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DM II > Spine > Flashcards

Spine Flashcards

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

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

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

A

activity modification, NSAIDs and other analgesics, PT, surgery

24
Q

disc disorders: degeneration/herniation

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
Q

cauda equina syndrome

A

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
Q

nocturnal back pain, unrelieved by rest

A

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
Q

sacroilitis

A

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
Q

spondylosis/spondylolisthesis

A

spondylosis: defect of pars interacrticularis: typically 5th lumbar vetebrae, occasionally 4th
spondylolisthesis: slippage of 1 vertebrae on top of another
most are asymptomatic

29
Q

spondylosis/spondylolisthesis symptoms

A

low back pain
hamstring tightness
pain radiating down legs
difficulty with upright posture and gait

30
Q

other causes of lower back pain

A

SI join strain / dysfunction
facet dysfunction
iliopsoas muscle strain

31
Q

imaging when and whom

A

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
Q

back pain diagnostics

A

xrays
CT
MRI
EMG

LABS:

  • CRP
  • CBC
  • alkaline phosphotase
  • calcium level
33
Q

activity and back pain

A

gradual introduction to low stress activities
bedrest not recommended
avoid prolonged sitting/standing/riding i vehicles/lifting/bending

34
Q

back pain tx

A

exercise, PT, manual therapies, traction, interventional procedures

meds:

  • otc analgesics
  • skeletal muscle relaxants
  • opioid analgesics
  • TCAs
  • SNRIs
  • gabapentin
35
Q

vertebral compression fracture

A 
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
Q

3 types of vertebral fractures

A

wedge
biconcave
crush

37
Q

vertebral compression fractures: risk factors and associated conditions

A

-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
Q

long term consequences of VCF

A

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
Q

vertebroplasty

A

faster surgery
less post op
cement leakage tho

40
Q

kyphoplasty

A

less cement leakage
but more costly
and overnight stay

41
Q

neck pain red flags

A

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
Q

spurling sign

A

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
Q

cervicalgia

A

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
Q

axial neck pain

A 
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
Q

loss of lordosis

A

seen in many causes of axial neck pain, including whiplash

46
Q

neck pain - mechanical

A

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
Q

neck pain - whiplash

A

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
Q

whiplash

A 
acceleration - deceleration injury
4 categories
i - general nonspecific
iii - + neuro signs
iv - fracture or dislocation
49
Q

cervical radiculopathy

A

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
Q

cervical radiculopathy

A

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
Q

cervical myelopathy

A

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
Q

emergent myelopathy symtpoms

A 
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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