AAPC Med Term/Anatomy/PathoPhysio #9f4267

CHAPTER 1

• mes/o - middle

• tripsy - crushing

• myring/o - tympanic membrane

PLURAL ENDINGS

• a - ae

• en - ina

• ex - ices

• ix - ices

• yx - ices

• is - es

• ma - mata

• nx - nges

• anx - nges

• inx - nges

• ynx - nges

• on - a

• um - a

• us - i

VOCAB

• integument - outer covering

• skeletal - bones

• interstitial spaces - potential spaces between tissues)

• alimentary tract - the continuous structure of the digestive system from mouth to anus

• introitus - external opening of the vagina

• CNS - central nervous system

• PNS - peripheral nervous system

• anteroposterior - from front-to-back

• adipose - fat tissues

• osseous - bone tissues

• epithelial tissue - a type of body tissue that forms the covering on all internal and external surfaces of your body, lines body cavities and hollow organs and is the major tissue in glands

• chromosome - linear strand made of DNA carrying genetic information

• cytology - the study of cells including formation, structure and function of cells

• RNA (ribonucleic acid) - transcribed from DNA by enzymes to play a crucial role in protein synthesis

• gene - specific segment of base pairs in chromosomes, functional unit of heredity

• mitosis - cells divided and multiply to form two cells

• dorsal cavity - comprised of the cranial and spinal cavities

• cranial cavity - space inside the skull, containing the brain

• spinal cavity - space inside the spinal column, containing the spinal cord

• ventral cavity - comprised of the thoracic, abdominal, and pelvic cavities

• thoracic cavity - space inside the chest, containing the heart, lung, esophagus, trachea, bronchi and thymus

• abdominal cavity - space containing lower portion of esophagus, the stomach, intestines, kidney, liver, gallbladder, pancreas, spleen and ureters

• pelvic cavity - space containing the urinary bladder, certain reproductive organs, part of the large intestines, and the rectum

• mucous membranes - line the interior walls of organs and tubes opening to the outside of the body (like digestive, respiratory, etc.), involved in absorption and secretion.

• serous membranes - line cavities including the thoracic, consisting of a layer of simple squamous epithelium overlaying connective tissue

• synovial membranes - line joint cavities and composed of connective tissue, secret synovial fluid into join cavity to lubricate the ends of bones so they can move freely

• meninges - comprised of three connective tissue membranes found within the dorsal cavity and serve as a protective covering of the brain and spinal cord

• cutaneous membrane - forms the outer covering of the body and consists of thin outer layer of stratified squamous epithelium attached to a thicker underlying layer of connective tissue

• etiology - the cause, set of causes, or manner of causation of a disease or condition.

• pathogenesis - the mechanisms by which it develops, progresses, and either persists or is resolved

• disease - any adverse change from an organism’s normal, structural, functional, or social condition that is accompanied by specific signs and symptoms and changes in function; four main disease types

• infectious disease - disorders caused by organisms such as bacteria, viruses, fungi or parasites

• deficiency disease - resulting from a dietary deficiency of minerals, vitamins, essential nutrients

• genetic disease - when a change to a gene (pathogenic variant) affects your genes or when you have the wrong amount of genetic material

• physiological disease - when the body malfunctions and causes illness, such as diabetes, glaucoma, or asthma

• communicable disease - classification meaning spreads from person to person through contact with blood, bodily fluid, airborne viruses or insect bite

• non-communicable disease - classification meaning noninfectious health condition that cannot be spread from person-to-person

• curative treatment - to cure a patient of a disease or illness

• palliative treatment - to alleviate symptoms of a disease or illness

• preventive treatment - to avoid or mitigate the onset or development of a disease or illness

• e/m - evaluation and management

  
  

CHAPTER 2

• epidermis is made up of 5 layers called strata and is replaced every 35-45 days

  • stratum corneum (squamous cells / outermost layer)

  • stratum basale (basal cells / deepest layer on top of dermis)

  • stratum lucidum (protective surface layer the forms in places of heavy use like palms and soles)

  • stratum granulosum (contains karatohyalin granuls to secrete protein for keratin and lamellated granules to secrete lipids to hold cells together)

  • statum spinosum (composed of prickle cells that are interwoven for protection)

  • melanocytes (found at the base of the epidermis making melanin for skin pigment)
    

• sweat glands - whenever there is an emotional stimuli (versus a temperature stimuli) such as anxiety or fear, the apocrine glands respond, potentially causing noticeable sweating on the palms, armpits and soles of feet

• sebaceous glands - increased sebum production, as a result of increased level of sex hormones in adolescence, collects in the glands and causes the ducts to enlarge forming pimples

