Term
| What percentage of the population is affected by cervical disc sx? |
|
Definition
|
|
Term
| Which C vertebrae are most often affected by cervical disc syndromes? |
|
Definition
| more than 90% occur at the level of c5 and c6, the most mobile segments. |
|
|
Term
| How many nn come out of the 7 cervical vertebrae? |
|
Definition
|
|
Term
| What is an extra x-ray view to see the cervical spine? |
|
Definition
|
|
Term
| fracture along top of odontoid. how do you tx? |
|
Definition
|
|
Term
| fx base of odontoid. HOw do you tx? |
|
Definition
|
|
Term
| fx middle of odontoid. how do you tx? |
|
Definition
|
|
Term
| which odontoid fx is most unstable? |
|
Definition
|
|
Term
| 2 major types of cervical disc lesions |
|
Definition
| 1. soft disc protrusion (herniation). 2. chronic disc degeneration |
|
|
Term
| Most common place for a disc to protrude |
|
Definition
| posterior/lateral bulge- soft disc protrusion (herniation)- cervical disc syndrome |
|
|
Term
| Which is the most common major type of cervical disc lesioin? |
|
Definition
| chronic disc degeneration |
|
|
Term
| Which type of cervical disc syndrome involves narrowing disc space? |
|
Definition
| chronic disc degeneration |
|
|
Term
| What casues soft disc protrusion (herniation))? |
|
Definition
| increased mechanical load |
|
|
Term
| What are 2 types of neurological compromise caused by herniation? |
|
Definition
| radiculopathy, paresthesias |
|
|
Term
| What results in narrowing of the disc space? In what age groups is this *most common*? |
|
Definition
| degenerative disc disease. more common in older age groups |
|
|
Term
| What is the end result of degenerative disc disease? |
|
Definition
|
|
Term
|
Definition
| look in corner to one side; follow a little bird as he flies through the sky to the other side. pain in shoulder opposite of direction pt is looking |
|
|
Term
| What is caused by osteophyte growth? |
|
Definition
|
|
Term
| Pt presents w/decreased ROM, localized tenderness, + spurling test, trigger points, and radicular or referred pain to upper or lower extremities. What tests could you order? |
|
Definition
| cervical problem. you could order plain radiography, ct, mri, emg- neuro-conduction studies |
|
|
Term
| How do you tx cervical disc syndromes? |
|
Definition
| 1. rest. 2. moist heat. 3. pt (massage, us, traction) 4. pharmacotherapy (nsaids, narcotics). 5. epidural steroid injections. 6. surgery (decompressive laminectomy, anterior cervical discectomy and fusion) |
|
|
Term
| Which cervical disc syndrome tx involves massage, us, and traction? |
|
Definition
|
|
Term
| What are 2 pharmacotherapy tx for surgical disc syndromes? |
|
Definition
|
|
Term
| What are 2 surgery tx for cervical disc syndromes? |
|
Definition
| decompressive laminectomy, anterior cervical discectomy and fusion |
|
|
Term
| What generally causes cervical strain? |
|
Definition
| rapid hyperextension of the neck (motor vehicle accidents and falls) |
|
|
Term
| Pt fell 10 days ago and experienced *no major problems at time of fall*. Since that time, pt has had gradual onset of neck stiffness, followed by pain and decreased rom, with minor radiculopathy. PE reveals general muscular tenderness. Neurological examination is normal. What might be this pt's problem? How do you tx? |
|
Definition
| cervical strain. brief period of rest, immediate ice, analgesia (nsaids, mm relaxants, narcotics). pt (heat-*rom*-ice) |
|
|
Term
| What is caused by unilateral contraction of neck mm? |
|
Definition
|
|
Term
| The following drug rxns can cause what pathology: phenothiazine (chlopromazine (thorazine), prochlorperazine (compazine)? |
|
Definition
| torticollis. drugs are a more common cause. |
|
|
Term
| The following cause what pathology: congenital, inflammatory, idiopathic, tumor, drug rxns, ra? |
|
Definition
|
|
Term
| Lateral views of teh cervical spine show ant subluxation of c2 on c3 |
|
Definition
|
|
Term
| what is the no one cause of gi bleeding in the world? |
|
Definition
| nsaids. don't give them to pts over 60. |
|
|
Term
