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In order Cuccurullo > Ch 7 - SCI: Pain, Pressure Ulcer > Flashcards

Ch 7 - SCI: Pain, Pressure Ulcer Flashcards

1
Q

What is nociceptive pain?

A

From bone, ligaments, muscle, skin, other organ

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2
Q

What is neuropathic pain?

A

From peripheral or central neural tissue damage

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3
Q

What is the MC joint affected by pain in SCI?

A

Shoulder d/t WB and overuse syndromes

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4
Q

What are risk factors of shoulder pain in SCI?

A

– Tetraplegia > paraplegia
– ↑ with time from injury, older age
– Manual WC use and transfers; overuse; overhead activities; inflexibility; muscle imbalances

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5
Q

Which muscles should be stretched in SCI patients with shoulder pain?

A

Anterior shoulder, adductors, and external rotators

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6
Q

Which muscles should be strengthened in SCI patients with shoulder pain?

A

Posterior shoulder girdle muscles (rotator cuff, shoulder stabilizers [trapezius, rhomboids, levator scapulae, serratus anterior] and adductors

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7
Q

What is neuropathic pain in SCI correlated with?

A

Increasing age at injury

Peaks 30-39 age group and then again >age 50

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8
Q

What is the only medication approved for neuropathic pain in SCI?

A

Pregabalin

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9
Q

What percentage of patients develop UE compression neuropathies in SCI?

A

2/3 of patients

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10
Q

What are UE compression neuropathies in SCI correlated with?

A

Increases with the length of time from injury

MC median and ulnar neuropathies

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11
Q

What is the incidence of CTS in paraplegia?

A

21-65%

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12
Q

What is the most common cause of progressive myelopathy after a SCI?

A

Posttraumatic syringomyelia

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13
Q

What is the MC presenting symptom of posttraumatic syringomyelia?

A

Pain: Aching or burning, often worse with coughing, sneezing, straining, and usually in the sitting rather than in the supine position

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14
Q

What is the earliest sign of posttraumatic syringomyelia?

A

Ascending loss of DTRs

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15
Q

What is the gold standard for diagnosis of posttraumatic syringomyelia?

A

MRI with gadolinium

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16
Q

What are Charcot joints?

A

Destructive arthropathy due to impaired pain perception or position sense

17
Q

What is Charcot spine?

A

Spinal trauma and analgesia below the level of injury makes SCI patients particularly prone to insensate joint destruction

18
Q

What tendon transfer procedures can be done in C5 SCI?

A

– BR to ECRB: Restore wrist extension

– Deltoid to triceps: Provide elbow extension

19
Q

What tendon transfer procedures can be done in C6 SCI?

A

– Moberg “key grip”: Restore lateral or “key” grip
– BR to FPL or finger flexors: Restore lateral pinch (FPL) or grasp (finger flexors)
– Posterior deltoid to triceps: Prior to hand reconstruction
– Rerouting of biceps brachii around radial neck: Correct supination contracture of forearm

20
Q

What tendon transfer procedures can be done in C7 SCI?

A

– BR to FPL: Restore thumb flexion

– ECRL or FCU to the FDP: Restore finger flexion

21
Q

What tendon transfer procedures can be done in C8 SCI?

A

Intrinsic minus or “claw hand” may be addressed with lumbrical bar, preventing hyperextension of MCPs to improve function

22
Q

What is the incidence of concomitant TBI in those with a primary SCI?

A

24%-74%

23
Q

What % of SCI patient experience depression?

A

20% to 45% within the first month

24
Q

Describe the relationship between suicide and SCI.

A

SCI patients 5x the age-sex specific suicide rate in US
Leading cause of death in SCI in the youngest age groups, especially for persons with paraplegia, and incomplete injuries
Greatest risk 1-5 years post-injury

25
Q

Where are the MC locations of pressure injuries in SCI?

A

Over bone prominences
First 2 years: sacrum> ischium>heels> trochanters
>2 years: ischial tuberosities

26
Q

What is the MC locations of pressure injuries in SCI in <13 yo?

A

Occiput

27
Q

What is the most important risk factors for developing pressure ulcers?

A

Persistent pressure and shear forces

28
Q

What is the MOI of a pressure injury?

A

Local soft-tissue ischemia results due to prolonged pressure over bony prominences that exceed supracapillary pressure >70 mmHg

29
Q

What tissue layer is most susceptible to pressure injury?

A

Muscles>skin

30
Q

What does friction or shearing forces cause?

A

Removes corpus striatum of the skin

31
Q

What are preventions of pressure injury?

A
  • Dec duration of pressure forces → turned and positioned ~2 hours
  • Pressure relief and repositioning should be done >2 minutes at a time, ~20 to 30 min when sitting

In order Cuccurullo (91 decks)

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