• rule of nines - technique used to establish the dimensions of burn injury where the body is divided into 11 areas of 9% each and genital area representing the last 1%

• ulcers -

  • stage 1 - reddened area that has not broken through the skin

  • stage 2 - have an opening in the top two layers of skin

  • stage 3 - open down through the epidermis, dermis and enter into the fatty tissue

  • stage 4 - deep wounds that may include muscle, tendons, ligaments and bone

• biopsies -

  • needle biopsy (percutaneous tissue biopsy) - a needle inserted through the skin to collect cells (if fluid is removed, it is an aspiration biopsy)

  • shave biopsy - a razor is used to scrape cells from surface of skin

  • punch biopsy - a circular instrument is used to remove a small section of the skin’s deeper level

  • incisional biopsy - a scalpel is used to excise a small portion of the lesion or tumor under study, potentially needing sutures post-procedure

  • excisional biopsy - an entire lump or lesion under study is removed, requiring either simple or layered closure

• sutures -

  • single layered - usually includes only non-dissolving suture in epidermis

  • layered - includes placing on layer of dissolvable sutures buried in the dermis or deeper tissue layers followed by either suture type under minimal tension to neatly oppose the epidermis

  • high tension or fragile wounds may require special suture techniques to spread tension
    

VOCABULARY

• acrochordons - skin tags

• lanugo - fine, soft hair of a newborn which develops around 30th week of pregnancy

• papillary - of or relating to being or resembling a papilla or nipple-shaped projection, mass or structure

• arrector pili - muscles connected to the papillary layer of dermis whose contractions cause goosebumps

• folliculitis - infection of the hair follicle typically caused by bacteria, virus or fungi, causing swelling from enzyme release found on the scalp and extremities

• lunula (little moon) - the part of the nail body closest to the root, at the cuticle

• lamellar corpuscle - skin receptor which detects pressure dep in the dermis

• superficial tactile corpuscle - skin receptor which detects light touch

• eccrine glands - smallest sweat glands which secrete directly onto surface of skin, releasing water and electrolytes

• apocrine glands - largest sweat glands located in the regions with hairy skin, such as armpits and the genital, anal and breast areas, producing oily substances including steroids, proteins and lipids through hair canals

• apoecctine gland - sweat gland developed during puberty which secretes watery fluids, found in the armpits and perianal region

• sebaceous glands - glands that secrete a lipid-rich sebum which lubricates both the hair and skin, found in the ducts of follicles to protect hair

• comedones - skin-colored, small bumps (papules) frequently found on the forehead and chin of those with acne (blackheads are open comedones that have darkened with air exposure)

• circular body - largest and most prominent part of the breast

• axillary tail - smaller part, runs along the inferior lateral edge of the pectoralis major towards the axillar fossa

• eczema - dermatitis causing red, scaly, oozing or crusty skin that may get dark, leathery or swollen

• psoriasis - dermatitis causing red, raised, silvery or scaly patches with thick and inflamed skin

• contact dermatitis - common allergic reaction to irritants causing itchy rash (pruritus), erythema and swelling where skin meets allergen

• irritant contact dermatitis - common dermatitis when non-allergic substance makes contact with skin

• atopic dermatitis - chronic dermatitis common in children and/or associated with asthma and hay fever which causes red, itchy skin

• stasis dermatitis - thickened discolored skin with inflammation appearing on the lower legs with swelling, relating poor circulation (venous statis rash)

• seborrheic dermatitis - scaly patches that commonly affect the scalp, causing red skin and stubborn dandruff

• papulosquamous disorders - skin lesions consisting of red or purple papules or plaques with scale

• papules - small well-defined bumps in the skin

• furuncles (abscesses, boils) - collection of pus under the skin from an infected hair follicle, typically caused by a staphylococcal infection, appearing reddish-purple, swollen and painful (when connected together referred to as carbuncles)

• scale - thin pieces of the outermost layer of skin resembling fish scales, symptomatic of a variety of conditions

• plaque - solid, elevated, superficial lesions, which are usually more than 1cm in diameter present in numerous skin disorders (most commonly psoriasis)

• erythema - congestion in the small capillaries of the skin which shows up as redness

• pityriasis rosea - circular patch on the skin which is itchy and red, following headache, sore throat or bouts of fatigue

• lichen planus - benign disabling inflammatory disorder affecting the mucous membranes and skin, causing swelling, hyperpigmentation and pruritus lasting months to years

• acne vulgaris - clogged hair follicles and oil glands on the face and upper trunk of adolescents