| What is a metal ring secured to skull w/pins and 2 metal rods attached to a well-fitted plastic jacket. w/this apparatus, it is possible to obtain complete fixation and to arrest almost all movmt of c-spine. the outcome of teis tx varies w/fx healing and fusing w/in 3 mos in 15-85% of pts |
|
Definition
|
|
Term
| what abnormality of a pe causes concern when you suspect a cervical strain? |
|
Definition
|
|
Term
| loss of lordotic curve on x-ray |
|
Definition
|
|
Term
| What are the nexus criteria for cervical spine radiography? |
|
Definition
| no post. midline c-spine tenderness. no evidence of intoxication or drugs. nml level of consciousness. no focal neuro deficits. no painful distracting injuries. 100% sensitivity over 10,000 pts. |
|
|
Term
| What is the only true mm relaxer? |
|
Definition
|
|
Term
| What are the 3 questions of the canadian c-spine rule |
|
Definition
| are there any high-risk factors that mandate radiography? are there any low-risk factors that would allow a safe assessment of a range of motion? is the pt able to actively rotate the neck 45deg to the left and to the right? |
|
|
Term
| How common is the complaint of back pain? In what age group is it more common? How narrow is the range of causes? |
|
Definition
| one of the most common medical and traumatic complaints. more common btwn 30-60 yo. can be caused by a variety of disorders. |
|
|
Term
| What is the definition of scoliosis? |
|
Definition
| lat curvature of spine greater than 10 degrees while standing upright |
|
|
Term
| Which type of scoliosis is fixed and non-flexible and does not correct w/side bending? |
|
Definition
|
|
Term
| Which type of scoliosis is flexible and corrects w/side bending? |
|
Definition
|
|
Term
| what is a common side effect of halo? |
|
Definition
| aspiration pneumonia; don't lay flat if at all possible |
|
|
Term
| What are 3 causes of structural scoliosis? which one is most common? |
|
Definition
| congenital abnormality, neurofibromatosis, *idiopathic* most common |
|
|
Term
| What are 3 compensatory mechanisms for nonstructural scoliosis? |
|
Definition
| leg length discrepancy. local inflammation. disc disease. |
|
|
Term
| What aspect of dx affects a scoliosis pt significantly? |
|
Definition
| pts do much better if the disease process is recognized early. |
|
|
Term
| Many pts have c-spine fx w/fall from what height? |
|
Definition
|
|
Term
| What is COBB ANGLE and why is it importang? |
|
Definition
| scoliosis; determines tx. tx- <20deg; observation. 20-40 deg; thoracolumbosacral orthotic (tlso) "milwauukee brace" and exercise. >45 deg, sx. |
|
|
Term
| What is an abnml anterior-post curvature of teh spine? what are 4 common causes? |
|
Definition
| kyphosis. disc disease, vertebral disease, osteoporosis, poor posture. |
|
|
Term
| What common source of back pain commoly occurs at l4/5? |
|
Definition
|
|
Term
| Pt presents w/low back pain that increases w/activity and improves w/rest, radicular pain, and paresthesias. PE reveals increased pain w/bending, localized tenderness, diminished sensation, foot drop, and bowel/bladder disfunction. pt bends away from painful side. |
|
Definition
|
|
Term
| What does the thoracolumbosacral orthotic "milwaukee brace" tx and how? |
|
Definition
| not corrective but assists in preventing progression of scoliosis |
|
|
Term
| Osteophyte formation predominantly at ant/lat aspect of superior and inf margins of vertebral bodies. How would pt present? |
|
Definition
| spondlosis. pt presentations range from being asymptomatic to s/s of nn root compression |
|
|
Term
| Pt presents w/pain, sensory changes, motor weakness and atrophy, and reflex changes to lower extremities Which dx studies might you order? |
|
Definition
| lumbar nn roots. plain x-rays, ct, mri* best choice, emg |
|
|
Term
| what can cause mild herniation w/o n root compression, herniation w/nn root compression, cauda equina syndrome, chronic degenerative disease w/ or w/o leg symptoms, or spinal stenosis? |
|
Definition
|
|
Term
| How do you tx lumbar disc disease? |
|
Definition
