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DM II > Spine > Flashcards

Spine Flashcards

(52 cards)

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1
Q

evaluating back and neck pain

A

self-limited (95%)
serious disease (5%)
—delay in dx -> poor outcomes
IMAGING HAS LIMITED ROLE

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2
Q

history questions - underlying disease

A 
age 
recent trauma
cancer/arthritis
weight loss
IV drug use
chronic infection
time and duration of pain
response to previous therapy
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3
Q

hx questions - psychosocial stressors

A

depression
substance abuse
job dissatisfaction
disability compensation

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4
Q

inspect

A

cervical, thoracic, and lumbar curves

inspect upright spinal column and alignment of shoulders, iliac crests, gluteal folds

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5
Q

spine - range of motion

A

neck & spine::: SAME
flexion, extension
rotation and lateral bending

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6
Q

neuro testing

A

focus on few test that seek evidence of nerve root impairment, peripheral neuropathy or spinal cord dsyfunction
over 90% of all clinically significant lower extremity radiculopahty due to disc herniation involves
L5 or S1 nerve root at the L4-5 or L5-S1 disc level

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7
Q

achilles reflex test

A

mostly S1 nerve root

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8
Q

patellar reflex test

A

mostly L4 nerve root

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9
Q

L5 nerve root

A

not tested with a reflex

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10
Q

babinski/plantar response

A

may indicate upper motor neuron abnormalities (such as myelopathy or demyelinating disease) rather than a common low back problem

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11
Q

sensory exam of the foot

A

medial - L4
dorsal - L5
lateral - S1

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12
Q

muscle strenght

A 
toe walking - S1
heel walking - L5, L4
single squat and rise - L4
dorsiflexor or great toe - L5 or L4
hamstrings and ankle evertors L5-S1
toe flexors S1
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13
Q

circumferential measurements

A

r/o muscle atrophy
differences of less than 2 cm may be normal
symmetrical muscle bulk and strength are expected unless the patient has a neurologic impairment or a hx of lower extremity muscle or joint problem

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14
Q

myelopathy

A 
disorder of the spinal cord itself
neuro findings are usually BILATERAL 
cancer, compression (hematoma, stenosis, mass) radiation
s/s : HYPERREFLEXIA
tx: surgical decompression
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15
Q

radiculopathy

A

dysfunction of nerve root anywhere along the spine
results in pain , weakness, and or decreased reflexes
typically UNILATERAL

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16
Q

red flags with back pain

A 
older than 50 
hx of cancer
unexplained weight loss
pain lastin longer than month
pain at night or at rest
hx of IV drug use
presence of infection
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17
Q

straight leg test

A

painful radiculopathy
more than 95% of disc herniations occur at L5-S1
look for ipsilateral calf wasting and weak ankle dorsiflexion

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18
Q

sitting knee extension test

A

sitting SLR

pt will complain or lean backward to reduce tension on the nerve

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19
Q

lumbago

A

low back pain
2nd most common reason for primary care visits (1st is URI)
back pain is SYMPTOM not diagnosis
usually resolves 6-12 weeks

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20
Q

mechanical low back pain

A

lumbosacral area
L5-S1 - may radiate into lower leg
usually acute (<3 months) idiopathic benign and self-limiting
usually worse standing, twisitng
30-50 y/o , work relatd
paraspinal muscle tenderness, pain with mvmt, loss of lumbar lordosis
NO MOTOR OR SENORY IMPAIRMENT
MRI - test of choice
labs not indicated
tx: NSAIDs, acetaminophen, muscle relaxants, back strenghtening, pt referral

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21
Q

sciatica

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A

sciatica = radicular lower back pain
it is SYMPTOM of some other condition putting pressure on sciatic nerve:
ie: herniated disc, piriformis syndrome, pelvic injury fracture, tumor

shooting pain below knee 
unilateral numbness and weakness
increased pain with sitting
improved standing
\+ straight leg

CT or MRI

rest, nsaids, pt, surgical consult

22
Q

lumbar spinal stenosis

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A

-PSEUDOCLAUDICATION
pain in back or legs with walking that improves with rest or lumbar flexion
-pain vague but usually BILATERAL with numbness in one or both legs
-hypertrophic degenerative disease, thickening of the ligament causing narrowing of the spinal canal
-common age > 60
-posture flexed fwd, lower extremity weakness, HYPOREFLEXIA
-MRI OR CT

23
Q

tx of lumbar spinal stenosis

Study These Flashcards
A

activity modification, NSAIDs and other analgesics, PT, surgery

24
Q

disc disorders: degeneration/herniation

Study These Flashcards
A

L4-L5 most common followed by L5-S1
Patients 30-50 y/o
symptoms severe w/ no neuro deficit
neuro symtpoms of sensory deficits, weakness, reflex changes
+SLR , weakness, abnormal relfexes
CT, MRI, EMG
tx: pain management, rest, heat, massage, pt, anti inflamm agents, steroids, surgery

