagnosis of Axial Pain

Answer 35

``` Bone: fracture, instability Disc: degeneration, herniation Joint: arthritis, instability Soft tissue: sprain, fibromyalgia Tumor/infection: primary, metastatic Inflammatory: RA ```

Question 36

Diagnostic Tests for Bone Pain

Answer 36

X-ray | Bone scan

Question 37

Diagnostic Tests for Disc Disease

Answer 37

MRI Myelo CT Discography

Question 38

Diagnostic Tests for Joint Pain

Answer 38

Bone scan Flexion/extension x-rays Facet injection

Question 39

Diagnostic Tests for Soft Tissue Pain

Answer 39

MRI | Diagnosis of exclusion

Question 40

Diagnostic Tests for Tumor or Infection

Answer 40

Labs Bone scan MRI CT

Question 41

Diagnostic Test for Inflammatory Conditions

Answer 41

Labs

Question 42

Non-Operative Treatment for Axial Pain

Answer 42

``` PT NSAIDs Narcotics? MR Education Activity modification Reassurance Pain management ```

Question 43

Pain Management Options for Axial Pain

Answer 43

Injection | Radiofrequency ablation

Question 44

Operative Treatment for Axial Pain

Answer 44

Fusion

Question 45

Differential Diagnosis for Extremity pain

Answer 45

Radiculopathy Myelopathy Peripheral nerves Joints

Question 46

Radiculopathy Differential Diagnosis for Extremity Pain

Answer 46

``` Herniated disc Spondylosis Instability Tumor Infection Fracture ```

Question 47

Myelopathy Differential Diagnosis for Extremity Pain

Answer 47

``` Herniated disc Stenosis Instability Cord lesions Medical Trauma Tumor Syrinx: CSF & cord completely fill spinal canal CNS ```

Question 48

Peripheral Nerve Differential Diagnosis of Extremity Pain

Answer 48

Entrapment Neuropathy Plexopathy Chronic radiculopathy pain syndrome

Question 49

Joint Differential Diagnosis of Extremity Pain

Answer 49

Rotator cuff | Tennis elbow

Question 50

Diagnostic Tests for Radiculopathy Extremity Pain

Answer 50

MRI Myelo/CT EMG SNRB: selective nerve regional block

Question 51

Diagnostic Tests for Myelopathy Extremity Pain

Answer 51

MRI Myelo/CT SSEP

Question 52

Diagnostic Test for Peripheral Nerve Extremity Pain

Answer 52

NCV

Question 53

Diagnostic Evaluation for Joint Extremity pain

Answer 53

Ortho eval

Question 54

Non-Operative Treatment of Extremity Pain

Answer 54

``` NSAIDs Narcotics? Steroid injection Traction Collar Myelopathy: urgent workup ```

Question 55

Operative Treatment of Extremity Pain

Answer 55

Decompression +/- fusion