Shared Flashcard Set

Details

Serious conditions of C-spine
Evaluation and treatment of the patient with cervical pain - serious conditions of cervical spine
82
Health Care
Graduate
02/05/2013

Additional Health Care Flashcards

 


 

Cards

Term
Serious conditions to be screened in cervical spine patients (7)
Definition
fx
instability
vascular insufficiency
neoplasm
CNS degenerative disease
CVA
cord compression/myelopathy
Term
steps of eval/rx of cervical pain pts (6)
Definition
screen for serious conditions
screen for non-spinal ortho & peripheral nn entrapment
determine tissue at fault
quantify pain/impairments/fxnl loss
(determine if pain processing issues are present)
determine effective rx
Term
Assume the presence of cervical fx when...
Definition
pt experienced ANY trauma c loss of consciousness
until excluded by CT/MRI
Term
Canadian C-Spine Rules (3)
Definition
high risk factor (mandating radiography)
low risk factor (prevents safe ROM assessment)
ability to rotate 45º bilat
Term
Canadian C-Spine Rules: high risk factors (3)
Definition
age >65
dangerous mechanism
paraesthesias in extremities
Term
Canadian C-Spine Rules: high risk factors - dangerous mechanisms (3)
Definition
fall >1m or 5 stairs
MVA >100km/hr (62mph), rollover or ejection
bicycle accident
Term
Canadian C-Spine Rules: low risk factors (5)
Definition
not simple rearend MVA
unable to sit in ER
not amb since injury
immediate onset of pain
midline pain
Term
Canadian C-Spine Rules: sensitivity & specificity
Definition
sn: 99.4%
sp: 45.1%
Term
types of C1-2 fx (2)
Definition
neural arch
odontoid
Term
neural arch fx: mech of injury
Definition
hyperext (post ring of C1 jammed betwn C2/occiput)
OR
axial load
Term
neural arch fx: Rx
Definition
collar

C0-C2 fusion if lateral masses spreading (2º to rupture of transverse ligt)
Term
odontoid fx: mech of injury
Definition
uncertain
Term
odontoid fx: severity
Definition
highly fatal
Term
neural arch fx: severity
Definition
usually no neuro damage
Term
odontoid fx: Rx
Definition
fusion
Term
C3-C7 flex-compression types of injury (2)
Definition
ant wedge fx
burst fx (post fragment may >> spinal canal >> cord injury)
Term
Ant wedge fx: Rx
Definition
collar (for comfort)
Term
C3-C7 hyperext injuries: pathology (3)
Definition
tear ant ligt
avulsion fx
facet compression
Term
C3-C7 hyperext injuries: Rx
Definition
collar
Term
C3-C7 hyperext injuries: xray
Definition
extension xray shows gap
Term
C3-C7 flex injuries: types (2)
Definition
dislocation s fx,
fx dislocation
Term
C3-C7 flex injuries: dislocation s fx description (3)
Definition
post ligt torn;
unilat OR bilat facet dislocation;
Rx = fusion
Term
C3-C7 flex injuries: fx dislocation description (2)
Definition
usually assoc c cord damage
injury sufficient to cause burst fx AND post ligt tear
Term
ADI =
Definition
atlas-dens interval
(AP gap; ant portion of C1)
Term
ADI normal limits
Definition
2-3 mm
(>2-3 mm is too high)
Term
Causes of non-traumatic instability (9)
Definition
arthritis
Marfan's syndrome
Grisel's syndrome
Down's syndrome
Ehlers Danlos syndrome
prolonged corticosteroid use
osteoporosis
congenital abnormalities
Chiari malformation (types I-IV)
Term
complications of RA in c-spine
Definition
cord compression >> sudden death
AA instability (12%)
sub-axial sublux (20%)
Term
Marfan's syndrome =
Definition
genetic ST disorder;
usually tall, thin individual (arm span longer than height)

more likely to have spondylo defects
Term
Marfan's syndrome: signs
Definition
wrist sign (overlap thumb/little finger @ wrist)
thumb sign (thumb ext beyond wrist)
pectus excavatum
Term
Grisel's syndrome =
Definition
spontaneous AA dislocation
Term
Grisel's syndrome: signs (3)
Definition
children 6-12 y/o
upper resp infection/chronic sore throat
spontaneous torticollis >> cock-robin posture
Term
Grisel's syndrome: Rx
Definition
early: antibiotics, collar, rest
late: fusion
Term
Down's syndrome: consequences (2)
Definition
odontoid hypoplasia (22% of children, 15% of adults)
incr ADI
Term
Ehlers Danlos syndrome =
Definition
ST disorder;
incr elastin in ST
(+ Beighton index)
Term
Ehlers Danlos problems
Definition
prone to jt dislocation; AA sublux
Term
Dens: full development at age...
Definition
12 yo
Term
Os odontoideum =
Definition
no IVD between C1-C2
Term
Chiari malformation =
Definition
inf displacement of cerebellum into foramen magnum (sometimes causes instability)
Term
Chiari malformation: types
Definition
I: SLOW development, UE weakness, HA, clumsiness, hearing loss, ataxia, hoarseness/dysphagia
II-IV: early dx
Term
Chiari malformation: avoid...
Definition
avoid extension
Term
Non-traumatic instability: S/Sx
Definition
sub-occ neck pain, possible HA
fever (Grisel's)
pain during ROM (rather than EOR)
MAYBE cord signs, deformity (cock-robin)
perioral symptoms, face numbness, tinnitus
mm spasm
Term
Cardinal signs of non-traumatic instability (6)
Definition
perioral anesthesia/peristhesia
quad limb paresthesia
drop attack
nystagmus
trauma
ROM in supine > ROM in sitting/standing
Term
Non-traumatic instability: Rx
Definition
sx stabilization (if neuro compromise)
exercise program (isometrics to subocc mm)
avoid flex
Term
Cervical Arterial Dysfxn: 2 parts
Definition
VAI
ICA (internal carotid)
Term
Parts of vertebral artery (4)
Definition
pars prevertebralis
pars transversaria
pars axo-atlantis
pars subarachnoidealis
Term
Pars prevertebralis: point of compression
Definition
between ant/mid scalenes (mm spasm, TOS)
Term
Pars transversaria: point of compression
Definition
osteophytic encroachment
Term
Pars axo-atlantis: point of compression
Definition
contralat rot >> intima damage >> bleeding/embolus
Term
Pars subarachnoidealis: point of compression
Definition
subocc ext (impinged between occiput & C1)
Term
Dangerous components of cervical manip (comps that >> vertebral a. trauma) (3)
Definition
rot, ext; traction
Term
VAI: S/Sx (4+)
Definition
ipsilat post neck pain
occipital HA
5 Ds
3Ns

