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MS of Back/Spine
Clinical Medicine II-Spring 2012
Question | Answer |
---|---|
MC disability under age 45 | Back and spine pain |
C spine issues causes what pain | neck and arm pain |
Fxn of intervertebral discs | shock absorber and twisting |
Anatomy of intervertebral disc | annulus fibrosus outside, nucleaus pulposus inside |
What do the cervical vertebrae nerves C4,5,6,7,8 and TI control | 4: trapezius, rhomboids, 5: deltoid,biceps, 6: wrist extensors, 7:triceps, wrist flexors, 8:finger flexors, T1: intrinsics of the hand |
What do L1,2,3,4,5 S1, and S2-5 supply for motor nerves | L1& L2: iliopsoas, L3: quads, L4: tibialis anterior, L5: EHL, gluteus medius S1: gastrocsoleus, peronei?, S2-5: rectal exam |
Cervical nerve Reflexes tested how?Lumbar? | C5: Biceps, C6: brachioradialis, C7, Triceps, L4: patellar, S1: achilies |
2 causes of degenerative processes | mechanical and pinched nerve with A LOT of overlap |
Does pain correlate w/ amount of disc degeneration | NO not at all! Amount of pain is NOT reliable |
What are spondylogenic causes of low back pain | disc degeneration, spondylolisthesis, fractures, inflammatory, infection, tumor |
Non spondylogenic causes of low back pain | vasculogenic, viscerogenic, neurogenic |
Disc disorders | degernerated w/fissures and annulus fibrosis, buldging, herniated, thinning, nucleosis pulpolsus: desiccated |
Aggreavating factors that ↑disc degeneration | smoking, vibration, lots bend, lift, twist, osteoporosis, genetic, occupational |
What 3 things should we remember to check w/ back pain in elderly | Compression fracture, tumor, infections |
How common is back pain in kids? | NOT. Must be evaluated eg. Painful sclerosis→not common |
Pain that travels or radiates | radiculopathy: look at which nerve it is coming from |
What is a common problem that results when a nerve root is compressed or irritated | radiculopathy: pain, numbness, tingling or weakness |
Sprain and Strains mean what? | Sprain: muscles Strain: ligaments |
Tx low back sprain/strain | NSAIDS, slight rest, gradual return to full activity |
What should we always consider w/ back sprain/strains as advice | wt loss and PT |
MC location of a herniated disc & characteristics | L4,5 and L5-S1 in age 30-40, sharp shooting pain “sciatic pain” |
What should the PE entail w/ suspect disc herniation | FULL H&P, deep tendon reflex, motor group test, sensory, nerve root tension: leg raise |
What warrants a MRI? | Severee pain or ANY neurologic deficit, can toMRI Myelogram, CT, or EMG |
Tx of disc herniation | 90% heal on their own w/ 3m of onset of sxs, Rest, PT, yoga, pilates RARE surgery unless completely compressed |
Degenerative process, arthritis of the spine | spondylosis |
Posterior aspect of spine known as pars intrarticularis, essentially a stress fracture in vertebral body | spondylolysis: common in kids low back pain |
One vertebrae slips forward on another | spondylolisthesis |
MC location of spondylolysis | lumbar d/t impact: stress fracture of vertebral body |
What is the scotty dog fracture | spondylolisthesis: gradual deformity of spine and narrowing of the vertebral canal |
Difference b/w spondylolysis and spondylolisthesis | greater sxs w/ listhesis, nerve root compression |
What are common fractures in postmenopausal women | compression fractures, 25%!!! |
Hx of a compression fracture | acute onset in low thoracic high lumbar back pain |
Tx of compression fracture of the spine | mild to mod, 6-12wk immobilization in brace or corset, severe, surgery: vertebroplasty |
Injecting a needle into vertebral body and injecting a cement like material | Vertebroplasty for severe compression fractures |
Common causes or RF’s of compression fractures | common cause of spine pain in elderly, malnutrition, corticosteroids, alcohol abuse |
What must we do f/u if we find a spinal tumor | check for metastatic lesions, lung, breast, prostate are MC |
Common types of vertebral body tumors | multiple myeloma, chordoma, osteosarcoma, hemangioma |
Types of radiographic image for spinal tumors | XR, bone scan, MRI, CT guided biopsy |
Signs, sxs of spinal stenosis | radiation to butt and down legs, worse w/ stand/walking, relieved w/ sitting and resting, Grocery cart sign |
Causes of spinal stenosis | disc herniation, bone spurs, degerative changes d/t overweight |
Non-surgical tx for spinal stenosis | activity modification, NSAIDS, epidural steroid injections, PT |
Surgical tx for spinal stenosis | decompression and stenotic neuroalignments: immediate results |
Muscle sprain of the cervical spine, dislocation of intervertebral disks and often damage to the spinal cord | cervical fracture: broken neck |
Tx for c spine fractures | minor: soft collar, severe: fracture/dislocations halo traction and surgical stabilization |
Effects of compression of the cauda equina | bowel and bladder control, sexual fxn |
Causes of cauda equina sxs | tumors/lesion, trauma, spinal stenosis (lumbar), inflammatory conditions |
Signs of cauda equina | weakness, saddle-anesthesia, incontinence common, sexual dysfxn |
Tx cauda equina syndrome | SURGICAL EMERGENCY spinal decompression, immobilize if caused by trauma |
Primary age of onset of scoliosis | 10-15yo |
Dx of scoliosis | H&P and full spine XR usually refer |
Tx curves less than 20 degree, 20-40, and >40 | <20: observation, 20-40: bracing, >40: surgical correction |