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NeuroDiagnosis
Dr Rosen/Herb
| Question | Answer |
|---|---|
| Where is injury for incomplete tetra/paraplegia? | Above the neck |
| Where is injury for complete tetra/paraplegia? | Below brachial plexus |
| Where are most frequent levels of injury? Why? | C5 with C4, C6, T12 following in frequency C5-7, T4-7, T10-L2 *Mostly C5 bc it is apex of lordosis, also involvement at C4 & C6. T12 bc transitional vertebra-- from kyphosis to lordosis |
| Which ASIA patients are most likely to be employed? | Those with Asia D (least involved) |
| Employment: Do pts who are employed tend to work F/t? Which jobs do they return to if they return w/in one year? Who has greater likelihood of returning to work? | Full time; Return to same job; Younger, male, white, more formal education, higher IQ |
| What influences return to work? | Type of injury, Support at work & home, Position/Type of work |
| Philosophy of Rehab | restoration thru personal health services of handicapped ppl to the fullest physical, mental social & economic usefulness of which they are capable, including ordinary treatment treatment in special rehab centers. |
| The Team Approach | Members: PT, OT, Speech, Vocational Rehab, Nurse, Physiatrist, Psychologist, Social Worker |
| Achievement of Goals | 1. Evaluate (at baseline, see what they can do) 2. Develop a program (based on pt's goals) 3. Motivate & Direct (encourage, be a cheerleader) |
| Individual Vertebrae: Structure | 2 Lamina + 2 Pedicles form transverse processes; Vertebral arches (?) form spinous processes |
| Where are discs found? | Bt C2/C3 -->L5/S1 |
| Where are ligaments found? | Bt vertebral bodies |
| What are the ligaments of the spinal column? | Anterior Longitudinal Ligament; Posterior Longitudinal Ligament; Ligamentum Flavum (bt Lamina); Ligamentum Nuchae; Supraspinous Ligament (tip of spinous processes); Interspinous Ligament (bt spin processes); Intertransverse Ligament (bt trans proces |
| Where does spinal cord go from & to? | Medulla spinalis- caudal continuation of brain. Exits occiput from foramen magnum-->L1L2. No cord at L4L5 so we do spinal tap here |
| Spinal Nerve Roots- talk about them | 31 pairs. Anterior root: ventral-efferent; posterior root: dorsal- afferent. Some "paired spinal segment" of nerve roots exit horizontally, some more obliquely (almost vertical) at bottom |
| What are Meninges layers & where is CSF housed? | Pia mater; Arachnoid mater- subarachnoid space houses CSF; Dura mater. |
| How long is spinal cord? How much does it weigh? | 45 cm in males & 42 cm in females; ~30 grams. |
| Inner organization of vertebra | Gray vs white matter; Columns anterior, posterior & two lateral & tracts. (know which column each tract is in) |
| What does nerve room come out of? | Nerve root comes out from correct segment. Cord segment of spinal cord does not match bone it sits on- difference bt neurological cord segment & its location compared to the bone it sits on. |
| Anatomical Relationships bt the Spinal Cord & the Vertebral Column | Cd seg: Vert Bdies: Spin Proc: C8 LowC6/UprC7 C6 T6 LowT3/UprT4 T3 T12 T9 T8 L5 T11 T10 S T12/L1 T12 |
| Rules for Anatomical Relationships bt the Spinal Cord & the Vertebral Column | Cord comes out above same # vertebra, then switches at C7/T1 bc there is a C8 nerve root Grays: Rough rule of 2- add 2 to spin process for C2-T10. (Tip of T9 process is at T12), then add 3. Close from C1-C4.. difference gets greater as u go down cord. |
| How can cord function without cortical input? What system does not need cortical input? | afferent/efferent nerve form loop- independent. Pt can maintain functions w/o cortical input. Bladder is system like this. Form isolated cord below level of lesion (?) |
| Major Motor tracts | Lateral corticospinal (Ips): voluntary mvt- precise mvts of distal limbs Ventral corticospinal (Con): voluntary mvt of axial mm (not very signif). Rubrospinal (Ips): voluntary mvt of UE, esp precise mvts of extremities. Vestibulospinal (Bil): Posture/B |
