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MSK > Spinal Symposium > Flashcards

Spinal Symposium Flashcards

1
Q

Dermatome

A

-a dermatome is an area of skin that is mainly supplied by a single spinal nerve

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2
Q

Myotome

A

-a myotome is the group of muscles that a single spinal nerve innervates

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3
Q

C5 movement

A

-shoulder abduction (deltoid)

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4
Q

C6 movement

A

-elbow flexion/wrist extension (biceps)

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5
Q

C7 movement

A

-elbow extension (triceps)

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6
Q

C8 movement

A

-long finger flexors (FDS/FDP)

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7
Q

T1 movement

A

-finger abduction (interossei)

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8
Q

L2 movement

A

-hip flexion (iliopsoas)

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9
Q

L3, L4 movement

A

-knee extension (quadriceps)

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10
Q

L4 movement

A

-ankle dorsiflexion (Tibialis anterior)

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11
Q

L5 movement

A

-big toe extension (extensor hallucis longus)

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12
Q

S1 movement

A

-ankle plantar flexion (gastrocnemius)

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13
Q

Complete spinal cord injury presentation

A
  • no motor or sensory function distal to lesion
  • no anal squeeze
  • no sacral sensation
  • ASIA Grade A
  • no chance of recovery
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14
Q

Incomplete spinal cord injury presentation

A
  • some function is present below site of injury

- more favorable prognosis overall

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15
Q

ASIS classification A

A

A - Complete. No sensory or motor function preserved in sacral segments S4-S5

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16
Q

ASIS classification B

A

B - Incomplete. Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5

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17
Q

ASIS classification C

A

C - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade <3

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18
Q

ASIS classification D

A

D - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade >3

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19
Q

ASIS classification E

A

E - Normal motor and sensory function

20
Q

Quadriplegia

A
  • Partial or total loss of use of all four limbs and the trunk
  • Loss of motor/sensory function in cervical segments of the spinal cord
  • Respiratory failure due to loss of innervation of the diaphragm
  • Spasticity
21
Q

Paraplegia

A
  • Partial or total loss of use of the lower-limbs
  • Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord
  • Spasticity if injury of spinal cord (i.e. above L1)
  • Bladder/ Bowel function affected
22
Q

Central cord syndrome

A
  • Older patients (arthritic neck)
  • Hyperextension injury
  • Central cervical tracts more involved
  • Weakness of arms > legs
  • Perianal sensation & lower extremity power persevered
23
Q

Anterior cord syndrome

A
  • Hyperflexion injury
  • Anterior compression fracture
  • Damaged anterior spinal artery
  • Fine touch and proprioception preserved
  • Profound weakness
24
Q

Brown–Sequard Syndrome

A
  • Hemi-section of the cord
  • Penetrating injuries
  • Paralysis on affected side (corticospinal)
  • Loss of proprioception and fine discrimination (dorsal columns)
  • Pain and temperature loss on the opposite side below the lesion (spinothalamic)
25
Q

Spinal shock

A
  • Transient depression of cord function below level of injury
  • Flaccid paralysis
  • Areflexia
  • Last several hours to days after injury
26
Q

Neurogenic shock

A
  • Hypotension
  • Bradycardia
  • Hypothermia
  • Injuries above T6
  • Secondary to disruption of sympathetic outflow
27
Q

Surgical fixation of spinal cord injury

A
  • Unstable fractures
  • Vast majority fixed from posteriorly
  • Pedicle screws preferred method
28
Q

Long term management of spinal cord injury

A
  • Physiotherapy
  • Occupational therapy
  • Psychological support
  • Urological /Sexual counselling
29
Q

Intervertebral disc joint type

A

-secondary cartilaginous

30
Q

Intervertebral disc prolapse

A
  • Annulus fibrosus
    - Tough outer layer
  • Nucleus pulposus
    - Gelatinous core
  • Annulus may tear and nucleus prolapse
    - Can cause cord / nerve root compression
  • Disc prolapses are usually posteriolateral
31
Q

Nerve root pain management

A
  • Physiotherapy
  • Strong analgesia
  • Referral after 12 weeks
  • Imaging - MRI
32
Q

Disc problems

A
  • Bulge (generalised) – common, majority asymptomatic
  • Protrusion (annulus weakened but still intact)
  • Extrusion (through annulus but in continuity)
  • Sequestration (dessicated disc material free in canal)
33
Q

Cauda equina syndrome aetiology

A
  • central lumbar disc prolapse (commonest)
  • tumours
  • trauma or spinal stenosis
  • infection (epidural abscess)
  • iatrogenic (spinal surgery or manipulation, spinal epidural injection)
34
Q

Cauda equina syndrome clinical features

A

-Injury or precipitating event
-Location of symptoms (bilateral buttock & leg pain + varying dysaethesiae + weakness)
–Bowel or bladder dysfunction (urinary retention +/- incontinence overflow)
–PR exam - saddle anaesthesia (perianal loss of sensation), loss of anal tone & anal reflex
–High index of suspicion in spinal post-op patients with increasing leg pain in presence of urinary retention

35
Q

Cauda equina radiological investigations

A
  • MRI

- CT myelogram if MRI contraindicated

36
Q

Cauda equina syndrome treatment

A
  • operative

- within 48 hours

37
Q

Cervical and lumbar spondyosis

A
  • Common
  • Degenerative change at facet joints, discs, ligaments, etc.
  • If severe, can compress whole cord causing myelopathy
  • UMN signs in limbs (increased tone, brisk reflexes, etc.)
38
Q

Ligaments around vertebrae

A
  • Anterior Longitudinal Ligament (ALL – along the front of the vertebral bodies – broad, strong)
  • Posterior Longitudinal Ligament (PLL – along the backs of the vertebral bodies, i.e. front of the spinal canal; narrower)
  • Ligamentum Flavum (between laminae)
  • Interspinous and Supraspinous Ligaments (between spinous processes)
  • Intertransverse Ligament (between transverse processes)
39
Q

Spinal Claudication

A
  • Usually bilateral
  • Sensory dysaesthesiae
  • Posterior weakness (drop foot – tripping)
  • Takes several minutes to ease after stopping walking
  • Worse walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding bicycle
40
Q

Lateral recess stenosis treatment

A
  • Nerve root injection
  • Epidural injection
  • Surgery
41
Q

Central stenosis treatment

A
  • Epidural steroid injection

- Surgery

42
Q

Foraminal stenosis

A
  • Nerve root injection
  • Epidural injection
  • Surgery
43
Q

ASIS B

A

B - Incomplete. Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5

44
Q

ASIS C

A

C - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade <3

45
Q

ASIS D

A

D - Incomplete. Motor function preserved below the neurological level; majority of key muscles have a grade >3

46
Q

ASIS E

A

E - Normal motor and sensory function

MSK (24 decks)

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