• acne rosacea - a chronic inflammation of the skin that appears on the forehead, nose, cheeks and chin of middle-aged adults, commonly women

• venous stasis ulcers - develop in the skin of the lower leg (typically ankle) as a result of poor venous circulation

• neuropathic skin ulcers - a common complication of uncontrolled diabetes mellitus, which causes nerve damage

• primary skin lesion - an abormal skin disorder which may be present at birth or may develop over a lifetime

• secondary skin lesion - progression of a primary skin lesion caused by irritation or manipulation

• fibroadenoma - a fibrous, benign growth found in breast tissue, usually painless and not attached to other structures in the breast (surgically removed)

• cyst - fluid filled sac, painful but not harmful (aspirated by needle through excision procedure)

• breast abscess - caused by infection creating collection of pus (cured with antibiotics or I/D)

• fibrocystic breast disease - very common condition associated with breast changes giving it a lumpy, irregular texture causing potential pain in the upper part of the breast usually characterized by an increase in fibrous and glandular tissues

• breast tumors or masses - pre-cancerous or cancerous white area found on a mammogram that may coincide with symptoms such as swelling, tenderness, discharge from the nipple, indentation of the nipple or skin dimpling over the tumor’s location

• skin flap - a portion of tissue which is harvested from a donor sit with its blood supply intact and suture onto the open recipient site

• skin graft - a free piece of tissue without its own blood supply, which relies on the nutrients from the wound bed for survival and success

• Mohs Micrographic Surgery - a procedure used to treat skin cancer that involves cutting away thin layers of skin, looking at the layers closely for signs of cancer while the process keeps going until there are no signs of cancer in the layers

• modified radical mastectomy - all of the breast tissue and the adjacent lymph nodes from the armpit are removed

• radical mastectomy - all of the breast tissue, underarm lymph nodes and chest muscle that lies underneath the affected breast are removed

• skin-sparing mastectomy - the dissection preserves the skin of the breast but not the nipple and areola

• nipple-sparing mastectomy - technique used to resection the breast tissue around the nipple and areola allowing for preservation

• actinic keratosis - precancerous condition caused by sun exposure

• bulla - raised, fluid-filled lesion larger than a vesicle

• eschar - black or brown necrotic tissue that results from a burn

• granulation tissue - pink/red moist appearance on a healing wound caused by healing

• impetigo - bacterial infection which causes eruption of yellow or red weeping or crusting pustular lesions

• lupus erythematosus (SLE) - chronic, progressive disease affecting connective tissue and other organs such as lung, kidney and heart

• non-granulating - absence of granulation tissue; wound surface appears smooth and red as opposed to granular

• pediculosis - infestation with lice

• pruritus - severe itching

• scabies - contagious skin infection caused by an itch mite

• scleroderma - thickening and tightening of the skin

• trichomycosis -fungal infection of the hair

• ulcer - lesion from destruction of skin and perhaps subcutaneous tissue

• vesicle - fluid-filled raised lesion less than 5 mm in size, a blister

• wheal - smooth, rounded, slightly raised area often associated with itching, seen in urticaria or resulting from allergy

• debridement - treatment for a wound in the skin

• autologous - obtained from the patient as both the donor and recipient

• avascular - not having a blood supply, nonviable, devitalized, necrotic

• dehisced/dehiscence - separate or fall apart from the main structure along natural or sutured lines

• epithelization - regeneration of epidermis across a wound surface

• intradermal - pertaining to within the skin

• macule - colored, flat spot less than 1cm in diameter (larger is called a patch)

• nodule - solid, raised lesion larger than a papule, often indicative of systemic disease

• papule - firm, circular raised surface lesion less than 1cm in size (like a pimple)

• percutaneous - a procedure performed through the skin, such as absorption or needle puncture

• slough - soft, most avascular tissue

• subcutaneous - pertaining to below the skin

• transcutaneous - penetrating, entering or passing through the skin

• undermining - area of tissue destruction that extends beneath the undamaged skin along the periphery of a wound, seen in shear injuries

• tendons

CHAPTER 3

MUSCULAR

• tendon → muscle to bone

• ligament → bone to bone

• ligament → band bones together

• striated / skeletal muscle - attached to the skeleton by tendons, contraction under voluntary control

• cardiac muscle - interlocking involuntary striated muscle which allows the electrical impulses to pass quickly across muscle fibers

• smooth muscle - found in the walls of the hollow organs of the body (except the heart), contraction reduces the size of these structures, not under voluntary control

• bicep - primary function to flex the elbow and rotate the forearm

• deltoid - flexes the arm away from the body (abduction)