(ataxic gait, dysmetria, dyssynergia, rotatory nystagmus, CN VII palsy, paresthesia)
Term
5 Ds of VAI
Definition
dizziness
diplopia
drop attacks
dysarthria
dysphagia
Term
3 Ns of VAI
Definition
nausea
numbness (usually extremities)
nystagmus
Term
S/Sx of internal carotid a dysfxn (6)
Definition
Horner's syndrome
pulsatile tinnitus
CN VI palsy
scalp tenderness
neck swelling
orbital pain
Term
Causes of Dizziness: 3 categories
Definition
inner ear
central
systemic
Term
Causes of Dizziness: inner ear (5)
Definition
Meniere's syndrome
infection
trauma
vestibulotoxic drugs
BPPV
Term
Causes of Dizziness: central (4)
Definition
VBI
tumors
cervical/SCM proprioceptor dysfxn
demyelinating disease
Term
Causes of Dizziness: systemic (4)
Definition
drugs (anticonvulsants, antihypertensives, hypnotics, alcohol, tranquilizers)
hypotension
hypothyroidism
dehydration
Term
Questions to ask pt c suspected VBI (4)
Definition
Trauma?
Cardiovascular hx
type of dizziness
positional symptoms (e.g. at hairdresser)
Term
C-spine pt neoplasm locations (3)
Definition
intracranial
intraspinal
pancoast
Term
Intracranial tumor: S/Sx (5)
Definition
45-55 y/o
HA (33% of pts) - retro-orbital, worse in AM, worse c exercise/bending forward
visual blind spots (incr ICP)
lethargy, mental clouding
CN VI palsy
Term
Screening for tumors (8)
Definition
>50 y/o
hx of CA
constant pain
night pain
HA
unexplained wt loss
visual ∆s
lethargy
Term
Tests to screen for tumors (3)
Definition
CN testing
UMN testing
imaging
Term
Intraspinal tumor: types (2)
Definition
Schwannoma
meningioma
Term
Intraspinal tumor: S/Sx (3)
Definition
intially: radiculopathy
progression: UMNL, Brown-Sequard
incr urinary frequency/impotence (males)
Term
Pancoast tumor =
Definition
apical lung CA;
asymptomatic until impingement of brachial plexus
Term
Pancoast tumor: S/Sx
Definition
ulnar n distribution; presents like TOS
shoulder pain (90%)
ulnar n distribution of pain
Term
Horner's syndrome caused by...
Definition
involvement of cervical sympathetic nn (occulosympathetic)
Term
Horner's syndrome: S/Sx (3)
Definition
enophthalmos
ptosis
miosis
Term
Degenerative diseases of CNS (2)
Definition
MS,
ALS
Term
MS =
Definition
viral-induced autoimmune disease of CNS >> edema, inflammation, demyelination
F>M
relapses
L'Hermittes sign
Term
ALS =
Definition
progressive motor neuron dz (unknown cause) >> degen/scarring of lateral spinal cord/brain stem/cortex
Term
ALS: S/Sx
Definition
early: asymmetrical weakness
fasciculation
UMN signs

depends on whether UMN/LMN affected first
Term
CVA (2)
Definition
>65 y/o (72% of strokes)
confused c cervical radiculopathy
Term
CSM =
Definition
cervical spondylitic myelopathy
Term
CSM: pathomechanics (4)
Definition
narrow spinal canal
C6 level affected
usually post part of cord
ligt flavum hypertrophy >> cord compression in ext
Term
CSM: pathophys (2)
Definition
vascular (ant spinal a. vulnerable to compression)

nerve (demyelination; Schwann cells sensitive to compression)
Term
CSM: S/Sx (7)
Definition
insidious onset (abrupt = vascular ischemia)
weakness/clumsiness of UE
ataxia, wide gait
pain/temp affected on opposite side
positive Hoffman's
reflexes: diminished at level, hyper below
decr proprio/balance/vibration
Term
CSM: Rx
Definition
severe: decompression sx
mild: C traction & T manip
Term
Mandatory questions of C-spine (3)
Definition
Dizziness, drop attacks, blackouts?
RA/inflammatory arthritis?
Neuro symptoms in legs (pain, N&T, spasticity, difficulty walking)?
Term
Infectious disorders of CNS
Definition
meningitis (bacterial OR viral)
Term
Meningitis: S/Sx
Definition
HA
stiff/painful neck
*fever*
Kernig's sign
Brudzinski's sign
Neurological ∆s (CNs, seizures, coma)
Supporting users have an ad free experience!