Trigger - Neck and back

Question 1

what are indications for a lumbar XR in acute lower back pain

Answer 1

• significant trauma
• atypical pain (?)
• nocturnal pain
• night sweats

Question 2

MCC of lost work time and disability in young adults. Also MC strained area of the body.

Answer 2

acute lower back pain

Question 3

associated stiffness is a hallmark finding for what

Answer 3

chronic LBP

Question 4

fracture of the base of odontoid is considered what type of C2 fracture classification

which fractures are most/least stable

Answer 4

Type 2 is the answer. this has high risk of non-union

type 1 - fx of upper odontoid peg (rare and unstable)
type 2 - fx of base of odontoid (unstable, high risk of non-union)
type 3 - through odontoid and into lateral masses of C2 (best prognosis)

Question 5

what is the initial care of a cervical strain

Answer 5

1. soft cervical collar, mild narcotic and/or NSAIDs x 1-2wks
2. muscle relaxers if muscle spasm
3. cervical pillow

usually resolved in 4-6 wks but can take up to 12

Question 6

what test indicates Indicates a long-tract spinal cord lesion

Answer 6

ankle clonus and babinski!!

babinski could also indicate upper motor neuron lesion

Question 7

what are waddell’s tests and how many must be positive to indicatelow likelihood of success w injections/surgical intervention

Answer 7

1. superficial tenderness (marked pain w light touch over lumbar spine)
2. axial loading (increased lumbar pain w downward pressure on pts head)
3. distraction test (no pain w seated SLR while pt is distracted)
4. regional disturbanecs (nonanatomic sensory/motor impairement)

3/4 = low likelihood of help w steroids or sugery

Question 8

bilateral fractures of the pedicles r pars interarticularis on C2 is known as what

Answer 8

hangmans fx

Question 9

where is the Odontoid (dens) fracture

Answer 9

C2

Question 10

how would nerve root impingement and spinal crod injury both present differently in a patient with cervical spine fractures

Answer 10

• nerve root impingement = focal UE numbness/tingling
• Spinal cord injury = global sensory/motor deficits

Question 11

gap or step off between spinous processes suggests what

Answer 11

• fracture of the pars of the vertebre
• ligamentous injury

Question 12

what are signs of instability on a cervical XR

Answer 12

• translocation of a vertebral body >3.5mm
• 11 degrees of angulation of adjacent vertebral bodies

Question 13

what is used for symptom relief in an isolated transverse process fracture of the thoracic or lumbar spine

Answer 13

thoracolumbar corset

Question 14

when do we use Thoracolumbosacral orthosis (TLSO) for 8-12 weeks

Answer 14

• stable, simple compression fractures <20 degrees
• also use oral narcotics for pain at this point

Question 15

what is the treatment for severe thoracolumbar vertebral fractures?

burst fx, severe compression fx, flexion-distraction/dislocation

Answer 15

sugrical decompression

Question 16

what is the MSK SE of haldol and reglan?

Answer 16

torticollis

Question 17

Enthesitis with chronic inflammation via T-cells

Answer 17

ankylosing spondylitis

Question 18

Enthesopathy is the hallmark of ……

Answer 18

ankylosing spondylitis

Question 19

can present with anterior uveitis, pulmonary fibrosis and cardiac disease

Answer 19

ankylosing spondylitis

Question 20

associated with Paraspinal spasms
and Occipital Headaches

Answer 20

cervical strain