25
cauda equina syndrome
rapidly progressive neuro symptoms low back pain associated with erectile dysf(x), saddle anesthesia, decreased sphincter tone, urinary retention compression of the spinal nerve root SURGICAL EMERGENCY tumor ruptured disk, infection, fracture or narrowing of spinal canal MRI = image of choice tx = surgical decompression
26
nocturnal back pain, unrelieved by rest
metastatic malignancy to spine? from cancer of prostate, breast, lung, thyroid, and kidney, and multiple myeloma hx of cancer, weight loss, new onset kidney disease, fever loss of normal lumbar lordosis, muscle spasm, lateral immobility of the spine CT or MR
27
sacroilitis
lumbosacral pain radiates to the buttocks, groin, or posterior thigh aggravated by extensive use prolonged exercise PE: tenderness at SI joint CAn be an overuse injury or related to systemic illnesses tx: rest, pt, anti-inflamm medications
28
spondylosis/spondylolisthesis
spondylosis: defect of pars interacrticularis: typically 5th lumbar vetebrae, occasionally 4th spondylolisthesis: slippage of 1 vertebrae on top of another most are asymptomatic
29
spondylosis/spondylolisthesis symptoms
low back pain hamstring tightness pain radiating down legs difficulty with upright posture and gait
30
other causes of lower back pain
SI join strain / dysfunction facet dysfunction iliopsoas muscle strain
31
imaging when and whom
hx of cancer, > 50 , weight loss, failure to improve with conservative therapy combined w either increased ESR, + x-ray immediate imaging if they have a hx of cancer
32
back pain diagnostics
xrays CT MRI EMG LABS: - CRP - CBC - alkaline phosphotase - calcium level
33
activity and back pain
gradual introduction to low stress activities bedrest not recommended avoid prolonged sitting/standing/riding i vehicles/lifting/bending
34
back pain tx
exercise, PT, manual therapies, traction, interventional procedures meds: - otc analgesics - skeletal muscle relaxants - opioid analgesics - TCAs - SNRIs - gabapentin
35
vertebral compression fracture
``` often present as acute thoracic or lumbar pain hx of fall or trauma previous VCF or other fractures onset of LE weakness or sensory changes bowel or bladder changes ```
36
3 types of vertebral fractures
wedge biconcave crush
37
vertebral compression fractures: risk factors and associated conditions
-prominent thoracic kyphosis -low BMD -osteoporosis -postmenopausal women > 55 -loss of 2 or more inches in height -glucocorticoid therapy >7.5 mg of prednisone
38
long term consequences of VCF
pain, spinal deformity, decreased lung capacity, imapired function, loss of appetite, sleeping problems, decreased activity, more bone loss, increased fracture risk, increased mortality and morbidities
39
vertebroplasty
faster surgery less post op cement leakage tho
40
kyphoplasty
less cement leakage but more costly and overnight stay
41
neck pain red flags
hx of recent fall or trauma to the head or neck unexplained weight loss severe, intractable pain or severe local tenderness cervical lymphadenopathy unexplained fever, especially in diabetics hx of cancer hx of chronic steroid use
42
spurling sign
axial compression of spine and rotation to the ipsilateral side of symptoms reproduces or worsens cervical radiculopathy pain on side of rotation is usually indicative of formainal stenosis and nerve root irritation
43
cervicalgia
very common -axial = neck and occiput - MSK arthritis, infection, tumor, WHIPLASH - radiculopathy = neck and arm pain / numbness / weakness - myelopahty = PRESSURE ON THE SPINAL CORD , neck pain w/ arma nd or leg weakness, numbness / walking problems
44
axial neck pain
``` localized to occiput and neck region MSK , tumor myofascial pain secondary to irritation of the muscles around the neck fibromyalgia RA malginancy / systemic inflam ```
45
loss of lordosis
seen in many causes of axial neck pain, including whiplash
46
neck pain - mechanical
aching pain, cervical paraspinal muscles and ligaments spasm, stiffness, tightness in shoulder and upper back duration : weeks no radiation, parasthesia, weakness headache maybe present PE: pt tenderness along paraspinal muscles, pain with movment, but usually not decreased ROM
47
neck pain - whiplash
aching paracervical pain and stiffness begin day after injury occipital headache, dizziness, malaise and fatigue present can be chronic > 6 months caused by forced hyperflexion/extension decreased ROM, perceived weakness of upper extremities
48
whiplash
``` acceleration - deceleration injury 4 categories i - general nonspecific iii - + neuro signs iv - fracture or dislocation ```
49
cervical radiculopathy
sharp burning or tingling pain in neck and one arm parasthesia and weakness in affected arm nerve root compression C7 most effected caused by herniated disc weakness in triceps if C7 weakness in biceps if C6
50
cervical radiculopathy
compression and irritation of an exiting cervical nerve root d/t - acute disc herniations - cervical spondylosis (bilateral) - foraminal narrowing (unilateral) tx : neck traction or shoulder adduction sx relief can help dx
51
cervical myelopathy
neck pain & bilateral weakness and pasthesia in both upper and lower extremities hand clumsiness plamar paresthesia gait changes urinary frequnecy neck flexion exacerbates caused by cervical spondylosis from degenerative disc or cervical stenosis or traua PE: hyperreflexia, + babinski, gait changes requires neck immobilization and neurosurgical eval
52
emergent myelopathy symtpoms
``` difficulty with manual dexterity babinski hoffman sign - flexion of terminal phalanx of the thumb hyperreflexia clonus ``` needs operative decompression

DM II (4 decks)

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