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CM2 Exam 2 > Spine- Beloy > Flashcards

Spine- Beloy Flashcards

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1
Q

The spinal nerves exit the

cervical spine above/below their corresponding vertebral body level?

A

above

For example, the C5 nerve root exits above C5 through the C4/5 neural foramen.

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2
Q

In the thoracic and lumbar spine it is above/below?

A

below

So the L5 nerve would come out below at the L5/S1 disc space.

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3
Q

Sensory distribution and muscle of C2

A

Radiates up the head & skull stabilizer

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4
Q

Sensory distribution and muscle of C3

A

Upper neck/jaw line & Nuchal muscles, Diaphragm

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5
Q

Sensory distribution and muscle of C4

A

Neck jaw line/superior shoulder & Nuchal muscles, Diaphragm

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6
Q

Sensory distribution and muscle of C5

A

Shoulder/Anterior arm & Deltoid, supraspinatus, infraspinatus

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7
Q

Sensory distribution and muscle of C6

A

Radial forearm into thumb & Biceps, brachioradialis, extensor carpi radialis, extensor pollicis

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8
Q

Sensory distribution and muscle of C7

A

Posterior arm into middle fingers & Triceps, lattisimus dorsi, pectoralis major

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9
Q

Sensory distribution and muscle of C8

A

Ulnar side, ring and pinky finger & Intrinsic hand muscles, finger extensors

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10
Q

Sensory distribution and muscle of T1

A

Same as C8. Ulnar side, ring and pinky finger & Intrinsic hand muscles, finger extensors

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11
Q

C3, C4, C5 are mostly sensory or motor?

A

sensory

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12
Q

Do thoracic n have motor fxn?

A

No only sensory so they are often cut in surgery with no repercussions

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13
Q

What is a muscle motor grading score of 5/5?

A

able to resist against the examiner resistance/full strength

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14
Q

What is a muscle motor grading score of 4/5?

A

able to move muscle group against gravity but only against minimal resistance/decreased strength

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15
Q

What is a muscle motor grading score of 3/5?

A

able to move muscle group against gravity but not against resistance

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16
Q

What is a muscle motor grading score of 2/5?

A

able to move muscle group but not against gravity

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17
Q

What is a muscle motor grading score of 1/5?

A

Muscle tone/contraction but not able to fully move muscle

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18
Q

What is a muscle motor grading score of 0/5?

A

muscle paralysis/flaccid tone

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19
Q

A straight leg raise can detect a problem with the _____ or ______ disc

A

L4/5 or L5/S1

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20
Q

These are what type of spine conditions?

  • Disc herniation
  • Facet joint osteoarthritis
  • Spinal stenosis
  • Degenerative disc disease
  • Spondylolisthesis
A

Degenerative spine conditions

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21
Q

Inflamed facet joints cause _______ pain only

A

back

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22
Q

Cervicalgia AKA _____ pain is common due to _________

A

neck pain, poor posture

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23
Q

What symptoms will you get with cervical spine pain?

A

Muscle tightness, spasms, decreased ROM, headaches, radiculopathy (numbness, tingling)

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24
Q

For cervical spine pain, you decide to get a cervical spine work up. What do you order first?

