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Musculoskeletal PT 2 > Cervical Radiculopathy Myelopathy > Flashcards

Cervical Radiculopathy Myelopathy Flashcards

1
Q

Spinal

Motion theory: Flexion

A
  • facets slide anterior/forward
  • superior vertebrae anterior tilts, translates forward
  • forward translation at the uncovertebral joints
  • IV foramen enlarge
  • spinal canal narrows but lengthens
  • little change in overall volume
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2
Q

Spinal motion theory

Extension

A
  • facets, uncovertebral joints slide down and backward
  • superior vertebrae tils, translates backward
  • vertebrae can step on one another
  • ligaments slackened
  • ligamentum flava bulges into the canal
  • IV foramen narrows
  • spinal canal shortens and narrows
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3
Q

Spinal motion theory

SB and rotation

A
  • SB and rotation occur to the same side
  • facets on SB slide down and backward bend
  • facets on oppsite side slide up and forward
  • upslide to downslide 2:1 ratio
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4
Q

Cervical IV disc

A
  • HNP disc does occur but less common in C/S than L/S
  • PLL is thicker and broader invested in disc
  • nucleus is less distinct and more fibrotic in nature
  • as age tends to fragments
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5
Q

Pathological degenerative process

DDD-aging

A
  • loss of GAGs, dehydration, nucleus fragmentation
  • intra-discal pressure falls
  • loss of disc height
  • ligamentous laxity
  • annular radial bulging
  • osteophytes form on vertebral bodies
  • narrowed IV foramen, spinal canal
  • may result in neurological S&S
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6
Q

DJD

A
  • DDD=> DJD
  • over 50
  • narrowing of IV foramen, spinal canal
  • 1º due to C/S spondylosis (stenosis)
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7
Q

C/S spondylosis

what is it and what happens

A
  • stenosis
  • increased forces. on osseous structures => DJD
  • Facet joint arthropathy, osteophytes
  • Uncovertebral joint osteophytes.
  • Vertebral body osteophytes (lipping)
  • Ligamentum flavum hypertrophy
  • Decreased size of spinal canal & IV foramen
  • Neurological S & S
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8
Q

Lateral foramenal stenosis

causes

A
  • DDD – nucleus fragmentation, loss of disc height, radial disc bulging
  • DJD – Osteophytes on facets, uncovertebral jts
  • Narrowing of IV foramen
  • May result in hypomobility, hypermobility, instability
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9
Q

Lateral foraminal stenosis

signs and symptoms

C/S

A
  • LMN - Peripheral NR involvement:
  • myotomal weakness
  • sensory deficits in dermatomal pattern
  • diminished reflexes
  • Neurogenic pain and paresthesia
  • neck, scapular, shoulder & arm regions
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10
Q

Clinical prediction rule with cervical radiculopathy

A
  1. Spurling’s Test – to painful side
  2. Distraction Test—supine C/S distraction force (relief of symptoms)
  3. C/S rotation less than 60 degrees ipslaterally
  4. ULTT(+ test) Symptom reproduction

4/4 positive = 99% specificity; 3/4 positive = 94% specificity

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11
Q

Central canal stenosis

causes- related to aging

A
  • DDD =>DJD
  • Ligamentum flava hypertrophy & bulging
  • Increased forces on osseous spine structures
  • Osteophytes - Facet, Uncovertebral joints, Vertebral bodies
  • Osteophytic “lipping” of vertebral bodies protruding into spinal canal.
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12
Q

besides degenerative processes what can cause central canal stenosis

A
  • Congenitally narrowed canal
  • Tumors
  • Hypermobility / instability (grade 3)
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13
Q

Central canal stenosis - cervical myelopathy

S&S

A
  • B/L neurological S&S - perhaps in arms & legs
  • Ataxic gait, loss of balance, proprioception
  • Clumsiness in hands and LEs
  • hypertonia
  • hyperreflexia
  • (+) Babinski,
  • (+) Clonus
  • (+) Hoffman’s sign
  • (+) Inverted brachioradialis (supinator) reflex
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14
Q

Hoffmans signs

A

indicates cervical myelopathy
flick index finger DIP
(+) test is flexion of thumb

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15
Q

Inverted brachioradialis reflex

A
  • tap brachioradialis
  • normal response = elbow flexion
  • abnormal = elicits wrist and finger flexion
  • indicates UMN lesion at C5-C^
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16
Q

Clinical prediction rule for cervical spine myelopathy

A

(1) Ataxic gait
(2) + Hoffmann’s test
(3) + Inverted brachioradialis (supinator) sign
(4) + Babinski test
(5) Age > 45 years

*If 3/5 tests positive:
A post-test probability of 94%.
positive likelihood ratio of 30.9 (95%CI) *

17
Q

What to look for with exam: history and interview

A
  • red flags: Viscera referred symptoms: heart / cardiac , lungs, liver etc.
  • MOI – Trauma or insidious. Hx - previous episodes
  • CC – Cervical pain; and or extremity symptoms
  • Radiculopathy: LMN UL Pain, paresthesia, mm weakness UL UE hypo-reflexia
  • CS Myelopathy: UMN hypertonia, hyper-reflexia symptoms b/l possibly all 4 extremities, extremity clumsiness, ataxic gait
  • Diagnostic tests – MRI, Xrays, NCV/EMG
  • Better, Worse with certain activities, positions:
  • Occupational: Looking up, driving, lifting, computer work etc.
18
Q

What positions during UQS should make them better in relation to lateral foraminal stenosis

A
  • Quadrant testing (Spurling test)
  • Worse with extension/SB/rotation involved side
  • Better – SB away, flexion.
  • Worse with compression; Better with distraction
19
Q

What other special test can be used for cervical myelopathy

A
  • (+) Shoulder abduction sign:
  • Arm on top of head may relieve traction on NR lift NR above/away from source of irritation.
20
Q

Differential diagnosis for CSM

A
  • Carpal Tunnel Syndrome: (+) exam findings and CTS Special Tests
  • Other UE peripheral nerve entrapments: (+) exam findings and ULTT
  • Thoracic Outlet Syndrome: (+) exam findings and TOS Tests
21
Q

Lateral formainal stenosis treatment

A
  • Exercise preference - CS retraction, extension; centralize radicular symptoms
  • Distraction of foramen
  • Avoid extension and quadrant positions end ranges that close foramen - radicular symptoms
  • Mobil/Manip restrictions in adjacent U/C, U/T spine
  • Stabilization ex’s if instability - Deep neck flexors (Jull method), CS extensors
  • Modalities
  • Education - posture
22
Q

Positional distraction

A

potential treatment for lateral foraminal stensois

  • patient supine
  • clincian: raises patients head and neck producing FB to level to be distracted head is then supported on form pillow or books
  • neck is side bent away from symptomatic side (gapping / opening involved side) Technique can be purely positional or traction may be applied in this position. Try 5 min progressing toward 20 min twice daily
23
Q

Central canal stenosisCSM: referrals

A

Referral to MD

  • Decompression Surgery-clean canal of osteophytes, foraminectomy commonly done, fusion/stabilization

If MD aware of condition & refers patient to PT:

  • Posture / education – avoid CS extension activities
  • Stabilization/support as appropriate
  • Gait, balance activities (ataxia)
  • Monitor patient’s symptoms

Musculoskeletal PT 2 (25 decks)

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