Spine Two - starts with lateral stenosis Flashcards
(73 cards)
1
Q
lateral stenosis
A
narrowing of lateral neural foramen (can see bone spurs on imaging)
2
Q
causes of lateral stenosis
A
degenerative changes
disk, posture
3
Q
t or f, lateral stenosis can cause radicular symptoms
A
t
4
Q
t or f, lateral stenosis is common in any age group
A
t
5
Q
what reproduces signs and symptoms of lateral stenosis? what decreases them?
A
closing facets reproduces them (positive quadrant)
opening facets decreases symptoms
6
Q
central stenosis
A
degeneration or narrowing of the spinal canal
7
Q
what age is central stenosis most common in?
A
60+
8
Q
what are some subjective findings with central stenosis
A
- pain with standing and walking
- possible numbness and tingling in lower extremities
9
Q
“shopping cart sign” is common in
A
central stenosis
10
Q
objective findings with central stenosis
A
- closing spinal canal reproduces symptoms and opening decreases symptoms
- limited AROM/PROM
- positive slump test
- possible UMN lesion
11
Q
age group for radiculopathy
A
any
12
Q
stenosis is the _______ and radiculopathy is the _______
A
diagnosis, symptom
13
Q
can you have radiculopathy without stenosis
A
NO
14
Q
can you have stenosis without radiculopathy
A
YES
15
Q
radiculopathy is _______ in thoracic spine
A
rare
16
Q
what can cause a nerve root impingment (3)
A
herniated nucleus pulposus
DDD/DJD
poor posture
17
Q
subjective findings with radiculopathy
A
- not usually relieved with rest
- deep, burning, sharp pain (dermatomal pattern)
- usually unilateral
- possible report of weakness (drop things, drag toes)
18
Q
objective findings with radiculopathy
A
- positive neural tension
- LMN lesion signs (hypo-)
- reproduced with foramen narrowing
19
Q
tests for cervical radiculopathy
A
- decreased pain with traction (head pull)
- positive spurling
- ULNTT (ulnar, median, radial)
20
Q
ULNTT
A
upper limb neural tension testing
21
Q
causes of cervical radiculopathy
A
disc pathology, spondylosis, posture
22
Q
tests for lumbar radiculopathy
A
- decreased pain with traction (leg pull)
- LLNTT (sciatic, femoral)
23
Q
causes of lumbar radiculopathy
A
disc pathology, spondylosis, posture, spondylolisthesis
24
Q
most common disk herniation? nerve root impingement?
A
C6/7
C7 nerve root
25
the likelihood of cervical radiculopathy _______ with age
decreases
26
two sets of rules ordering imaging is based on
1 - canadian c-spine rules (most common)
2 - american college of radiology suspected spine trauma appropriateness criteria
*applies to those over 14
27
What is the sensitivity and specificity of the canadian cervical spine rules
sensitive = 1
specificity - 0.43
28
canadian c spine rules
1 - over 65
2 - dangerous MOI
3 - paresthesia in extremeties
*if yes to any of these, they need an xray
29
canadian c spine low risk factors
- able to sit in ED
- simple rear end MVA
- ambulatory at any time
- delayed onset of neck pain
- no midline c-spine tenderness
*if any of these are present with no high risk factors you can safely asses ROM
30
t or f, if you cannot assess cspine ROM then they need a radiograph
t
also needed if less than 45 degrees of bilateral rotation
31
how is the odontoid/transverse lig assessed in a plain film radiograph
open mouth view
32
what could be compressed in thoracic outlet?
subclavian artery
subclavian vein
brachial plexus
33
what is the compression in thoracic outlet usually coming from? what may it also involve?
1st rib
may also involve scalenes, clavical, pec minor
34
what are some possible causes on TOS
- head/neck/shoulder trauma
- poor posture
- hypertrophied scalenes (COPD, asthma, weightlifters)
35
common demographic for TOS
middle aged women
36
subjective findings for TOS
- edema, skin tightness, cyanosis
- pain and fatigue
- heaviness
- night pain
- numbness and tingling (usually C8/T1)
37
what should you rule out in TOS
- cervical radic
- systemic diseases (raynauds, lupus)
- DVT (swelling with activity that doesn't resolve)
38
What TOS you should asses neural __________. what is the most common?