• gastrocnemius - two headed muscle in the back of the lower leg, flexing the knee and helping flex the foot (plantar flexion)

• hamstring - help flex the knee and extend the hip (extension) (semimembranosus, semitendinosus and biceps femoris)

• pectoral - two muscles (pectoralis major and pectoralis minor) that help with moving the arm toward the body (adduction) and rotating the arm inward

• quadricep - group of four muscles that cover the front and sides of the thigh, whose main job is to keep the knee stable and help straighten it

• triceps - large three-headed muscle on the back of the arm helping extend the elbow joint and keeps the humerus secured to the glenohumeral joint

• extensor - tendon which allows the joint to open or straighten out

• flexor - tendons that allow a joint to close or contract, also present in the hips

• sprain - an injury to a ligament, ranging in grades from overstretched to complete tear

• ligament - elastic fibers that keep joint from moving too far L/R or front/back

• femur-to-tibia ligaments - anterior curciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL)

SKELETAL

• -clasis - surgical break or fracture

• -lysis - to free up, loosen

• -orraphy - surgical suture
  

• appendicular skeleton - shoulder bones, arms, pelvic bones, legs (126 bones)

• axial skeleton - skull, hyoid, rib cage, sternum, vertebrae (spine) and sacrum (80 bones)

• skull - the housing for the brain made up of 8 bones, a closed system except for the Foramen of Magnum (the spinal cord exit)

• valgus - angulation (or bowing) within the shaft of a bone or joint in the coronal plane pointing outward/lateral

• varus - angulation (or bowing) within the shaft of a bone or joint pointing inward/medial

• volar - relating to the palm of the hand or sole of the foot

Axial Skeleton

• 8 Bones of the Skull →

  • 1 Frontal bone

  • 1 Occipital bone

  • 1 Ethmoid

  • 1 Sphenoid

  • 2 Parietal

  • 2 Temporal

• Facial Bones →

  • maxilla

  • 2 zygomatic

    • mandible

    • nasal

    • palatine

  • inferior nasal conch (2)

  • lacrimal (2)

  • 1 vomer (1)

• Cranial bones of the auditory system

  • 2 incudes

  • 2 mallei

  • 2 stapes

• Hyoid Bone (under the chin)

• Bones of the thorax

• 24 ribs

• 1 sternum

• Spinal column

  • 7 cervical

  • 12 thoracic

  • 5 lumbar

  • sacrum

Appendicular Skeleton

• Shoulder girdle

• 2 clavicles

• 2 scapulae

• Pelvic girdle

• 2 hip bones

• Upper extremities

  • 2 humeri

  • 2 radii

  • 2 ulnae

  • 16 carpals

  • 10 metacarpas

  • 28 phalanges

• Lower extremities

  • 2 femurs

  • 2 tibiae

  • 2 fibulae

  • 2 patellae

  • 14 tarsals

  • 10 metatarsals

  • 28 phalanges

Fracture Types

• Common Fractures

  • closed facture - does not involve a break in the skin

  • Colles’ fracture - occurs in wrist and affects the distal radius bone

  • comminuted fracture - more than two separate bone components (fragments)
    compound fracture - projects through the skin with a possibility of infection

  • compression fracture - vertebrae collapse due to trauma, tumor or osteoporosis

  • epiphyseal fracture - occurs when matrix is calcifying, and chondrocytes are dying; usually seen in children

  • greenstick fracture - only one side of shaft is broken and other is bent, common in children

• Transverse Fractures (breaks a shaft of a bone across the longitudinal axis)

  • spiral fracture - spread along length of bone and produced by twisting stress

  • Le Fort I fractures (horizontal) - extends from nasal septum to lateral pyriform rums, horizontally above the teeth apices, ultimately interrupting the pterygoid plates

  • Le Fort II fractures (pyramidal) - extends from the nasal bridge at or below the nasofrontal suture through the frontal processes of the maxilla ultimately crossing the pterygomaxillary fissure and through the pterygoid plate

  • Le Fort III fractures (transverse) - a total craniofacial separation; starting at the nasofrontal and frontomaxillary sutures and extends posteriorly until the lower face is essentially no longer attached to the skull

• Physeal/Salter-Harris fractures - occur through a growth plate (physis); specific to children

  • Type I - fracture line extends within the growth plate or through physis

  • Type II - through both the metaphysis and growth plate (most common)

  • Type III - fracture in the joint extending through the growth plate and epiphysis (rare)

  • Type IV - extends through the growth plate, the epiphysis and the metaphysis

  • Type V - result of a crushing or compression injury

Cartilage and Joints

• cartilage - nonvascular connective tissue softer than a bone, cushioning between bony surfaces

