Lecture #4 and #5 - Bony Conditions of the Spine + Sprains and Strains
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Questions and Answers

What is the more common region of the spine where fractures occur?

Cervical spine

List two types of fractures and provide an example for each.

Acute: Compression; Insidious: Stress

Which two spinal structures are associated with spondylolithic fractures?

Pars interarticularis and vertebral end plate

Define Rust's sign and its significance in assessment.

<p>Rust's sign is self-stabilizing of the neck; it indicates potential upper cervical instability.</p> Signup and view all the answers

What are two important elements of a fracture rule-out?

<p>Mechanism of Injury (MOI) and associated symptomology</p> Signup and view all the answers

Is it possible to be asymptomatic with a stable acute fracture in the vertebral column?

<p>Yes</p> Signup and view all the answers

What should be done if a person with a recent MVC is unwilling to move their neck?

<p>It is a red flag; assessment should not continue until imaging rules out fractures.</p> Signup and view all the answers

What is the international equivalent of Canadian C-spine rules?

<p>National radiography utilization study (NEXUS)</p> Signup and view all the answers

What are the four inflammatory types of spondylopathies?

<p>Ankylosing spondylitis, sacroiliitis, psoriatic arthritis, Reiter’s syndrome.</p> Signup and view all the answers

Define spondylosis in the context of non-inflammatory spondylopathies.

<p>Spondylosis refers to age-related wear and tear on the spine, involving degeneration of spinal discs and vertebrae.</p> Signup and view all the answers

List three structures that should be palpated to assess for spondylopathies.

<p>Spinous processes, facet joints, lumbosacral junction.</p> Signup and view all the answers

What is the significant consequence of osteoporosis mentioned in the content?

<p>Progressive structural deterioration of bone tissue leading to low bone density.</p> Signup and view all the answers

Describe the difference between a Grade 1 and a Grade 3 sprain.

<p>Grade 1 involves slight damage and little loss of function, whereas Grade 3 involves complete damage and substantial loss of function.</p> Signup and view all the answers

What is the primary factor involved in acute torticollis?

<p>It is frequently associated with whiplash.</p> Signup and view all the answers

Identify one type of neurodynamic examination relevant to spondylopathies.

<p>Adverse neurodynamics.</p> Signup and view all the answers

In whiplash associated disorders, what does Grade 2 describe?

<p>Neck complaints of pain, stiffness, tenderness with musculoskeletal signs including decreased ROM.</p> Signup and view all the answers

What is crucial when dealing with cases of spondylopathies?

<p>Referral is absolutely crucial.</p> Signup and view all the answers

Which type of stenosis is specifically characterized by narrowing of the spinal canal?

<p>Central stenosis.</p> Signup and view all the answers

What are the most common regions for insidious fractures?

<p>The thoracic spine and lumbar spine.</p> Signup and view all the answers

Name two structures involved in spondylolithic fractures.

<p>Pars interarticularis and vertebral end plate.</p> Signup and view all the answers

What role does axial compression play in fracture evaluations?

<p>Axial compression is a mechanism of injury often linked to trauma like motor vehicle accidents.</p> Signup and view all the answers

What are the associated symptoms to be monitored during assessments for acute fractures?

<p>Central pain, local pain, and bilateral paresthesia.</p> Signup and view all the answers

List two situations that may indicate a red flag during an assessment.

<p>Inability to move the neck and the presence of Rust's sign.</p> Signup and view all the answers

Explain the significance of Rust's sign in neck assessments.

<p>Rust's sign indicates the need to stop the assessment and refer for imaging.</p> Signup and view all the answers

What should be done if no appropriate imaging is available for a patient with neck concerns after a recent MVC?

<p>The assessment should not continue until imaging is performed.</p> Signup and view all the answers

Identify an important examination protocol related to acute neck injuries.

<p>The presence of Rust's sign mandates stabilization, stopping the assessment, and referral for imaging.</p> Signup and view all the answers

What defines a Grade 2 sprain in terms of damage and loss of function?

<p>A Grade 2 sprain involves moderate damage and a painful loss of function.</p> Signup and view all the answers

What characterizes spondylolisthesis among the non-inflammatory types of spondylopathies?

<p>Spondylolisthesis is defined as a bilateral defect of pars interarticularis accompanied by displacement of the vertebral body.</p> Signup and view all the answers

Name two neurological signs included in Grade 3 of whiplash associated disorders.

<p>Decreased or absent deep tendon reflexes (DTR) and muscle weakness are neurological signs in Grade 3.</p> Signup and view all the answers

What is the significant feature of Baastrup’s disease in the context of spondylopathies?

