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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 |
Created by:
streetsmarts
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