A

Xray and need 4 views: AP/Lateral/Flexion/extension

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25
Instability in the c-spine is > _______ mm of motion
2-3
26
First line tx for C-spine pain?
PT, activity modification (changing desk height, posture, chiro, time
27
When would you order an MRI for a patient with C-spine pain?
- Instability noted on xrays - Weakness - Signs/symptoms of cord compression - No improvement with conservative care after 6-8 weeks
28
Spinal cord dysfunction that can lead to paralysis (a syndrome)
Myelopathy
29
What are some symptoms of myelopathy?
Gait instability, weakness, incoordination (can't button shirt), bowel or bladder incontinence, burning in bilateral hands
30
Are symptoms of myleopathy reversible or irreversible?
Can be IRREVERSIBLE
31
If a patient has bowel or bladder incontinence, what test should urgently be ordered?
MRI
32
The thoracic spine has not a lot of degen and is hard to treat why?
- Tricky to treat as the spinal cord can not be manipulated - Can not do surgery from the front as the lungs and heart are in the way. - Common location for compression fractures, can lead to kyphosis
33
______ back pain lasts a short period of time and heals in a few days whereas _______ back pain lasts 3 months or more and causes a dull/aching pain
acute, chronic
34
Sciatica affects these dermatomes
L4, L5, S1
35
________ is a tear in the ligament that connects your vertebra to your disc.
Annular tear
36
How do you treat an annular tear?
- Response well to rest and NSAIDs - Interventional injections can be helpful - Does not require surgery *also strengthening the muscles that support the joint
37
a fragment of the disc nucleus that is pushed out of the annulus, into the spinal canal through a tear or rupture in the annulus.
Herniated disc The disc degenerates due to natural loss of elasticity and/or injury over years
38
A herniated disc occurs in _______ or ______
L4/L5 or L5/S1
39
A narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs.
Lumbar stenosis Does not require surgery if there are no symptoms
40
What are signs of neurogenic claudication that can occur in lumbar stenosis?
- Buttock and leg pain when walking or standing - May only be able to walk a few yards before legs get “tired” - Relieved by sitting or bending over “shopping cart sign”
41
What is a positive shopping cart sign?
The pain usually decreases when bending forward or sitting. This is often referred to as the “shopping cart sign”; patients with lumbar spinal stenosis often feel relief from their symptoms when leaning forward over the shopping cart while shopping at a grocery store.
42
What type of spine changes are these called? Scoliosis and spoldylolisthesis
Deformity
43
Spondylolysis vs spondylolisthesis
Spondylolysis is a crack or stress fracture in one of the vertebrae, the small bones that make up the spinal column. Whereas spondylolisthesis is when the stress fracture weakens the bone so much that it is unable to maintain its proper position in the spine—and the vertebra starts to shift or slip out of place.
44
What is a good muscle relaxer to use for treatment of spondylolysis or spondylolisthesis?
methocarbamol
45
Treatment for spondylolysis or spondylolisthesis?
Pt, activity modification (it it hurts, don't do it), chiropractic care, inversion/decompresison, tylenol, NSAIDS, steroids, muscle relaxers,, physiatry for interventional injections
46
When should you order an MRI?
Instability on xray, no improvement after 6-8 wks, cauda equina symptoms **Pain with palpation of the lumbar spine
47
What symptom is a straight up emergency?
Bladder incontinence!!! (Cauda equina), saddle anesthesia & numbness in groin MUST CHECK RECTAL TONE
48
These symptoms can cause what condition? - Persistent fever - History of IV drug use - Current or recent UTI, respiratory or other infection such as dental abscess
Discitis/Osteomyelitis
49
Slow loss of bone mass affecting 28 million americans
osteoporosis
50
the DEXA scan assesses what bones in the body?
Lumbar vertebrae femur, bones in forearm
51
A DEXA score of < -1 =
normal
52
A DEXA score of -1 to 2.4 =
osteopenia osteopenia the bone loss is not as severe as in osteoporosis.
53
A DEXA score of > 2.4 =
osteoporosis
54
Medical management of osteoporosis?
- Calcium/Vit D | - Bisphosphonates (boniva, "dronate meds")
55
Class A spinal cord injury = Class B spinal cord injury= Class E spinal cord injury=
A- complete: no motor or sensory function preserved in sacral segments B- incomplete: sensory, but no motor function preserved below the neurological level E- sensory and motor function normal
56
- Effects hand and arms. Its major injury to the central grey matter of the spinal cord. - Weakness and burning in hands
Complete cord syndrome
57
- Weakness on one side of the body - Loss of sensation (hemianesthesia) on the opposite side
Brown sequard syndrome
58
-Motor loss below lesion, but intact sensation
anterior cord syndrome (can't move foot but can feel it)
59
______ or anterior compression fractures account for 50-70% of all T/L fractures
Wedge
60
An anterior/wedge fracture is stable if
the posterior ligament complex is not disrupted
61
An anterior/wedge fracture is unstable if
* Severe compression: > 50% of vertebral height * Significant fracture kyphosis: > 30° * Rotational component to the injury * Fractures at multiple levels
62
a descriptive term for an injury to the spine in which the vertebral body is severely compressed
burst fracture
63
Tx of a burst fracture
- neuro checks - raise MAPs if neuro deficit - steroids - bracing - surgical stabilization - PT/OT - pain management
64
55y/o male with no pmHX present to clinic with low back pain and right posterior calf pain that started after mowing the lawn 5 days ago. Exam: He has a positive straight leg raise on the right.
L4/L4/S1 = herniated disc Xray, PT, NSAIDS
65
82 y/o female presents with thoracic spine after falling in her garden yesterday. She states she has had a dull back pain but this is more stabbing in nature. She has also noticed some numbness along her nipple line for the last 6 months. Exam: Normal, except tenderness to palpation along her mid thoracic spine
T4 affected (ask if bilateral because this could be a sign of shingles) Compression fracture Get xray
66
24 y/o female who was recently treated for a UTI presents to your office has new low back pain and low-grade fever. She has pain into her bilateral anterior thigh down her medial calf. Exam: Her strength in normal.
L4/L5 Osteomyelitis MRI with contrast, ESR, CRP
67
62 y/o male with neck pain with bilateral hand numbness but has noticed worsening imbalance and has been having a hard \ time putting on his watch. Normal except he has a positive Hoffman’s sign
C6-C8 Cervical spine stenosis Xray and MRI
68
25 y/o female with right arm pain She has pain in her posterior scapula and middle finger Exam: Normal except her right triceps is a 4/5
C7 Herniated disc Xray, PT, possible MRI
69
A hoffman's test tests disturbance in UMN pathways and problems with which part of the spine?
C-spine
70
This test is used to determine whether your fingers or thumbs flex involuntarily in response to certain triggers.
Hoffman's
71
Hoffman's, clonus and babinski test for ________
Hyperflexion
72
Internal and external rotation tests which L spines?
L3/L4

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