• chondritis - inflammation of the cartilage

• costochondritis - inflammation of the rib cartilage

• chondromalacia - condition where cartilage becomes soft (often seen in the patella)

• Joint Types

  • fibrous - held together by dense connective tissue, immovable (skull, teeth)

  • cartilaginous - held together by cartilage, slightly moveable (ribs, vertebrae)

  • synovial - bones enclosed within a capsule lined with synovial fluid, free- moving (most common joint type, 6 subtypes)

    • ball-and-socket (shoulder, hip)

    • hinge (knee, elbow)

    • pivot (neck)

    • plane/gliding (ankle)

    • condyloid/ellipsoidal (wrist)

    • saddle (thumb)

The Spine

• 24 discs made of fibrocartilaginous material

• annulus fibrosus - outer rim of the disc, made of a strong material surrounding a jelly-like mucoprotein gel which absorbs impact of spinal pressure called the nucleus pulposus

• facet joint - synovial-lined joints that connect to the articular facets of the vertebrae above and below to allow some motion to the spine

Common Diagnostic Testing

• arthrogram - imaging inside a joint using contrast dyes (x-ray, CT or MRI)

• CT / CAT scan - imaging to diagnose problems with bones or muscles

• DEXA scan (Dual-energy X-ray absorptiometry) - measures density and mass of structures in the body (bone mass)

• electromyography (EMG) - measures electrical activity of a muscle

• FABER test - positive sign identifies sacroiliac dysfunction (FABER = flexion, abduction, external, rotation)

• fluoroscopy - a type of imaging that uses continuous x-ray images to look at a body part or system

• Finkelstein test - positive sign identifies de Quervain’s tenosynovitis as the cause of wrist pain

• Homan’s sign test - positive sign indicated possible deep vein thrombosis (DVT), also called dorsiflexion test

• MRI - uses radio waves and magnetic fields to capture soft tissue or joint damage

• Thompson test- tests for Achilles tendon rupture, by squeezing the calf and checking for involuntary flexion of the foot

• Tinel’s sign - positive sign indicated carpal tunnel syndrome, performed by tapping over the carpal tunnel at the wrist

• ultrasound - uses soundwaves to image soft tissue

• X-ray - imaging using electromagnetic waves to diagnose problems

Common Procedures

• arthrocentesis - fluid is aspirated from an affected joint using a needle and examined under the microscope (good for RA treatment, and detecting synovial inflammation and other arthritis causes)

• arthroscopy - surgical technique where a small scope is used to examine the inside of a joint

• kyphoplasty - minimally invasive surgery to treat spinal compression fracture by inserting a balloon to create a cavity and using bone cement to reinforce the vertebra at the compression site

• fasciotomy - cutting into the fascia to release, not remove, to relieve fasciitis

• TKR / TKA (total knee replacement/arthroplasty) - all of the joint, including bone, cartilage and osteophytes are removed and replaced with artificial components

• PKR / UKA (partial knee replacement / unicompartmental knee arthroplasty) - the healthy bone is left in place and the diseased parts are removed and replaced

• THR (total hip replacement) - replacement of the hip joint commonly approached from the posterior aspect of the upper thigh/buttock

• BTHR/BTKR (bilateral total hip/knee replacement) - replacement procedure done on both left and right side in the same operation/same day

• trigger finger release - tendolysis at A1 pulley to allow more movement of flexor tendon through tendon sheath

• trigger point injection - injections into a muscle trigger point (muscle knot) with a small amount of anesthetic and/or steroid may relieve pain

• vertebroplasty - minimally invasive surgery to treat spinal compression fracture

Additional Musculoskeletal Vocab

• A1 pulley - band of tissue holding flexor tendon closely to finger bones, near palm

• arthrodesis - surgical fixation of a joint

• calcaneus - the large bone of the heel

• carpal - pertaining to wrist bones

• concentric reduction - putting dislocated joint back to it’s normal position, allowing the joint to move freely

• chondral - pertaining to cartilage

• coccygeal - pertaining to the coccyx

• crystalloid (solution) - used to increase intravascular volume caused by loss of fluid during surgery

• dactylic - pertaining to finger or toe

• hallux - big toe

• hallux rigidus - refers to stiff big toe, usually due to OA and bone spurs of the MTP joint

• hallux valgus - progressive deformity of the metatarsophalangeal (MTP) joint (most common foot deformity, bunion)

• hammer toe - deformity of the toe commonly caused by arthritis or ill-fitting shoes causing the toe or toes to curl downward instead of lying flat