| brief per of rest, exercise and pt, heat-ice, nsaids and anagesia, epidural injection of steroids, surgery (laminectomy, spinal fusion) |
|
|
Term
| What surgeries might be performed for lumbar disc disease? |
|
Definition
| laminectomy, spinal fusion |
|
|
Term
| Where is spondylolisthesis most common? |
|
Definition
|
|
Term
| what is vertebral slipping hat develops in teen years and becomes symptomatic later in life? in what populations is incidence increased? |
|
Definition
| spondylolisthesis. football players and gymnasts |
|
|
Term
| Pt presents w/low back pain, paraspinal mm spasm, increased lordotic curve, palpable "step-off" of teh spinous process |
|
Definition
|
|
Term
| How do you tx a "HOT" LESION (acute)? |
|
Definition
| orthotic bracing, restricted activity, attempt bony healing before fibrous nonunion can occur |
|
|
Term
| How do you tx a "COLD" lesion? |
|
Definition
| conservative tx: rest, exercise program, nsaids, weight loss, occupational change |
|
|
Term
| In what order should you do reflexes? |
|
Definition
| right and left to compare before you move on. |
|
|
Term
| What involves narrowing of the spinal canal and nn root foramina? |
|
Definition
| spinal stenosis (mri's probably best) |
|
|
Term
| What could cause secondary spinal stenosis? |
|
Definition
| disc disease or arthritis |
|
|
Term
| Pt presents w/neurogenic claudication: low back pain, motor weakness, leg cramping; symptoms worsen w/walking or l/s spine extension; symptoms improve w/rest or l/s spine flexion. How do you tx? |
|
Definition
| spinal stenosis. reduction of increased lordotic curve: corset bracing, strengthening exercises, epidural injections, sx: decompression +/- spinal fusion |
|
|
Term
| What is a common cause of lumbar strain? |
|
Definition
| acute incident or ongoing chronic factors |
|
|
Term
| What are tx options for tx of lumbar strain? |
|
Definition
| 1-2 days of rest; heat-stretch-ice; stay active; nsaids and analgesia; tx precipitating factors (obesity, smoking, repetitive movements, high heeled shoes, lack of exercise) |
|
|
Term
| When tx lumbar strain what precipitating factors should be discontinued? |
|
Definition
| obesity, smoking, repetitive movements, high heeled shoes, lack of exercise |
|
|
Term
| What is an injury to the spinal cord resulting in a change, either temporary or permanent, in the nml motor, sensory, or autonomic function? |
|
Definition
| complete spinal cord injury |
|
|
Term
| What are 3 mechanisms that can cause complete spinal cord injury? |
|
Definition
| destruction from direct trauma. compression by bone fragments, hematoma, or disk material. ischemia from damage or impingement on the spinal aa. |
|
|
Term
| what's teh best imaging modality for spinal stenosis? |
|
Definition
|
|
Term
| What are 2 types of spinal cord injuries? |
|
Definition
|
|
Term
| What type of sci involves absence of sensory and motor functions in the lowest sacral segments? |
|
Definition
|
|
Term
| What type of sci involves preservation of sensory or motor function below the level of injury, including the lowest sacral segments? What is evidenced by sacral-sparing? |
|
Definition
| incomplete sci. sacral-sparing is evidence of the physiologic continuity of spinal cord long tract fibers |
|
|
Term
| What grading of mm strength has normal power? |
|
Definition
|
|
Term
| What grading of mm strength involves submaximal movmt against resistance? |
|
Definition
|
|
Term
| What grading of mm strength involves moderate movmt against resistance? |
|
Definition
|
|
Term
| What grading of mm strength involves slight movement against resistance? |
|
Definition
|
|
Term
| What grading of mm strength involves movement against gravity but not against resistance? |
|
Definition
|
|
Term
| What grading of mm strength involves movement w/gravity eliminated? |
|
Definition
|
|
Term
| What grading of mm strength flicker of movement? |
|
Definition
|
|
Term
| What grading of mm strength involves no movement? |
|
Definition
|
|
Term
| For most spine problems, do not use |
|
Definition
|
|
Term
