Spinal MSK Flashcards
(90 cards)
1
Q
How many cervical nerve roots are there
A
8
2
Q
Who gets wedge compression fractures
A
Old ladies (and men) with osteoporosis
3
Q
Who gets burst fractures
A
We do! Those without osteoporosis
- burst in vertebral body
4
Q
What investigation would be best to identify damage to the posterior ligaments of the spine
A
MRI
5
Q
What kind of fracture are the elderly more likely to sustain to the spine
A
Wedge compression fracture due to osteoporosis
6
Q
Whiplash
A
Neck strain flexion extension injury
–> pain
7
Q
Where is the most likely spot for a spinal fracture
A
Junction between thorax (fixed) and lumbar (free) vertebrae
–> L1 and T12
8
Q
ALTS protocol
A
Advanced trauma life support protocol - ABC..
9
Q
What percentage of spinal fractures will have another spinal injury elsewhere
A
10%
10
Q
Neurogenic shock
A
Normal circulating volume but all extremities are dilated - blood pressure drops…
11
Q
Spinal shock
A
Damage to spinal cord
–> flaccid paralysis then start to return
Need to assess neurologically after a few days
12
Q
ASIA assessment
A
Grade A - compete spinal cord injury - no motor or sensory function
Grade E - normal where motor and sensory are normal
13
Q
Anterior cord syndrome
A
Affects both motor and sensory pathways
Crude sensation, movement and fine sensation are lost
14
Q
Central cord syndrome
A
Weakness and paralysis of arms and some sensory loss
Legs are less affected (sacral sparing)
15
Q
Brown-sequard syndrome
A
Injury to half the cord
Movement and some sensory loss below injury
Pain and temperature loss on opposite side
Spinal concussion - complete or incomplete last few hours to days
16
Q
How to children differ from adults regarding trauma to the spine
A
Children have a larger head relative to body
Can see ossification centres/growth plates
17
Q
Tough outer layer of intervertebral disc
A
Annulus fibrosis
18
Q
Gelatinous core of intervertebral disk
A
Nucleus polposus
19
Q
Which movements cause IV discs to fail
A
Twisting movements
20
Q
Management of nerve root pain
A
Physio
Strong analgesia
21
Q
Disc problems
A
Disc bulge
Protrusion
Extrusion
Sequestration
22
Q
Sensory loss of disk L5/S1
A
S1 nerve root
–> little toe and sole of foot
23
Q
Motor weakness due to damage of S1
A
Plantar flexion of foot
24
Q
Which nerve is affected by L4/5 disc prolapse
A
L5
25
Sensory loss from L5 lesion
Great toe and 1st dorsal web space
26
Motor weakness from L5 lesion
Extensor hallucis longus
27
Symptoms of L4 nerve root damage
Medial aspect of lower leg sensory loss
Quadricep weakness
28
Which regions of the spine are most commonly affected by degeneration
Cervical and thoracic
29
Effect of cauda equina compression - why is it an emergency
SURGICAL EMERGENCY
Sacral nerve root compression can result in permanent bladder and anal sphincter dysfunction and incontinence
30
Aetiology of cauda equina syndrome
Central lumbar disc prolaps (common)
Tumours
Trauma (to spine) or spinal stenosis
Infection - epidural abscess
Iatrogenic - spinal surgery or manipulation, an epidural injection 😱
31
Clinical features of cauda equina syndrome
Location of symptoms - bilateral buttock and leg pain and varying dyskinesia and weakness
Bowel or bladder dysfunction (urinary retention +/- overflow incontinence)
PR exam - saddle anaesthesia (perianal loss of sensation), loss of anal tone and anal reflex
32
Treatment of cauda equina syndrome
Operative - 48 hours❗️
Discectomy/route of problem
33
Spondylosis
Degenerative change
34
Effect of cervical and lumbar spondylosis
If severe can compress whole cord causing myelopathy
35
Movements permitted at the facet joints of the vertebrae at the lumbar spine
Flexion and extension
36
Name the ligament on the front of the vertebral bodies
Anterior longitudinal ligament
37
Name the ligament along the back of the vertebral bodies