• metacarpal - long bones making up the palm

• metatarsal - five bones extending from tarsus to phalanges (between the ankle and toe)

• osteoblast - cells that form bone tissue

• sternotomy - incision of the sternum

• tuberosity - large prominence of bone for attachment of muscles or ligaments

Common Tendon Abbreviations

• FDP - flexor digitorum profundus

• ECU - extensor carpi ulnaris

• FPL - flexor pollicis longus

• EIP - extensor indicis proprius

• EPL - extensor pollicis longus

• EHL - extensor hallucis longus

• APL - abductor pollicis longus

• AT - Achilles tendon

• ECRB - extensor carpi radialis brevis

• FDL - flexor digitorum longus

• ECRL - extensor carpi radialis longus

• FHL - flexor hallucis longus

• PTB - patellar tendon bearing

• EDM - extensor digit minimi

• PT - patellar tendon

CHAPTER 4

Nervous System

• CNS (Central Nervous System) - brain and spinal cord, command center

• PNS (Peripheral Nervous System) - cranial and spinal nerves, communication lines linking all parts of the body to the CNS

• gangli/o - ganglion

• ganglion/o - ganglion

• gli/o - neuroglia

• -lalia - babble or speech

• -lepsy - seizure

• -lexia - reading

• -mania - obsessive or excited state

• medull/o - medulla oblongata, spinal cord

• mening/o - meninges

• meninge/o - meninges

• myel/o - spinal cord

• narc/o - unconsciousness or stupor

• neur/o (neur/i) - nervous system, tissues, nerves

• -paresis - weakness

• -phasia - speech

• -phobia - irrational and persistent fear

• -plegia - paralysis

• -psych/o - mind

• radicul/o - spinal nerve root

• somn/o - sleep

• thalam/o - thalamus

• ventricul/o - ventricle, cavity

• ataxia - loss of muscular coordination

• axon - fiber in the neuron that carries impulses away from the body of a cell

• cephalgia / cephalalgia - headache

• cerebrospinal - pertaining to the brain and spinal cord

• craniotomy - surgical opening in the skull

• dendrite - a fiber in the neuron that carries impulses toward the body of a cell resembling tree branches

• discectomy - surgical excision (removal) of an intervertebral disc

• dysphasia - impairment of speech

• encephalomalacia - softening of the brain due to ischemia or infarction

• epidural - pertaining to above or outside the dura mater

• gray matter - axons that are not covered in myelin

• hemiparesis - weakness on one side of the body

• intrathecal administration - injection into the spinal canal or subarachnoid space

• laminectomy - excision of the vertebral posterior arch or spinal process

• myelin - a substance that covers some axons to insulate, protect and assist in electrical conduction

• myelitis - inflammation of the spinal cord

• neurolysis - destruction of nerve tissue or lysis (breaking up) perineural adhesions

• neuron - basic functional unit of the nervous system

• neurorrhaphy - repair of severed nerve by suture, graft, or synthetic conduit

• neurosis - emotional condition or disorder; anxiety is a primary characteristic

• neurotransmitters - a chemical that transmits energy across a snyapse

• paranoia - mental disorder often including delusions of persecution

• poliomyelitis -inflammation of the gray matter of the spinal cord

• psychosis - an abnormal condition of the mind, gross disorganization or distortion of mental capacity

• radiculitis - inflammation of the spinal nerve roots

• vagotomy - surgical incision of the vagus nerve

• white matter - axons that are covered in myelin

Peripheral Nervous System

• two subcategories

  • somatic nervous system - responsible for voluntary bodily movements

  • autonomic nervous system - responsible for involuntary responses (heart beating, intestines squeezing /fight or flight)

• most nerves in the PNS are myelinated (the axon is coated with a myelin sheath, a layer of fatty cells for insultation)

• myelin sheath damage causes jerky, irregular movements (like in MS) due to unwanted response from nearby neurons receiving impulses through damaged sheath

• nerve plexus - a network of intersecting nerves that combine spinal nerves serving the same area

  • cervical plexus - serves the head, neck and shoulders

  • brachial plexus - serves the chest, shoulders, arms and hands

  • lumbar plexus - serves back, abdomen, groin, thighs, knees and calves

  • sacral plexus - serves the pelvis, buttocks, genitals, thighs, calves and feet

  • solar plexus (celiac plexus) - serves internal organs

• major nerves of the PNS

  • femoral nerve - sensory and motor nerve supplying the front of the thigh and lower leg

  • common fibular nerve (common peroneal) - sensory and motor nerve supplying the knee, and superior tibiofibular joints and tibialis anterior muscle, divides into superficial and deep fibular nerves, a branch of sciatic nerve supplying movement and sensation for the lower leg, foot and toes