<p>Baastrup’s disease involves the ossification or degeneration of the ligamentum flavum, leading to pressure on neural structures.</p> Signup and view all the answers

In the context of spondylopathies, what are the implications of 'adverse neurodynamics'?

<p>Adverse neurodynamics refers to abnormal movement or tension in the nervous system that can cause pain and functional limitations.</p> Signup and view all the answers

How does central stenosis differ from foraminal stenosis?

<p>Central stenosis refers to the narrowing of the spinal canal, while foraminal stenosis refers to the narrowing of the vertebral foramina.</p> Signup and view all the answers

What is the primary risk associated with untreated osteoporosis as noted in the provided content?

<p>The primary risk of untreated osteoporosis is progressive structural deterioration of bone tissue, leading to increased fracture incidence.</p> Signup and view all the answers

Which structures are palpated to assess spondylopathies involving the lumbosacral junction?

<p>The palpation includes the lumbosacral junction, sacrum, and the erector spinae muscles.</p> Signup and view all the answers

What type of pain characterizes a Grade 1 sprain based on the provided content?

<p>A Grade 1 sprain is characterized by mild to moderate pain, with little loss of function.</p> Signup and view all the answers

What is an important consideration when assessing acute torticollis in patients?

<p>An important consideration is the potential association with whiplash or cervical strains.</p> Signup and view all the answers

In which two regions of the spine do insidious fractures most frequently occur?

<p>The thoracic spine and the lumbar spine.</p> Signup and view all the answers

What does axial compression refer to in the context of vertebral fractures?

<p>It refers to a force coming from the top of the head, regardless of head alignment.</p> Signup and view all the answers

What significance does Rust's sign hold in the assessment of cervical stability?

<p>Rust's sign indicates an individual self-stabilizing their neck, suggesting potential upper cervical instability.</p> Signup and view all the answers

What are two associated symptoms to monitor during fracture assessments that may indicate a serious underlying condition?

<p>Central local pain and bilateral paresthesia.</p> Signup and view all the answers

List two common traumatic forces that can result in axial compression injuries.

<p>Motor vehicle accidents (MVA) and other significant traumatic incidents.</p> Signup and view all the answers

What three immediate actions should be taken if Rust's sign is observed during an assessment?

<p>Stop the assessment, stabilize the patient, and refer for imaging.</p> Signup and view all the answers

Name two elements of the fracture rule-out process indicated by the acronym 'CLear Beads Dangle Near Heads to Note Cranial Signs.'

<p>Mechanism of Injury (MOI) and associated symptomology.</p> Signup and view all the answers

What are the two specific structures most commonly involved in spondylolithic fractures?

<p>Pars interarticularis and vertebral end plate.</p> Signup and view all the answers

What distinguishes vestibular joint pathology from spondylopathy in clinical assessment?

<p>Vestibular joint pathology involves dysfunction in joint mechanics, while spondylopathy primarily concerns vertebral degeneration or inflammation.</p> Signup and view all the answers

How does age-related wear and tear contribute to spondylosis?

<p>Age-related wear and tear leads to the degeneration of spinal discs and vertebrae, resulting in pain and reduced flexibility.</p> Signup and view all the answers

In what way does whiplash commonly relate to acute torticollis?

<p>Whiplash often causes acute torticollis due to concurrent injuries to contractile and inert neck tissues.</p> Signup and view all the answers

What are potential consequences of untreated spondylolisthesis?

<p>Untreated spondylolisthesis can lead to chronic back pain and potential nerve damage due to spinal instability.</p> Signup and view all the answers

Describe the significance of careful palpation of the erector spinae in spondylopathies.

<p>Palpation of the erector spinae is significant for assessing muscular tension or tenderness associated with spinal problems.</p> Signup and view all the answers

What defines the clinical impact of Baastrup’s disease in the context of lumbar disorders?

<p>Baastrup’s disease is characterized by pain related to contact between adjacent spinous processes, indicating degenerative changes.</p> Signup and view all the answers

How does central stenosis differ in presentation from foraminal stenosis?

<p>Central stenosis involves narrowing of the spinal canal affecting nerves centrally, while foraminal stenosis specifically narrows the openings where nerves exit the spine.</p> Signup and view all the answers

What are the implications of adverse neurodynamics in the evaluation of spondylopathies?

<p>Adverse neurodynamics indicate potential nerve irritation or dysfunction related to spinal issues, impacting mobility and treatment strategies.</p> Signup and view all the answers

How would you classify a Grade 2 strain in terms of clinical features?

