Spine Flashcards
(38 cards)
1
Q
Spinal History Red Flags
(3)
A
- Fracture
- Trauma - remember, elderly may fx c minor tx
- Compression
- Tumor/Infection
- Hx cancer
- Constitutional changes
- > 50 yo
- Neuro compromise
- Cauda Equina Syndrome
- Ask about bowel/bladder function
- **Prepare to eval rectal tone **
- Cauda Equina Syndrome
2
Q
Spine-Specific Hx Questions
(5)
A
- Injury
- Injury type
- Mechanisms
- violence
- work related
- Pain eval (OPQRSTUVW)
- ADL’s *(think bathing) *
- Bladder/bowl function
- Attempted tx
- OTC meds
- Massage
- Chiropractory
3
Q
Spine Palpation
(4 aspects)
A
Check all points for pn/spasm while pt is standing (if possible)
- Spinous processes
- Paraspinal muscles
- Pelvis level
- SI joint
4
Q
Neurological Components, Spinal Exam
(4 general)
A
Conduct on upper and lower limbs
- Dermatomes
- Reflexes
- Pulse
- Sensation
5
Q
Gait Protocol
A
- Observe gait pattern when pt walks into room
- Antalgic (limping)
- Trandelenburg
- Short leg
- Foot Drop
- Have pt toe walk (S1)
- **Heel walk (L4/5) **
6
Q
Standing Evaluation
A
- Nerve Root Tension - pt stand c one knee bent in spite of equal leg lengths (this poisition relieves tension)
- Prolapsed Intervertebral Disc - “List” or “tilt” may be compensatory for nerve root compression
7
Q
Abnml Spinal Curvature
A
- Spinally mediated (exaggerated curves)
- Muscle weaknesses/spasm
8
Q
Spinal Landmarks
(
A
- T3 - spine of scapula
- T7 - just distal to inf angle of scapula
- L4 - Sacrospinalis
- S2 - Gluteus medius
These are helpful for palpating spinal tenderness - you can identify potential level of injury
9
Q
Palpation Points, Spine
(5)
A
- Vertebral tenderness - localized vs generalized
- Paraspinal muscles - spasm/tenderness
- Sacroiliac joint - tenderness
- Groin - masses/abscesses
- Abdomen - masses/abscesses
10
Q
Spinal ROM
A
- Flexion/extension
- Lateral flexion/extension
- Rotation L/R
11
Q
Seated Inspection, Spinal Exam
(2 aspects)
A
- Observe movement on/off table
- Assess pt posture for obvious conditions
12
Q
Straight Leg Raise (SLR)
A
- Lay pt supine
- Passively raise 1 leg at a time up to 60 degrees (going further may introduce hamstring tightness)
- Note the angle @ which pn radiating down leg occurs
+ exam = sciatic pn/parasthesia/discomfort/burning c ligament laxity that may be contra or ipsilateral to SC injury
- exam = 80-90 degrees s pn (potential tightness)
13
Q
Sciatic Stretch Test
A
- Perform straight leg raise (passively flex leg from supine)
- Dorsiflex ankle
+ exam = additional nerve pn radiating down leg
14
Q
Patrick’s/Faber’s Test
A
Procedure:
- Place pt supine
- Have pt place L knee just proximal to R patella
- Stabalize pelvis sharply, externally rotating hip to approach knee to table
- Repeat on other side
Results:
+ exam = hip/sacroiliac disease or injury
- exam = normal joint mobility
15
Q
Spinally Relevant Reflexes
(7)
A
*Perform for upper and lower extremities, respectively *
- Biceps = C5
- Brachioradialis = C6
- Tricep = C7
- Knee = L4
- Ankle = S1
- Anal = S2/S3/S4 reflex arc (like cauda equina syndrome)
- Babinski = upper motor neurons
16
Q
LE Myotomes
A
- Psoas = L2
- Quadriceps = L3 (L2/L3 disk)
- Tibialis Anterior = L4 (L3/L4 disk)
- Extensor Hallicus = L5 (L4/L5)
- Gastrocnemius, peroneus longus/brevis = S1 (L5/S1)
- Bladder sphincter = S2
- Anal sphincter = S3
*Remember, move these against resistance to test each motor neuron *
17
Q
Lower Extremity Dermatomes
A
Only pay attention to left 2 pictures
18
Q
LE Nerve Dependent Eval
(motor/reflex/sensation for L4/L5/S1)
A
-
L4
- Motor = tibialis anterior (inversion)
- Reflex = patellar
- Sensation = medial leg
-
L5
- Motor = extensor hallicus (toe dorsiflexion)
- Reflex = none
- Sensation = dorsum of foot
-
S1
- Motor = peroneus longus/breviw (eversion)
- Reflex = achilles
- Sensation = lateral foot
19
Q
Upper Motor Neuron Dysfunction Signs
(3 exams)
A
- Hoffman’s Reflex
- pt seated c hand relaxed and cradled in yours
- flick middle finger nail
- watch for index finger/thumb flexion
- Babinski Reflex
- pt supine
- stroke lightly upward on plantar foot surface
- watch great toe extension
- Ankle clonus
- pt seated