  • intercostal nerves - upper thoracic nerves primarily in chest and upper abdomen, only nerves not generating from plexus

  • median nerve - innervates most flexor muscles of the forearm, provides sensation for the thumb, index, middle and portion of the ring finger (only nerve passing through the carpal tunnel)

  • musculocutaneous nerve - sensor and motor nerve of the coracobrachialis, biceps brachii and greater part of the brachialis, arising from brachial plexus

  • radial nerve - innervates the triceps branchii and all 12 muscles in posterior osteofascial compartment of forearm

  • saphenous nerve - sensory nerve of knee joint, subsartorial and patellar plexus and the skin on medial side of leg and foot

  • sciatic nerve - largest nerve of the body, derived from spinal nerves L4 to S3, runs through buttock and down lower limb, divides just above the knee into tibial and common fibular nerves to supply skin of the leg and muscles of the back of the thigh

  • subcostal nerves - sensor and motor nerves of the skin of lower abdomen and later side of gluteal region, and parts of abdominal transverse, oblique and rectus muscle

  • tibial nerve - sensory and motor nerve supplying muscles and skin of knee, calf, sole of foot and toes

  • ulnar nerve - provides sensation for the little finger and potion of the ring finger and innervates some muscles of the hand and forearm

Brain Lobes

• brain is divided into distinct regions

  • cerebrum

    • located in the supratentorial region

    • contains:

      • frontal lobe (front part of brain)

        • thinking, planning

        • personality

        • problem solving

        • behavior control

        • decision making

      • temporal lobe (one on either side of brain)

        • hearing

        • language

        • memory (left: verbal memory, right: visual memory)

      • parietal (bilateral behind frontal lobe, above temporal lobe)

        • control sensation

          perception

        • object classification

        • spelling

        • knowledge of numbers

        • spatial perception

      • occipital lobes (back of the brain)

        • vision

        • color blindness

  • cerebellum

    • located in the infratentorial region, bottom of the brain below occipital lobe

    • controls:

      • muscle coordination

      • balance

  • brainstem

    • the low extension of the brain where it connects to the spinal cord where most cranial nerves come from

    • controls:

      • necessary neurological survival functions

        • breathing

        • digestion

        • heart rate

        • blood pressure

      • contains pons and medulla

    • ventricles

      • structures containing cerebrospinal fluid (CSF) bathing and cushioning the brain and spinal cord

Spinal Cord and Spine

• spinal cord

  • a bundle of nerves that extends from the base of the brain (medulla oblongata) downward to the space between the first and second lumbar vertebrae (conus medullaris)

  • lies within the vertebral column, protection

  • cauda equina

    • collection of nerves at the end of the spinal cord

      • consists of:

        • 2nd - 5th lumbar nerves

        • the 5 sacral nerves

        • the coccygeal nerve

    • the spinal cord has three main functions

      • serve as a conduit for motor information traveling down to the muscles

      • serve as a conduit for sensory information traveling up to the brain

      • serve as a center of coordinating reflexes

    • grouped into regions:

      • 7 cervical segments (8 pairs of cervical nerves)

      • 12 thoracic segments (12 pairs of thoracic nerves)

      • 5 lumbar segments (5 pairs of lumbar nerves)

      • 5 sacral segments (5 pairs of sacral nerves, sometimes considered one segment)

      • 3-5 coccygeal vertebral segments fused to form coccyx (1 pair of coccygeal nerves)

  • laminectomy - complete excision of laminae in addition to entire posterior portion of the vertebra (spinous process)

  • laminotomy - partial excision of one or more lamina

Common Conditions

• Amyotrophic Lateral Sclerosis (ALS)

  • characterized by progressive degeneration of motor nerve cells which cause the loss of muscle control from the brain and eventually atrophy

  • affecting muscles needed to move, speak, eat and breathe

  • early symptoms include difficulty walking, standing, climbing stairs, frequent falling and fine hand motion impairment

• Cerebrovascular Accident (Stroke)

  • 5th leading cause of death in the US

  • caused by the brain being deprived of oxygen due to interruption or reductio in blood supply to the brain

  • 87% of strokes are ischemic caused by an abrupt blockage of arteries the supply oxygenated blood to brain

  • other strokes are hemorrhagic strokes caused by bleeding into the brain, the increase pressure on the brain tissue further damages the cells

  • transient ischemic attack (TIA) - mini-stroke with symptoms lasting a few minutes to 24 hours with no permanent damage, usually precedes a more serious stroke within 1 year