Posterior longitudinal ligament
38
Name the ligament between laminae
Ligamental flavum
39
Symptoms of spinal claudication
Bilateral (usually)
Sensory dysaesthesiae
Possible weakness - drop foot
Takes several minutes to ease after stopping walking
WORSE ON WALKING DOWNHILL BECAUSE SPINAL CANAL BECOMES SMALLER IN EXTENSION
40
Types of spinal stenosis
Lateral recess
Central
Foraminal
41
Symptoms of spondylolysis
Low back pain
Occasionally radicular symptoms
Limits hyperextension activities/sports
Comon
42
Stages of fracture healing
1) Inflammation - haematoma and fibrin clot, angiogenesis
2) Soft callus - until bony fragments are united by cartilage or fibrin tissue, continued increase in angiogenesis
3) Hard callus - secondary bone healing = obvious callous; rigid fixation no obvious callus = primary bone healing
4) Bone remodelling - conversion of woven bone to lamellar bone
43
Delayed union of fracture could be caused by
```
High energy injury
Instability
Infection
Steroids/immune suppressants
Smoking
Warfarin
NSAID
```
44
How may we help delayed healing
Different dixation
Dynamisation
Bone grafting - autogenous is best choice as allogenic has risk of disease transmission
45
3 main functions of spine
Support axial skeleton
Movement of truck
Protect spinal cord
46
Source of infection in acute osteomyelitis in infants
Infected umbilical cord
47
Source of infection in acute osteomyelitis in children
Boils, tonsilitis, skin abrasions
48
Source of infection in acute osteomyelitis in adults
UTI, arterial line
49
What conditions may predispose to acute haematogenous osteomyelitis
```
Diabetes
Rheumatoid arthritis
Immune compromise
Long term steroid treatment
Sickle cell
```
50
Acute osteomyelitis infection organisms
Staph aureus most common all ages
Infants: e.coli
Older children: strep pyogenes, haemophilus influenzae
Adults: strep pyogenase, pseudomonas aeroginosa
51
Responsible organism for acute osteomyelitis secondary to penetrating foot injury and IVDA
Pseudomonas aeroginosa
52
Pathology of acute osteomyelitis
Starts at metaphysis
Vascular status - venous congestion and arterial thrombosis
Acute inflammation - increased pressure
Abscess (supuration)
Release of pressure
Necrosis of bone
New bone formation
Resolution (or chronic osteomyelitis if not)
53
Clinical features of acute osteomyelitis in a child
Severe pain
Reluctant to move (neighbouring joints held flexed); not weight bearing
May be tender and inflamed
Fever and tachycardia
Malaise, fatigue, nausea, vomiting
Toxaemia
54
Clinical features of acute osteomyelitis in an infant
May be minimal signs or be very ill
Possibly drowsy or irritable
Metaphyseal tenderness and swelling
Decreased ROM
Positional change
55
Clinical features of acute osteomyelitis in an adult
Primary OM seen commonly in thoracolumbar spine fever
--> back ache
History of UTI or urological procedure
Old, diabetic, immunocompromised
Secondary often seen after open fracture, surgery
56
Diagnosis of acute osteomyelitis
FBC and diff WBC - neutrophil leucocytosis
ESR CRP
Blood culture - take 3
U and E - ill and dehydrated
Xray (may be normal if early) or show metaphyseal destruction
Ultrasound
Aspiration into bone
Bone scan
MRI
57
Define sequestrum
Osteonecrosis
58
Define involucrum
New bone
59
Differential diagnosis for acute osteomyelitis
```
Soft tissue infection
Acute septic arthritis
Trauma
Acute inflammatory arthritis
Transient synovitis
```
Rare - sickle cell disease, haemophilia
60
Treatment of acute osteomyelitis
Supportive for pain and dehydration
Rest and splintage
Antibiotics - empirical fluclox and benzylpen while waiting
Surgery - aspiration, drainage of abscess, debridement of dead/contaminated tissue
61
Complications of acute osteomyelitis
Septicaemia, death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
62
Chronic osteomyelitis is...
