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29 Cards in this Set
- Front
- Back
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Two categories of pain in SCI patients
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NOCICEPTIVE - bone, ligament, muscle, skin
NEUROPATHIC - peripheral or central neural tissue damage |
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Is nociceptive or neuropathic pain more common in SCI patients?
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NOCICEPTIVE
*Neuropathic pain is usually more SEVERE though |
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Which joint is most commonly affected by pain in SCI patients?
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SHOULDER
UE's are reported to have more pain in SCI patients in general (tetraplegia>paraplegia) |
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Therapy for NOCICEPTIVE pain in SCI patients should focus on strengthening which group of muscles and stretching what other group?
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STRETCH = anterior
STRENGTHEN = posterior |
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What are the age groups of SCI that most commonly experience NEUROPATHIC pain?
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Bimodal distribution for age at onset of injury:
1. 30-39 2. >50 yo |
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CTS in SCI who is more greatly affected tetraplegics or paraplegics?
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PARAplegics
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What is the most common cause of PROGRESSIVE MYELOPATHY after SCI?
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posttraumatic SYRINGOMYELIA
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Lesions in posttraumatic syringomyelia usually progress in what direction?
When do these lesions develop usually? |
CEPHALAD - upwards
- they can develop at any time following injury |
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What is the most common presenting symptom of posttraumatic syringomyelia?
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PAIN
- aching/burning, worse with coughing, sneezing, straining - worse with sitting>supine |
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What is the earliest clinical SIGN of posttraumatic syringomyelia?
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- Ascending loss of MSRs
- Ascending SENSORY loss also common (lesion starts in grey matter between dorsal columns & dorsal horns) *dissociated sensory loss (impaired P&T, light touch intact) *weakness rarely occurs in isolation |
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New Horner's syndrome in an SCI patient that is 15 years postinjury. What should be on your differential?
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SYRINGOMYELA
also look for... worsening resp drive, AD, loss of reflex bladder, change in spasticity, hyperhydrosis, diaphragmatic paralysis, CN dysfunction |
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What is the gold standard for detection of posttraumatic syringomyelia?
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MRI w/ GADOLINIUM contrast
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Activity restrictions for syringomyelia?
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- Avoid increases in abdominal/intrathoracic pressure (wt lifting, valsava, crede, quad coughing)
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When is surgery indicated for syringomyelia?
What are the surgical options? |
- progressive neurological decline
- severe intractable pain - shunting, reconstruction of arachnoid space, cordectomy |
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Prognosis for syringomyelia after SURGERY?
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Usually good PAIN control and improvement in STRENGTH
- sensory recovery is usually poor *Recurrence rate is 50%!!! |
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During muscle transfers in tetraplegic patients what grade of strength is considered functiona?
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4 or 5, but not 3
- muscle usually loses one strength grade after transfer |
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What two surgical interventions are available for SCI patients at a C5 level to aid with ADLs & mobility?
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1. BR to ECRB tendon tx = wrist flexion
2. deltoid to triceps tendon tx = elbow extension |
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What four surgical interventions are available for SCI patients at a C6 level to aid with ADLs & mobility?
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1. BR to FPL = lateral pinch/grasp
2. Moberg "key grip" procedure 3. deltoid to triceps = elbow extension 4. rerouting biceps around radial neck = correct supination contracture that may form |
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What two surgical interventions are available for SCI patients at a C7 level to aid with ADLs & mobility?
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1. BR to FPL = restore thumb flexion
2. ECRL/FCU to FDP = restore finger flexion |
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What interventions is available for SCI patients at a C8 level to aid with ADLs & mobility?
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Lumbrical bar to prevent hyperextension at MCPs that can cause "claw hand"
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What is in the incidence of TBI in those with SCI?
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as high as 59%!!!
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What is the suicide rate for those with SCI?
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5x the age-specific suicide rate in the U.S.
-leading cause of death in youngest age group SCI patients with incomplete injuries (highest 1-5 years post injury) |
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What is the second most common etiology for rehospitalization in chronic SCI?
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SKIN ISSUES
*first is pulmonary issues |
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List the most common locations for pressure ulcers in adults with SCI in the first 2 years post injury
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1. SACRUM
2. ISCHIUM 3. heels 4. trochanters *after two years trochanters are most common |
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Most common site of pressure ulcer in children with SCI up to age 13?
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OCCIPUT
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How high does pressure have to be to develop a pressure ulcer?
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Higher than supracapillary pressure (>70mmHg)
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Pressure relief/repositioning should be done how often when sitting?
How often should an SCI patient be turned when lying flat? |
every 20-30 minutes
every 2 hours |
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How do wound vacs help heal pressure ulcers?
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- increase blood flow to wound and adj tissues
- which means increased O2 & nutrient delivery - increased clearance of bacteria |
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If a pressure ulcer requires surgery what is the most common procedure?
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Musculocutaneous flap (followed by 3-4 wks strict bed rest)
*rotation flap *transposition flap *advancement flap |