| Last Major Motor tract | Lateral & Medial Reticulospinals (Ips): Posture, balance, modulation of spinal reflexes, axial & proximal limb motions; in performance of motor tasks, comlements actions driven by corticospinals |
| Sensory Tracts | Anterolateral system: Spinothalamic, spinoreticular & Spinotetal tracts (Contra): Pain, temp & crude touch Dorsal column (Ips): Proprioception, vibratory sense, deep touch & discriminative touch |
| Last 2 Major Sensory Tracts | Dorsal Spinocerebellar (Ips): Unconscious proprioception from trunk & LE Ventral spinocerebellar (Bil): Unconscious proprioception from trunk & LE |
| How many pairs of spinal nerves from each section? (thor, lumbar, cerv) | Cerv: 8, Thoracic: 12, Lumbar: 5. |
| Anterior spinal artery | Runs along anterior fissure until it gets to thoracic spine- here, gives rise to sulcal (supply center of cord) & pial (supply lateral cord) arteries. |
| Lateral spinal arteries | A set. Comes from b/t lateral artery b/t C2 & T2. |
| Segmental Radicular arteries | Continuation of anterior spinal artery below T4. Have connection to intercostal artery from Aorta. Largest component of this is Adam Kiewicz: supplies anterior part b/t C8-T4. Responsible for Thoracic & Lumbar spine. |
| Posterior spinal arteries | From posterior nerve roots- supply posterior horn. Start inter-cranially & descend all the way down. |
| Centrifugal system | Comes from anterior median fissure. Arises from anterior spinal artery & supplies center of cord: supplies ___ (most) of gray matter & inner 1/2 of white matter. |
| Centripetal system | Comes from anterior & posterior spinal arteries & supplies outer part of white matter. Supplies posterior horns: inner & outer part of lateral column. |
| Fracture dislocation - importance | Often the etiology of SCI- causes large bleeds. Capillary network is more dense in gray than in white matter. |
| How do u conduct examination of joint? | Subjective, Observation & palpation (posture & limb posturing), Active mvt testing (quick tests), Resistive tests, Passive mvt testing, Special tests/other tests (neuro), Palpation: specific |
| How do u conduct active mvt testing at shoulder complex? | Clear jts above & below, Quick tests (tests the shoulder complex)- if these reveal no problems, do Quick tests w/overpressure, Scapular motions, GH jt motions, Elbow flexion & extension |
| How do u conduct passive mvt testing at shoulder complex? | Clera jts above & below, Passive ROM = physiologic motions (shoulder jt, ST jt, GH jt), Joint Mobility Testing = accessory mvt (ST jt, SC jt, AC jt, GH jt) |
| How do u conduct Resistive testing at shoulder complex? | Muscles for scapular motions, muscles for GH jt motions, muscles for elbow motions |
| What is purpose of special tests? What do u test? | Orthopaedic & neuro: tests designed to stress certain structures |
| How do u take subjective of shoulder complex? | Hx of present illness (why here? what about shoulder bothers u? ever bothered u before?), Dominant arm (R or L), Neck/thorax prob (upper back/neck refers pn), Systems review - search for referred pn, Job/sport- simulate offending mvts, PMH, PSH, Sochx |
| What are major things to ask during subjective? | Area- where pn? Onset- when start? Nature- what feel like (burn/pinch)? Meds: helping? What about job/sport interacts w/this prob? How long pn last (irritability)- show me w/good arm what creates prob What can't u do? (****) |
| Referred pn- red flag example & how do u intervene? | Pt says they have shoulder pn that comes on w/climbing steps only - send to dr to get cardiogram *CV may have probs |
| Examination: Observation of shoulder complex | Posture: attitude of arm, body posture/habits, willing to mv?, atrophy or hypertrophy (imbalanced mm), note edema-jt could get inflamed then mv down to elbow, symmetry (1 blade much higher). If bad attitude no willing to mv- have TLC- massage to decr. pn |
| Examination: Palpation of shoulder complex | Palpate: temperature, edema, atrophy, tenderness (capsule, tendon, bursa, etc), analyze alignment & pos'n- is blade dropped? msr w/tape msr- document "at rest pos'n, scap angle at level of T7." use this as baseline to document changes. |