| Which spinal level involves elbow flexors (biceps, brachialis)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves wrist extensors (extensor carpi radialis longus and brevis)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves elbow extensors (triceps)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves finger flexors (flexor digitorum profundus) to the middle finger? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves small finger abductors (abductors digiti minimi)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves hip flexors (iliopsoas)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves knee extensors (quadriceps)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves ankle dorsiflexors (tibialis ant)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves long toe extensors (extensors hallucis longus)? DON'T MEMORIZE |
|
Definition
|
|
Term
| Which spinal level involves ankle plantar flexors (gastrocnemius, soleus)? DON'T MEMORIZE |
|
Definition
|
|
Term
| At what spiny levels is sensory testing performed? |
|
Definition
|
|
Term
| What is sensory scoring for light touch and pinprick? |
|
Definition
| 0- absent. 1-imaired or hyperesthesia. 2- intact. |
|
|
Term
| What is the most common isci? |
|
Definition
|
|
Term
| What is most frequently identified among older persons w/cervical spondylosis who sustain hyperextension injury? |
|
Definition
|
|
Term
| What results from posterior pinching of the cord by a buckled ligamentum flavum or from anterior compresssion of teh cord by osteophytes? With what may this also be associated? |
|
Definition
| central cord syndrome. may also be associated w/fx dislocation and compression fx. |
|
|
Term
| Does central cord syndrome involve greater impairment in the upper or lower extremities? |
|
Definition
|
|
Term
| How wide is the spectrum of sensory loss w/central cord syndrome? |
|
Definition
| varying degrees of sensory loss |
|
|
Term
| What would involve bladder dysfunction and a variable amt of sensory loss below level of injury? |
|
Definition
|
|
Term
| What imaging technique of central cord syndrome involves views of the cervical spine that delineates fx and dislocations, as well as teh degree and extent of spondylotic changes? |
|
Definition
|
|
Term
| What imaging technique for central cord syndromes shows images of cervical spine w/spinal canal compromise? |
|
Definition
|
|
Term
| What imaging technique for central cord syndromes demostrates direct evidence of spinal cord impingement from bone, disc, or a hematoma? |
|
Definition
|
|
Term
| What is the primary focus of rehab for central cord syndrome? |
|
Definition
| primary focus of pt is preservation of rom and the enhancement of mobility skills. also involves strengthening of any preserved mm function. |
|
|
Term
| What are 4 potential complications of cental cord syndrome? |
|
Definition
| neurogenic bladder, spasticity, neuropathic pain, pressure ulcers. |
|
|
Term
| Which potential complication of central cord syndrome involves urinary retention? |
|
Definition
|
|
Term
| Which potential complication of central cord syndrome involves initial dperession of reflexes, but once period of spinal shock resolves, pts may experience increased spasticity in upper and lower extremities? |
|
Definition
|
|
Term
| Which potential complication of central cord syndrome involves consideration of anticonvulsant medications? |
|
Definition
|
|
Term
| Which potential complication of central cord syndrome involves unrelieved pressure and shear forces on the skin? |
|
Definition
|
|
Term
| What is typically observed w/anterior spinal aa infarction? |
|
Definition
|
|
Term
| Ant cord syndrome results in problems where, relative to lesion? What is spared? Why is this? |
|
Definition
| paralysis below level of lesion, w/ loss of pain and temperature sensation below the level of the lesion, sparing touch, vibration, and position sense. Posterior columns receive their primary blood supply from the posterior spinal aa |
|
|
Term