- dorsiflex ankle suddenly
- observe rhythmic beating c duration and # of “beats”
20
Q
S1 Tests
(3)
A
- Toe walking
- Straight leg raise
- Ankle reflex test
21
Q
L4/L5 Specific Testing
A
- Lumbar list - *observe trunchal shift (L or R) when pt stands c feet together *
- Heel walking - L4
- Great toe extensor weakness - L5
22
Q
Flip Test
(procedure, + result)
A
Procedure
- Sit pt on edge of table
- Passively flex pt hip (c knee straightened)
Positive - pt extends or “flips” backwards, indicating sciatic tension
23
Q
Superficial Abdominal Index
(Procedure, Results, Indication)
A
Indication: perform to eval for paralysis in trauma pt
Procedure:
- pt supine
- stroke lightly towards umbilicus
Results:
- exam = pull umbilicus towards stimulated side
+ exam = no umbilicus movement
24
Q
Piriformis Syndrome
A
Inflammation/pressure on piriformis muscle that compresses sciatic nerve and causes irritation
Often seen c wallet in back pocket
25
Scoliosis
(def, prevalence, screening, cause, prognosis)
_Def_: abnl lateral spinal curvature \> 10 degrees
_Prevalence_: 2%, M = F
_Screening_: starts @ age 6
_Cause_: 85% cases idiopathic, but usually linked to muscular abnormality
_Prognosis_: back pn not significantly higher, changes as follows
1. \< 30% curve at bony maturity (adolescence) = unlikely to progress
2. \> 50% curve at bony maturiy = progress 1 deg/year
3. 19% females c curves \> 40% have sig psychological illness
26
Scoliosis Signs
| (7)
1. Uneven shoulder blade prominence
2. Head not centered above pelvis
3. 1 raised, prominent hip
4. Rib cages at different heights
5. Uneven waist
6. Change in skin overlying spine
* dimples
* hairy patches
* color change
7. Unilateral leaning
27
Cobb Angle
Measurement to quantify spinal bending in scoliosis
28
Lumbosacral Strain
| (hx, 3 findings)
_Hx_:
* acute/subacute onset in low back
* pt can't get comfortable
_Findings_:
1. Muscle tenderness/spasm
2. Loss of flexion/lateral bending
3. **Normal neuro exam**
29
Discogenic (Annulus) Pain
| (hx, 3 findings)
_Hx_: acute/subacute back/buttock pn
_Findings_:
1. Worse c flexion
2. Loss of flexion c inc pn
3. **Normal neuro exam **
30
Herniated Nucleus Pulposus (HNP)
(hx, 5 findings, diagnostic testing, prognosis)
_Hx_:
* Acute/subacute onset of back/buttock + radiating leg pn
* +/- Minor trauma (including sneezing)
_Findings_:
1. Exacerbated c flexion, cough, valsalva
2. Localized tenderness + spasm
3. + Straight leg raise
4. Radicular findings on neuro exam
5. Dec/absent DTR and/or weakness in strength testing
_Diagnostic Studies_:
* Test = MRI
* Indication = no change after **4 weeks** of s/sx
* 20% asymptomatic young adults will show HNP
_Prognosis_: 90% pts heal s surgery
31
Cervical Spine Exam
| (4 aspects)
1. Symmetry
* scoliosis
* torticollis (muscular)
* tumor/gland growth
2. Landmarks
* Hyoid = C3
* Thyroid = C4/5
* Cricoid = C6
3. Sternum
* Excavatum
* Carinatum
4. Muscles
* SCM (torticollis)
* Facial assymetry
32
C5
| (motor, sensory, reflex)
Motor = deltoid and bicep flexion
Sensory = skin over deltoid
Reflex = biceps
33
C6 Exam
| (motor, sensory, reflex)
Motor = bicep, extensor carpi raialis longus, extensor carpi radialis brevis flexion
Sensory = lat forearm, incld thumb and index
Reflex = brachioradialis
34
C7 Neuro Exam
| (motor, sensory, reflex)
Motor = tricep flexion, wrist flexor, finger extensors
Sensory = middle finger
Reflex = tricep
35
C8 Neuro Exam
| (motor, sensory, reflex)
Motor = interossei, finger flexors
Sensory = medial arm, 4th and 5th digits
Reflex = none
36
Spurlings Test
(indication, procedure, results, caution)
_Indication_: detect cervical spine problem
_Procedure_:
1. Forcibly press down on top of head
2. Lateral bend to L then R -- compressing nerve roots
_Results_: pain indicates nerve swelling
_Caution_: may cause compression fx in frail pt or serious spine dz
37
Axial Load Test
| (Indication, Procedure)
_Indication_: ID disk pathology
_Procedure_:
1. Pt standing
2. Push down on pt head
38
Lhermitte's Sign
| (def, two causes)
_Def_: electric shock-like impulses transmitted down spine/lower limbs when neck flexed
_Causes_:
* cervical cord injury
* MS