| How to conduct examination of shoulder complex: active mvt testing | incl jts above & below affected jt. Neck: tell pt to look up to sky, then L, then R. then overpressure- but no overpressure this semester. Quick tests: apply overpressure if no limitation- Flexion, Abdn, Hand behind back, Hand behind head, Rotator cuff. |
| What to look for during examination of shoulder complex: active mvt testing | Symmetry, painful arcs ("pn started at 45-->120, then went away"), willingness to mv, pain |
| What does painful arc help u determine? | Where probs are |
| What motions to test during examination of shoulder complex: active mvt testing | C-spine, scapular elev/depression, scapular upward & downward rotation, scapular ad/abduction, GH physiologic motions, elbow flex/extension |
| How to apply overpressure during flexion of shoulder | Stabilize scapula, put hand on distal humerus, apply overpressure (stresses ligaments to the max). If no pn, u clear this motion, so this wouldn't fall into ur goals unless goal is to maintain ROM. |
| What motions to do Resisted (Active) Mvt Testing on for pt w/prob in shoulder complex | Scapular, glenohumeral, elbow. For hypermobile joints: if looking for end-range cardinal sign (pn at end-range in shoulder) then u can apply overpressure to hypermobile jt (otherwise, don't) |
| What to include in passive mvt testing | Test joints above & below affected jt. Passive physiologic motion & goniometry. Joint mobility testing: remember good body mechanics, relax (pt and PT), get pt feedback |
| What end-feel is normal for shoulder complex? | Capsular at 120. Before 120 is not normal. Empty is ROM limited by pain. |
| What are the 3 things u are assessing with passive mvt testing? | Arc of mvt (goniometer - preset it to estimated range so u aren't fiddling with it), End-feel, Quality (if u feel hitches or muscle spasm) |
| What should do u for a stiffer joint during passive mvt testing? | Alternate hand-placement- gravity doesn't help as much- PT has to perform motion. |
| What mvts do u passively test for Scapulothoracic jt? Which direction is pt lying? | Elevation/depression, Ab/adduction, Up/downward rotation, "distraction" (sidelying) |
| What mvts do u passively test for Sternoclavicular jt? Which direction is pt lying? What mvts are u testing? | Cephalad & caudad glide, A-P glide (pt supine) Accessory mvts |
| What mvts do u passively test for Acromioclavicular jt? Which direction is pt lying? What mvts are u testing? | A-P glide, P-A glide (pt supine) Accessory mvts |
| What is the concept of hand-placement when passively testing SC joint, ST joint & AC jt? | Stabilize scapula, control distal same arm as pt, After 90 use opp arm as pt. Note whether GH motion stops at 120. |
| What mvts do u passively test for Glenohumeral jt? Which direction is pt lying? What mvts are u testing? | Lateral distraction of head of humerus, anterior glide, posterior glide, ER of head of humerus, IR of head of humerus, longitudinal mvt in neutral, inferior glide (pt supine) Accessory mvts |
| Hand Placements- Caution with: | Tender areas (pt will tell u where they are), Unstable bony segments (ie recent fractures, ORIF), *Osteoporosis (u can still test but use no force? |
| What mvts do u assess/mobilize(?) for Scapulothoracic jt? | Elevation/depression, Protraction/retraction, Ab/adduction, Lifting scapula |
| What is correct hand placement/body mechanics for scapulothoracic mobilization? | Pt sidelying. One hand's web-space on inferior angle, other hand on superior border. Stabilize upper arm w/your forearm- lock ur elbows & mv your legs. |
| What mvts do u assess/mobilize for Sternoclavicular jt? | Inferior glide to increase elevation, Superior glide to increase depresion, A-P glide to increase retraction, P-A glide to increase protraction, |
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melaniemelanie
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