tension
39
special tests for TOS
adson's, costoclavicular, hyperabduction, Roos
40
7 common pathologies in thoracic and lumbar spine
1 - osteoporosis
2 - rib dysfunction
3 - scoliosis
4 - ankylosing spondylosis
5 - scheuermann's disease
6 - HNP
7 - spondylolysis/spondylolisthesis
41
t or f, males are at greater risk for osteoporosis
f, females 6:1
42
osteoporosis is commonly _____ until fracture
asymptomatic (*may report limited thoracic extension)
43
subjective findings with osteoporosis
- family history of osteoporosis
- early menopause (osteopenia)
- decreased activity
- low levels of calcium and vitamin D
- WB activities most painful, improves with rest
44
objective findings with osteoporosis
- increased thoracic kyphosis and lumbar lordosis
- localized pain if fracture is present
- thin figure
- may have decreased strength/proprioception
** be careful if you suspect osteoporosis
45
what do you need to screen for in osteoporosis
balance because falls can cause a fracture
46
T or F: osteoporosis is more common in obese pop
false, less common *more stress to bones promotes bone growth
47
where is the most common place for a compression fracture?
thoracolumbar junction (T10-L2) * may refer to low back pain with or without radiculopathy
48
what scan do you need to look at bone density
DEXA scan
49
what imaging do you get to look for a fracture?
radiograph or CT, lateral view
50
a compression fracture is common with traumatic falls but can also occur with what during ADLs?
forward bending (low trauma)
51
3 possible MOIs for rib dysfunction/subluxation
1 - twisting or AP compression - typical ribs
2 - overuse of scalenes - 1st rib
3 - traumatic
52
what is rib dysfunction commonly seen with?
chronic breathing pathologies (COPD, asthma)
53
subjective findings with rib dysfunction
- sharp pain with breathing/coughing/sneezing
- possible sternal and/or thoracic pain
- no neuro involvement unless 1st rib issue or TOS
54
function non-structural scoliosis
- no problems with vertebrae
- spine adapts to postural deformities
- can be reversed if cause is found
55
what can cause functional non-structural scoliosis
SIJ dysfunction
leg length discrepancy
poor posture
hip contracture
nerve root irritation
56
possible factors in idiopathic scoliosis
structural
musculature
metabolic/chemical
endocrine
CNS
57
scoliosis can interfere with...
breathing
internal organ function
appearance
58
what method is used with plain film imaging for scoliosis
cobb method
- ap film is used
- measures the curve and documents progression
59
a spine curve of less than __________ does not need treatment and greater than ________ may need surgery
10, 40
60
ankylosis spondylitis
- ossification of joints and ligaments of entire spine
* sounds like arthritis but has an earlier onset
61
ankylosis spondylitis is a ______- disorder
rheumatoid
(patient will probably have an endocrinologist)
62
what age is ankylosis spondylitis usually seen in? more common in males or females?
15-40, peaks in mid 20s, more common in males
63
does ankylosing spondylitis affect the thoracic or lumbar vertebrae first?
thoracic
64
subjective findings with ankylosing spondylitis
- 1st symptom - stiff low back w/ or w/o pain
- pain at night
- intermittent pain during the day (spine, shoulders, and/or hips)
- difficulty standing up striaght
65
objective findings with ankylosing spondylitis
- decreased active/passive trunk extension
- restricted passive accessory with multiple segments
- excessive flexed posture
- hip/knees flexed posture
- decreased shoulder elevation
- decreased SB
- restricted chest expansion
66
imaging findings with ankylosing spondylitis
- sacroilitis
- squaring of vertebral bodies
- apophyseal joints fused
- ligamentous ossification
- "bamboo spine" in more advanced cases
67
etiology of scheuermann's disease
congenital weakness in endplate increases flexion loading causing anterior wedging of vertebral body
68
what can happen to the endplates with scheuermann's disease
it can crack allowing nuclear material to migrate into vertebrae
69
schmoral's nodes
NP protrudes into endplate seen in scheuermann's disease
70
where is scheuermann's disease most common
T10-L2
71
what age is scheuermann's disease most common in? more common in males or female
2nd decade of life
more common in males
72
what kind of imaging do you need for scheuermann's disease
MRI to detect disc/endplate involvement
73
signs and symptoms of scheuermann's disease
"growing pains"
stiffness/pain after rest
increased thoracic kyphosis
pain with axial loading and decreased pain with unloading