• Epilepsy

  • abnormal electrical activity within the brain causing seizures

• Parkinson’s Disease (PD)

  • chronic neurodegenerative disorder that gradually strips away motor abilities, leaving people with slow and awkward gait, rigid limbs, trembling of the extremities and head while at rest and a lack of balance, most common movement disorder

  • cause remains unknown, potentially due to complex interaction between genetic and environmental factors. most cases arise spontaneously, some hereditary

  • cells in the substantia nigra stop working and die off, causing dopamine levels to reduce which is need for control and coordination of muscles

• Anxiety

• Depression

• Schizophrenia

• Substance Use Disorder (SUD)

Common Procedures

• Skull, Meninges and Brain

  • two additional cranial fontanel in infant skulls

    • posterior (between occipital and parietal bones)

    • anterior (between front and two parietal bones)

• Craniectomy or Craniotomy

  • craniotomy - any bony opening cut into the skull, removing (and subsequently replacing) a bone flap to access the brain

  • craniectomy - craniotomy where the bone flap is not intended to be replace after removal

  • labeled by the part of skull that is opened (if more than one part is opened they will be named)

  • a series of small holes (burr holes) are made into the skull and then it is cut between each burr hole until the bone flap is separated from the surrounding skull

• Transsphenoidal Hypophysectomy

  • operation performed through the nose to remove pituitary tumors

• Vagus Nerve Stimulator (VNS)

  • used to reduce seizure frequency in patients who are not candidates for lobectomies

• Cerebrospinal Fluid (CSF) Shunt

  • placement of an extracranial shunt, or tube, to divert extra CSF from the ventricles of the brain to another body area (typically the abdominal cavity)

• Neurostimulators (Brain)

  • pulse generator system surgically implanted where pre-programmed intermittent pulses are delivered to nerve(s) or brain structure(s) to treat conditions not responding to medication (pacemaker-like)

  • Deep Brain Stimulation (DBS) - high frequency electrical stimulation of anatomy regions deep within brain using neurosurgically-implanted electrodes, unilaterally or bilaterally

    • three targerts of DBS:

      • thalamic ventralis intermedius nucleus (VIM)

      • subthalamic nucleus (STN)

      • globus pallidus interna (GPi)

• Routine Electroencephalography (EEG)

  • a test to measure electrical activity in your brain, recording any abnormalities in the brain waves, used to diagnose brain disorders (epilepsy, sleeping disorders)

  • 20-40 minutes of recording (extended EEG codes are designated to include reporting times longer than 40 min.)

  • Specific EEG codes:

    • Both an awake and asleep study were done

    • Only awake study planned but patient fell asleep

    • Based on the person who performed the EEG

    • Whether with or without video / type of monitoring and maintenance performed

    • Some codes have a time requirement

    • Most EEGs run on digital machines but using a digital recorder alone does not support reporting a digital analysis code (digital analysis describe by CPT requires analysis using quantitative analytical techniques such as data selection, quantitative software processing, and dipole source analysis)

• Injection, Drainage, or Aspiration

  • epidural lysis of spinal adhesions

    • a needle is inserted near pt’s coccyx and a catheter is thread through to inject medication into adhesions and may remain in place for several days after procedure for continued treatment

  • percutaneous aspiration

    • a needle is used to remove contents of a cyst or syrinx using a C-arm to verify placement (used to treat intraspinal abscess, syringomyelia, disorders of the meninges)

    • syrinx - fistula or diseased area

    • fistula - abnormal connection between two body parts usually as a result of injury or surgery

    • syring/o - a tube or long cavity, a fistula

  • injections of neurolytic solutions

    • (alcohol, phenol, iced saline solution)

    • given to destroy nerve tissues or adhesions

  • injections of non-neurolytic solutions

    • (anesthetic, antispasmodic, opioid, steroid)

    • used to control pain and/or muscle spasms

  • Laminotomy and Laminectomy

    • surgical procedure performed to relieve back pain cause by pressure on the spinal cord or spinal nerves by removing portions of vertebra

    • laminotomy - removal of a small piece of vertebra through a hole in the lamina

    • laminectomy - more involved procedure removing most of the bone

      • grouped according to spinal region (cervical, thoracic, lumbar)

  • Neurostimulators (Spinal)

    • low voltage electrical stimulation to the dorsal columns of the spinal cord to block the sensation of chronic back pain

    • electrodes are implanted along the spine and connected to a programmable pulse generator or receiver

  • Shunt, Spinal CSF

    • a shunt inserted through the dura into the subarachnoid space and passed to the peritoneal, pleural or other space for drainage of excessive accumulation of CSF (hydrocephalus)