<p>A Grade 2 strain presents with moderate damage, decreased strength, and significant pain during movement.</p> Signup and view all the answers

What role does referral play when addressing cases of spondylopathies?

<p>Referral is crucial for multidisciplinary management, ensuring comprehensive evaluation and treatment of complex spondylopathies.</p> Signup and view all the answers

What are the common regions of the spine where acute fractures typically occur?

<p>Acute fractures are more commonly found in the cervical spine.</p> Signup and view all the answers

Identify a structure involved in both acute and insidious fractures of the spine.

<p>The vertebral body.</p> Signup and view all the answers

What is a possible cause of fragility fractures in the thoracic spine?

<p>Osteoporosis.</p> Signup and view all the answers

In the assessment of cervical spine injuries, what condition might lead a patient to exhibit Rust's sign?

<p>Upper cervical instability.</p> Signup and view all the answers

What immediate assessment strategy should be applied if Rust's sign is observed?

<p>Stop the assessment, stabilize, and refer for imaging.</p> Signup and view all the answers

Describe the symptoms associated with an acute fracture involving axial compression.

<p>Symptoms may include central and local pain, as well as bilateral paresthesia.</p> Signup and view all the answers

What role does the mechanics of injury (MOI) play in assessing spinal fractures?

<p>The mechanism of injury helps determine the potential severity and type of fracture.</p> Signup and view all the answers

What may indicate a red flag during patient assessment after a motor vehicle collision?

<p>Inability or unwillingness to move the neck.</p> Signup and view all the answers

What are the main characteristics of Grade 3 sprains in terms of strength and pain?

<p>Grade 3 sprains involve complete damage, leading to weak strength and no pain at the time of injury.</p> Signup and view all the answers

Describe the distinction between central and foraminal stenosis.

<p>Central stenosis refers to narrowing of the spinal canal, while foraminal stenosis involves narrowing of the vertebral foramina.</p> Signup and view all the answers

What role does referral play in the management of spondylopathies?

<p>Referral is crucial in managing spondylopathies to ensure proper evaluation and treatment.</p> Signup and view all the answers

How is spondylolisthesis classified among non-inflammatory spondylopathies?

<p>Spondylolisthesis is characterized by a bilateral defect in the pars interarticularis with displacement of the vertebral body.</p> Signup and view all the answers

What is the clinical significance of palpating the erector spinae in patients with spondylopathies?

<p>Palpating the erector spinae can reveal tension or tenderness, indicating underlying spinal issues.</p> Signup and view all the answers

What is the primary injury mechanism associated with whiplash and acute torticollis?

<p>Both conditions are frequently associated with high velocity trauma leading to concurrent injury of contractile and inert tissues.</p> Signup and view all the answers

Identify two key symptoms that are monitored during assessments of acute fractures.

<p>Decreased reflexes and sensory deficits are crucial symptoms to monitor.</p> Signup and view all the answers

What distinguishes limited range of motion in Grade 2 whiplash associated disorders from Grade 3?

<p>Grade 2 presents decreased range of motion with musculoskeletal signs, while Grade 3 includes neurological signs such as muscle weakness.</p> Signup and view all the answers

Describe the features of Baastrup's disease in the context of spondylopathies.

<p>Baastrup's disease is characterized by excessive contact between adjacent spinous processes, leading to pain and potential degeneration.</p> Signup and view all the answers

What is the significance of understanding the difference in symptoms between strains and sprains?

<p>Different symptoms can indicate whether muscle or ligament involvement has occurred, impacting treatment direction.</p> Signup and view all the answers

Which type of fracture is characterized by a bony fragment being torn off?

<p>Avulsion</p> Signup and view all the answers

Infrequent fractures in the spine mostly occur in the lumbar region.

<p>False</p> Signup and view all the answers

Name one associated symptom to monitor during assessments for acute spine fractures.

<p>Bilateral paresthesia</p> Signup and view all the answers

The structures commonly involved in fractures are the spinous process, transverse process, and ________.

<p>vertebral body</p> Signup and view all the answers

Match the following fracture types with their characteristics:

<p>Compression = Caused by axial loading of the spine Stress = Involves repetitive stress leading to fatigue Avulsion = Bony fragment torn off by muscle Fragility = Associated with osteoporosis</p> Signup and view all the answers

What should be done if a person presents with Rust's sign during an assessment?

<p>Both B and C</p> Signup and view all the answers

It is possible for someone with a stable acute fracture in the vertebral column to be asymptomatic.

