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189 Terms
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cruciate ligament

holds dens in place during rotation of head

longitudinal and transverse bands

PREVENTS POSTERIOR DISLOCATION OF DENS

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apical ligament

deep to cruciate

attaches dens to skull

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alar ligament

laterally attaches dens to skull

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Thoracic vs lumbar vs cervical

cervical- transverse foramen

thoracic- pointed down spinous process, articular facets for ribs, rounded vert body

lumbar-more square spinous process, oval vert body

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where do cervical nerves exit

Exit above their respective vert body

except C8

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where do non-cervical nerves exit

emerge below vertebral body

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at birth, spinal cord ends at

L3

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adult spinal cord ends at

bottom of L1/ top of L2

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where does adult dura mater end

S2

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what does the cauda equina contain

dorsal and ventral roots

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what are the 3 layers of spinal membranes

dura mater (subdural matter)

arachnoid mater (subarachnoid/CSF)

pia mater

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What do the denticulate ligaments do

separates the ventral and dorsal rootlets from each other

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what are denticulate lig composed of

extensions of pia mater

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dorsal rami supplies

medial branch - post cutaneous branch

lateral branch- intrinsic muscles of back

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ventral ramus supplies

anterior and lateral cutaneous branches

extrinsic muscles of back

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where is lumbar puncture done

L3-L4, enters subarachnoid space

spinal cord ends at L2

(where CSF is stored)

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Extradural space contains

aka epidural (around dura mater)

epidural fat, internal vert venous plexuses

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where does lumbar epidural anesthesia go?

into sacral hiatus

want it below S2 because that is where dura mater ends

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main blood supply for spinal cord

anterior and superior spinal arteries

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what is significant about lumbar veins

no valves, easy spread of cancer to cranial level

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L4-5 disc compression pain/numbness

pain over sacroiliac joint, hip, lateral thigh/leg

numbness on first 3 toes

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L4-5 leads to loss of

dorsiflexion of great toe and foot, difficulty walking on heels, foot drop (deep fibular nerve)

internal hamstring reflex diminished

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L5-S1 disc compression pain/numbness

pain over sacroiliac joint, hip, posterolateral thigh/leg-heel

numbness on back of calf, lateral heel, foot to 5th toe

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L5-S1 disc compression loss of

plantar flexion and great toe may be affected (tibial nerve), difficulty walking on toes

muscle mass of triceps surae

ankle jerk diminished

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lumbar laminectomy used to

relieve pressure, due to disc herniation

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gray matter vs white matter

gray matter: cell bodies

white matter: myelinated and unmyelinated axons that ascend to brain and descend through spinal cord

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purpose of gray and white rami communicantes

distribute sympathetic fibers that will emerge from T1-L2 to respective areas

form symp ganglion that descend or ascend or travel at same level to various organs

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ganglia

collection of nerve cell bodies in PNS

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Cardiopulmonary plexus

supplies heart, sympathetic outflow

T1-T4

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Pain during heart attack

referred pain at left arm, jaw, left chest

due to dermatomal distribution of T1-T4 cardiopulmonary plexus

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significance of herpes zoster

varicella zoster virus reactivates from latent state in posterior dorsal root ganglion

shingles rash on skin along dermatome

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3 main plexuses

cervical, brachial, lumbosacral

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What forms a sacral plexus

ventral rami —> peripheral nerves —> motor

dorsal will receive sensory info

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Erbs palsy affect what region of nerve

C5, C6, C7 upper brachial plexus (mostly C5 and 6)

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cause of erbs palsy

increase of angle between neck and shoulder —> rupture of fibers from C5, C6, C7 (mostly C6 and C7)

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erbs palsy presentation

sensory loss along lateral border of arm, affects entire arm

arm adducted and internally rotated, forearm extended and pronated

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klumpkes palsy affects

C8/T1 of brachial plexus (lower brachial plexus)

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cause of klumpkes palsy

excessive upward pull of limb

cervical rib can cause compression of lower fibers of brachial plexus

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klumpkes presentation

loss of all intrinsic hand muscles- ulnar and medial

sensory loss along medial border and hand and forearm and arm

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cartilage in lumbar disc

hyaline

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outer annulus fibrosis made of

collagen type I

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inner nucleus pulposus made of

type II collagen, PG molecules, water

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blood supply to lumbar vertebrae

avascular!