Repeated breakdown of "healed" wounds
Chronically discharging sinus fixed to underlying bone
63
Organisms responsible for chronic osteomyelitis
Staph aureus
E.coli
Strep. Pyogenes
Proteus
64
Treatment of chronic osteomyelitis
Local - gentamycin cement/beads
Systemic
Eradicate bone infection surgically
Treat soft tissue problems
Correct deformity/reconstruct
Consider amputation
65
Complications of chronic osteomyelitis
Ongoing metastatic infection - abscesses
Pathological fracture
Growth disturbance and deformities
Amyloidosis
66
Route of infection in acute septic arthritis
Direct invasion via penetrating wound or intra-articular injury
Eruption of bone abscess
Haematogenous spread
67
Organism in acute septic arthritis
Staph aureus
Haemophilus influenzae
Strep pyogenes
E.coli
68
Presentation of acute septic arthritis in a neonate
Picture of septicaemia
- irritability
- resistant to movement
- ill
69
Presentation of acute septic arthritis in child
Acute pain in single large joint
- reluctant to move
- increase temp and pulse
- increase tenderness
70
Investigations for acute septic arthritis
FBC, WBC, ESR, CRP, blood cultures
Xray
Ultrasound
Aspiration
71
Most common cause of acute septic arthritis in an adult
Infected joint replacement
72
Differential diagnosis for septic arthritis symptoms
Acute osteomyelitis
Trauma
Irritable joint
Haemophilia
Rheumatic fever
Gout
73
Treatment of acute septic arthritis
General supportive
Antibiotics
Surgical drainage and lavage
74
Clinical features of tuberculosis
Insidious onset and general ill health
Contact with TB
Pain (esp. At night), swelling, loss of weight
Low grade pyrexia
Joint swelling
Decreased ROM
Ankylosis
Deformity
75
Polymyalgia rheumatica is characterised by
Pain and stiffness in the shoulders, neck, hips and lumbar spine, which is worse in the morning
It is rare in the under 60s
76
Most specific investigation for rheumatoid arthritis is
Anti-citrullinated peptide antibodies
However is not routinely performed before taking rheumatoid factor - send for anti-CCP if rf is negative or to judge course
77
First line therapy for rheumatoid arthritis
Non steroidal anti inflammatory drugs
78
Which joints of the hand are usually spared at the beginning of rheumatoid arthritis
Distal interpharyngeal joints
79
When is the pain generally worse in osteoarthritis
The evenings
80
Heberden's and bouchard nodes are features of what
Osteoarthritis
```
Heb = DIP
Bouchard = PIP
```
81
Main radiographical features of osteoarhritis are
Reduced joint space
Subchondral sclerosis
Bone cysts
Osteophytes
82
Radiographical features of rheumatoid arthritis
Reduced joint space
Soft tissue swelling
Peri-articular osteopenia
Bony erosions
Joint subluxation
83
Management of someone presenting to A&E with suspected septic arthritis
Aspiration and blood culture
Empirical antibiotic treatment IV - benzylpen and fluclox
Immobilise joint
Perform an Xray
Physio for follow up
84
Clinical features of reactive arthritis
Acute assymetrical lower limb arthritis occurring 1-4 weeks following an infection (dysentery or urethritis)
Conjunctivitis
Enthesitis which may result in plantar fasciitis or archilles tendonitis
Ulceration of the glans penis
Nail dystrophy
Mouth ulcers
Aortic incompetence (rarely)
85
Treatment of reactive arthritis
NSAIDs and local steroid injection for symptomatic control
86
Psuedo-gout is caused by the presence of what crystals
Calcium pyrophosphate
87
Which condition presents with rhomboidal, weakly positive bifringent crystals under polarised light microscopy of joint fluid
Pseudo-gout
88
How does gout present under polarised light microscopy of joint fluid
Needle-shaped negatively birefringent crystals
89
Why might someone with rheumatoid arthritis get pulmonary fibrosis
How would this present
Extra articular manifestations
And is a side effect of methotrexate (DMARD)
--> shortness of breath, fine basal inspiratory crepitations and dry cough
90
Anti-phospholipid syndrome
Recurrent arterial or venous thrombosis with a history of miscarriages
Can occur secondary to SLE