<p>True</p> Signup and view all the answers

What are the two types of fractures mentioned that can occur in the spine?

<p>Acute and Insidious</p> Signup and view all the answers

Which of the following is NOT an inflammatory type of spondylopathy?

<p>Spondylosis</p> Signup and view all the answers

Spondylolisthesis involves a bilateral defect of the pars interarticularis with displacement of the vertebral body.

<p>True</p> Signup and view all the answers

What is the primary factor associated with acute torticollis?

<p>Whiplash</p> Signup and view all the answers

Whiplash involves injury to both contractile and _______ tissues of the cervical spine.

<p>inert</p> Signup and view all the answers

Match the following grades of sprains with their characteristics:

<p>Grade 1 = Slight damage, little loss of function Grade 2 = Moderate damage, painful with decreased strength Grade 3 = Complete damage, substantial loss of function</p> Signup and view all the answers

Which of these statements is TRUE regarding Grade 2 sprains?

<p>Damage is moderate, and there is a decrease in strength.</p> Signup and view all the answers

In Grade 3 sprains, there is typically no pain at the time of injury.

<p>False</p> Signup and view all the answers

List one common structure palpated during the assessment of spondylopathies.

<p>Spinous processes</p> Signup and view all the answers

Spondylosis is characterized by degeneration of spinal _______ and _______.

<p>discs, vertebrae</p> Signup and view all the answers

Which condition is specifically described by narrowing of the spinal canal?

<p>Central stenosis</p> Signup and view all the answers

Study Notes

Bony Conditions of the Spine

  • Fractures: Occur infrequently, with insidious types (e.g., stress, fragility) more common, especially in the cervical spine.
  • Types of Spinal Fractures:
    • Acute:
      • Compression
      • Avulsion (bony fragment torn off).
    • Insidious:
      • Stress (potentially related to spondylosis/spondylolisthesis)
      • Fragility.
  • Common Locations for Insidious Fractures:
    • Thoracic spine (associated with osteoporosis)
    • Lumbar spine (associated with spondylosis/spondylolisthesis).
  • Structures Involved in Fractures:
    • Spinous process
    • Transverse process
    • Vertebral arch
    • Pars interarticularis
    • Vertebral end plate
    • Vertebral body.
  • Spondylolytic Fractures: Involve pars interarticularis and vertebral end plate.
  • Axial Compression: Force from the head (neutral or not).
  • Important Fracture Rule-Out Elements (Acronym):
    • MOI: Axial compression, motor vehicle collisions.
    • Associated Symptoms: Central/local pain, bilateral paresthesia, neck symptoms (the 5 Ds and 3 Ns, headaches, tinnitus, nausea, cranial nerve symptoms).
  • Rust's Sign: Self-stabilizing neck; a crucial sign demanding immediate stabilization and referral for imaging. This is observed as the patient grabbing the back of their neck to aid in sitting up. This sign implies upper cervical instability and is a critical finding.
  • Canadian C-Spine Rules Equivalent: National radiography utilization study (NEXUS).
  • Red Flag: Inability/unwillingness to move the neck (even without Rust's sign) after an MVC (motor vehicle collision) indicates possible injury necessitating imaging prior to further assessment.
  • Spondylopathies: Disorders of the vertebrae.
    • Inflammatory Types: Ankylosing spondylitis, sacroiliitis, psoriatic arthritis, Reiter's syndrome.
    • Non-inflammatory Types: Spondylosis, spinal stenosis (central, foraminal), spondylolysis, spondylolisthesis, Baastrup's disease, vertebral stress fracture.

Sprains and Strains

  • Classification of Sprains and Strains (Grade 1-3): Based on the level of damage, loss of function, strength, and pain (with 3 being complete). Severity of swelling also correlates with the grade.
  • Whiplash: Concurrent injury to the contractile and inert tissues of the cervical spine in high-velocity trauma.
  • Acute/Acquired Torticollis: Frequently associated with whiplash and cervical strains.
  • Whiplash Associated Disorder Classification (Grades 0-4): Different grades categorize complaints of pain, stiffness, tenderness, neurological signs, and/or fracture/dislocation.
  • Crucial Consideration for Spondylopathies: Referral.
  • Osteoporosis: Progressive deterioration of bone tissue, resulting in decreased bone density and porosity.

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Description

Explore the various bony conditions affecting the spine, focusing on fractures and their types. Learn about acute and insidious fractures, common locations, and the structures involved. This quiz will test your knowledge on spinal injuries and their clinical implications.

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