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CAM III > Spine > Flashcards

Spine Flashcards

1
Q

What are red flags in a pt’s hx for spinal issues?

A 
Bowel or bladder dysfunction
Fever/fatigue (constitutional)
Wt loss
Saddle paresthesia
Progressive neuro decline
Trauma
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2
Q

Sensory testing for C1-C2

A

Front of face

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3
Q

Motor testing for C1-C2

A

Neck flexion

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4
Q

Sensory testing for C3

A

Lateral face and skull

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5
Q

Motor testing for C3

A

Lateral flexion

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6
Q

Sensory testing for C4

A

Supraclavicular

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7
Q

Motor testing for C4

A

Shoulder shrug

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8
Q

Sensory testing for C5

A

Lateral shoulder/upper arm

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9
Q

Motor testing for C5

A

Shoulder abduction

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10
Q

Reflex testing for C5

A

Bicipital (musculocutaneous)

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11
Q

Sensory testing for C6

A

Lateral lower arm and hand (thumb and index finger)

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12
Q

Motor testing for C6

A

Elbow flexion and wrist extension

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13
Q

Reflex testing for C6

A

Brachialradial (musculocutaneous)

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14
Q

Sensory testing for C7

A

Palmar aspect of hand- middle 3 fingers

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15
Q

Motor testing for C7

A

Elbow extension and wrist flexion

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16
Q

Reflex testing for C7

A

Triceps (radial)

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17
Q

Sensory testing for C8

A

Medial lower arm and hand

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18
Q

Motor testing for C8

A

Finger flexion and thumb extension

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19
Q

Sensory testing for T1

A

Medial elbow and upper arm

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20
Q

Motor testing for T1

A

Finger abduction

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21
Q

Kyphosis

A

Exaggerated rounding of back

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22
Q

Causes of kyphosis

A

Usually after osteoporosis/disc degeneration weakens the spine
Birth malformations

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23
Q

Tx of kyphosis

A 
Maintain good bone quality with 
diet
exercise
osteoporosis meds
Bracing in children
Exercises
Spinal fusion is last resort
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24
Q

What are signs of scoliosis?

A

Uneven shoulders
Curve in spine
Uneven hips (ASIS should be even in nl presentation)

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25
What is considered mild scoliosis?
Cobb angle of 10-20 degrees
26
What is considered moderate scoliosis?
Cobb angle 21-40 degrees
27
What is considered severe scoliosis?
Cobb angle >40 degrees
28
How is a Cobb angle taken?
Find which one is bent most, then find one turned the most opposite way Find the intersection
29
What should tx be for a Cobb angle of >20?
Monitor
30
What should tx be for a Cobb angle of 20-29?
Braced according to risk
31
What should tx be for a Cobb angle of >30?
Braced
32
What are the general components of low back pain?
``` 80% of people with back pain Most <3 mos Hx of lifting/twisting Nl neuro exam Pain with ROM Generalized diffuse pain ```
33
How should one proceed in an exam and dx of low back pain?
Clinical dx No imaging needed R/o red flags
34
When should one image in low back pain?
``` Neuro signs Bony pain Stepoff Saddle anesthesia Bowel/bladder sx ```
35
Myelopathy
Something pressing on the spinal cord itself A functional disturbance or pathological change in the spinal cord Usually progressive
36
Upper motor neuron signs of myelopathy
``` Weakness Spasticity Altered tonus Hyperreflexia Hoffman's sign ```
37
Hoffman's test
Relax pt Flick middle finger Nl: only middle finger should move Abnl: Index finger moves as well
38
Lower motor neuron signs of myelopathy
``` Weakness Atrophy Hyporeflexia Flaccidity Fasciculations Bowel/bladder dysfunctions ```
39
Radiculopathy
Motor/sensory disturbance due to specific nerve root compression
40
S/sx of radiculopathy
``` Pain Weakness Numbness Sensory loss Reflex changes ```
41
What is considered an acute case?
<6 wks
42
What is considered a chronic case?
>12 wks
43
What is considered radicular pain?
Radiating, tingling/numb/shock
44
Spondylosis
Disc space narrowing
45
S/Sx of spondylosis
``` Neck pain Dec ROM Muscle spasms Trouble sleeping Antalgic gait ```
46
Spondylolysis
Sometimes neck of Scotty dog is broken- pars defect or pars fx Get oblique spine views
47
Cause of spondylolysis
Trauma cause | Tumbling, other sports that have high impact on the legs
48
Spondylolysthesis
One vertebral body is shucked on the other- concern for pars defect
49
S/sx of spondylolisthesis
Back pain Worse with activity (bending/lifting) Trouble with lumbar flexion Muscle spasms
50
Grade I spondylolisthesis
1-25% slip
51
Grade II spondylolisthesis
26-50% slip
52
Grade III spondylolisthesis
51-75% slip
53
Grade IV spondylolisthesis
76-100% slip
54
Tx for spondylolisthesis
Stable can be left alone Can tell when unstable when back pain is increasing Most are gradual Fusion
55
Causes of radicular pain
Young-herniated disc | Older-foraminal narrowing
56
S/sx of cervical radiculopathy
``` Numbness Paresthesias Muscle spasms Weakness Dec coordination ```
57
PE of cervical radiculopathy
``` Decreased or painful ROM Sensory changes Muscle weakness Decreased reflexes Pos Spurlings maneuver ```
58
Conservative tx for cervical radiculopathy
``` Spontaneous resolution in 6-12 wks NSAIDs Steroids PT Traction Refer if failure of tx, atrophy, weakness, myelopathy ```
59
What is the MC cause of sciatica?
Bulging or herniated disc
60
Test for sciatica
Straight leg test | Pain at 30-70 degrees radiates below the knee
61
Tx for sciatica
``` Most will resolve Heat or cold NSAIDs/steroids/muscle relaxants Injections PT Surgery ```
62
Cervical sprain/strain components
``` Usually caused by whip lash through an MVA Muscles and/or ligaments Decreased ROM, TTP Nl neuro exam Could take 6 mos to resolve RICE is mainstay of tx ```
63
Compression fx
``` Wedge-shaped vertebra Osteoporosis Midline pain Kyphosis Look for the vertebra that's different ```
64
Tx for compression fxs
Pain control Brace Surgery referral Kyphoplasty
65
What is a risk of a kyphoplasty?
Could get more fxs above and below d/t weak structures
66
Jefferson fracture
Fracture to C-1 (atlas)
67
Dx of Jefferson fx
Open mouth view
68
Cause of hangman fx
Spinous process is broken
69
Hangman fracture
Fracture to C-2 (axis)
70
Spinal stenosis
Narrowing of canal Compression of nerve roots Older pts Usually degenerative in nature
71
S/sx of spinal stenosis
``` Neurogenic claudication Radiculopathy Worse with walking/prolonged standing Better with rest/laying down Relief with stooping Back pain that shoots downward Worse with extension ```
72
Spinal stenosis tx
NSAIDs Therapy Epidural injections Surgery/fusion
73
Causes of cauda equina syndrome
``` Disc herniation Epidural abscess Epidural hematoma Trauma Burst fxs ```
74
Tx for cauda equina syndrome
Surgical emergency Must decompress ASAP NPO
75
What differentiates a spinal epidural abscess?
Fever
76
S/sx of spinal epidural abscess
``` Severe back pain "Shocking" or "shooting" Sensory changes Motor weakness B/b dysfunction Fever/malaise ```
77
What are the most common cancers to metastasize to the spine?
``` Breast Lung Thyroid Kidney Prostate ```

CAM III (12 decks)

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