History and Physical Schpeels

History  AMPLE  Mechanical pain  OPQRST  Extension vs flexion  Positional improvement  Back vs buttock, midline vs paramidline  Back dominant vs leg cominant  Deformity  Noticed change to ribs or spine  Myelopathy  Changes in gait  Balance  Fine motor (buttoning shirt, handwriting)  Neuro  Changes to sensation or moto funcion  Claudicant  Vascular vs neuro  Neuro  Better with flexion  Radicular  BowelContinue reading “History and Physical Schpeels”

Scheuermann’s Kyphosis

Background  Rigid spinal kyphosis cause by anterior wedging  Definition: Thoracic kyphosis with anterior wedging >5 degrees of at leas 3 consecutive vertebral bodies  Adolescents (onset age 10)  M>F  Autosomal Dominant  2 forms  Typical  Apex T6-8, curve T1-L1  Non structural lumbar hyperlordosis  Atypical  Apex TTL  More progressive and sympomatic  Pathophys  Unknown  Osteonecrosis of anterior apophyseal ring Continue reading “Scheuermann’s Kyphosis”

Cervical Spondylosis

Background  Natural degenerraiotn  Starts age 40  85% of asymptomatic patientst >65 have spondylotic changes  C56  RF  Excessive driving  Lifting  Athletes  Smoking  Pathophys  Natural aging  Degeneration  Disc:  Dessication, height loss, bulding, herniation  Joints: Uncinate spurring, facet arthrosis  Ligamentum flavum: thicken, infold due to disc height loss  Deformity: kyphosis – disc height loss, shift load to uncinatesContinue reading “Cervical Spondylosis”

Spinal Cord Anatomy

Long Tracts (DC ST CT)  DC Dorsal Tract (Posterior)  Proprioceptive  Cross at brainstem  Ipsilateral deficit  Central LE  Sensory enters distally first (distal to proximal) so sacral is central  CT Corticospinal Tract (Lateral) Pyramidal  Motor  Crosses at brainstem  Ipsilateral deficit  Central – UE  Sensory enters distally first so sacral WAS central but then it crossed  STContinue reading “Spinal Cord Anatomy”

Spinal Cord Injury

Background  Injury to spinal cord resulting in temporary or permanent change to sensory, motor or autonomic function  Bimodal  Young – high energy  Elderly – minor trauma + degenerative narrowing of canal  M:F 4:1  Race  Caucasian > Black > Hispanic  Types  Incomplete tetraplegia (34%) – Central Cord  Complete paraplegia (25%)  Complete tetraplegia (24%)  Incomplete paraplegia (17%) Continue reading “Spinal Cord Injury”