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function of nucleus pulposus

resist compressive loads through hydrostatic forces

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function of annulus pulposus

resist tensile/torsional loads

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if a disc degenerates, load can transfer to

zygapophyseal joints —> spondylolisthesis

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lumbar radiculopathy

pain that radiates down leg in specific dermatomal distribution

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red flags of radiculopathy —> urgent MRI

bowel or bladder dysfunction

fever chills

known malignancy/metastases

saddle anesthesia

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supine straight leg test for

L4-S1 radiculopathy

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seated straight leg test

modified supine straight leg

L4-S1

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contralateral straight leg test

raising asymptomatic causes pain in symptomatic leg

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lasegue test

hip flexed, knee flexion relieves leg symptoms

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femoral tension sign

prone, knee passively flexed with hip extended

L2-L4 radiculopathy

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timeline of disc herniation healing

improvement in 3 months for 90%

macrophage phagocytosis (3-6 mnths)

12 mnths most symptoms reside w conservative tx

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conservative tx of disc herniation

NSAID

PT

corticosteroid

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roof of carpal tunnel

transverse carpal ligament aka flexor retinaculum palmar side

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muscular effects of carpal tunnel

thenar muscles eventually waste away

muscle weakness —> fine motor tasks difficult

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carpal tunnel effect on palm

none, palmar branch upstream and does not enter carpal tunnel so palm unaffected r

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risk factors for carpal tunnel

repetitive stress

obesity

pregnancy

underlying conditions like RA

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phalens test

flex wrists and hold together for 1 min —> sx of carpal tunnel

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tinels sign

tapping transverse carpal ligaments —> sx of tingling, carpal tunnel sx

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durkans test

manually compress transverse carpal ligament for 30 seconds —> sx of carpal tunnel

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tx of carpal tunnel

behavior mod

PT

splinting

corticosteroids

surgical division of transverse carpal ligament

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opioid receptors 3 types

mu, kappa delta

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inhibitory neuron in opioid pathway

secrete neurotransmitters signaling other neuron to NOT secrete dopamine

when opioid binds to receptors, this is inhibited —> other neuron secretes dopamine

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theories of tolerance to opioids

less sensitive receptors

downregulation (fewer receptors available for binding)

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opioids effects

dec HR, BP, wakefulness, respiratory rate

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what drugs used to help wean off opioid

methadone (full ag) and buprenorphine (partial ag)- opioid agonists that avoid euphoria sensation

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spondylolysis

defect/break in pars interarticularis (aka pars defect)

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what typically causes spondylolysis

stress fx/overuse injury in children and adolescents

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spondylolisthesis

spondylolysis + anterior slippage of vertebra in relation to vertebra below

break in pars —> disruption of structural integrity of vertebra (grade 1-4)

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multipolar neurons have _____

2 or more dendrites, 1 axon

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bipolar neurons have _____

1 dendrite, 1 axon

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unipolar/pseudounipolar neurons have _____

1 process that splits into 2 “axons”

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anaxonic neurons have _____

many dendrites, no axon

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CNS supporting cells

astrocytes

oligodendrocytes

microglia

ependymal cells

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microglia

macrophages of CNS

engulf infectious/foreign substance

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astrocytes

support neurons (CNS)

BBB

structural support

replicates to occupy space of dying neurons

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ependymal cells

cover ventricles and central canal (CNS)

CSF pdn and circ

line ventricles of brain and central canal of spinal cord

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PNS supporting cells

satellite

schwann

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Satellite cells

PNS

electrical insulation of cell bodies

reg nutrient/waste for cell bodies in ganglia

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schwann cells

make myelin (PNS)

aka neurolemmocyte

wrap around axon —> faster propagation

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oligodendrocytes

make myelin for CNS axons —> faster propagation

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unmyelinated axons

smaller diameter —> slower prop

single wrap of schwann cell

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