| What involves an incomplete lesion of the spinal cord characterized by *ipsilateral* upper motor neuron paralysis and loss of proprioception, w/*contralateral* loss of pain and temperature sensation? |
|
Definition
| brown-sequard syndrome. clincial presentations range from mild to severe neurologic deficit |
|
|
Term
| SCIWORA is most common in what age group? What do imaging modalities show? |
|
Definition
| MRI, CT, X-rays (including flexion/extension) neative w/neurologic deficit. 1-16 yo. |
|
|
Term
|
Definition
| bedrest. c-collar until nml flex/ext. halo for 1-3 wks recommended by some. no sports for 3 mos. |
|
|
Term
| How serious is cauda equina syndrome? |
|
Definition
|
|
Term
| What is formed by nerve roots caudal to the level of spinal cord termination? |
|
Definition
|
|
Term
| Pt presents w/low back pain, unilateral or usually bilateral sciatica, saddle sensory distrubances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss |
|
Definition
|
|
Term
|
Definition
| paresthesias everywhere that would hit a saddle |
|
|
Term
| What imaging modality is most helpful for ce syndrome? |
|
Definition
| MRI>CT- may show actual ce compression. plain radiography not generally helpful- may show destructive changes, disk-space narrowing, or spondylolysis. |
|
|
Term
| What accounts for 30% of worker's compensation payments, w/significant increase in lawsuits and personal injury settlements w/non-specific physical findings (difficult to obtain a specific dx; easy to fabricate)? |
|
Definition
|
|
Term
| What are 4 parts of eval for back pain? |
|
Definition
| accurate detailed hx. pe. dx studies. tx. |
|
|
Term
| How speciic are the findings generally for back pain? |
|
Definition
|
|
Term
| What diagnostic studies can be done for back pain? |
|
Definition
| x-rays (low yield of positive results), ct/mri (35% of asymptomatic pts have + results) |
|
|
Term
| What is tx for back pain? |
|
Definition
| pt, rehab, work hardening, injections (steroid), surgery |
|
|
Term
| What is the clinical term for reiter's syndrome? |
|
Definition
|
|
Term
| In what pt populations is multiple myeloma more commonly found- age and gender? |
|
Definition
| in pts over 40 yo and men 2x as frequently as women |
|
|
Term
| Pt presents w/ *back pain*, weakness, anorexia, weight loss, and *bone pain*, *spine* is most common that progresses to anemia, increased bone pain, renal insufficiency, and bacterial infections (recurrent penumonia and uti's) |
|
Definition
|
|
Term
| "punched out' lesions. where are they more comon? |
|
Definition
| multiple myeloma. most common in the *spine*, skull, ribs, and pelvis. |
|
|
Term
| radiologic findings: diffuse osteoporosis secondary to general demineralization. pathologic fx of long bones and vertebral bodies |
|
Definition
|
|
Term
|
Definition
| multiple myeloma: xs synthesis and secretion of free monoclonal light chains |
|
|
Term
| anemia, elevated esr, elevated serum calcium, w/excess synthesis and secretion of free monoclonal light chains |
|
Definition
|
|
Term
|
Definition
| maintain proper ambulation and hydration b/c of increased urine and serum calcium and uric acid. plasma cell tumors can be sensitive to radiation and chemo. extremely poor prognosis despite any tx. |
|
|
Term
| Potential cause of back pain in *IVDA* |
|
Definition
|
|
Term
| Pt presents w/fever, low back pain, decreased rom, unknown etiology. ivdu. |
|
Definition
|
|
Term
| What is a decrease in total bone mass of the skelton? In what populations was it originally observed? In what populations is it now observed? |
|
Definition
| osteoporosis. first observed in older, caucasian females but now clearly seen in female athletic triad. |
|
|
Term
| What is the female athletic triad? |
|
Definition
| disordered eating, menstrual dysfunction, osteoporosis. |
|
|
Term
| What is the best imaging modality for osteoporosis? |
|
Definition
| dexa scan. bone density measurements |
|
|
Term
| What is teh prevention and tx of osteoporosis? |
|
Definition
| exercise, balanced nutrition, hrt (estrogen)(estorge/ca2+ combo), calcitonin, bisphosphonates (alendronate (fosamax), etidronate (didrocal)), fluoride |
|
|
