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MSK 2 > 1c - CSpine Dx > Flashcards

1c - CSpine Dx Flashcards

1
Q

what are 2 dx that fall under the neck pain w mobility deficits category

A

facet dysfunction
cervical spondylosis/DJD

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2
Q

what dx falls under neck pain with radiating pain

A

cervical radiculopathy
- intervertebral disc herniation
- DJD

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3
Q

what care does every pt w neck pain receive

A

multimodal care
- pt ed
- exercise
- manual therapy

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4
Q

what is the significance of neck pain CPG classifications

A

tells us how to prioritize treatments

certain paths associated with each category

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5
Q

what are 3 common sx of neck pain w mobility deficits

A
  1. central and/or unilateral neck pain
  2. limitation in neck motion that consistently reproduces sx
  3. associated (referred) shoulder girdle or UE pain may be present
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6
Q

referred pain vs radicular pain

A

referred pain
- pain is felt in distal tissues from location

radicular pain
- radiating along course of nerve
- narrow band close to dermatome of what nerve supplies

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7
Q

what is the C2-3 facet joint referred pain pattern

A

L back of skull, L upper back of neck (behind ear)

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8
Q

what is the C3-4 facet joint referred pain pattern

A

R back of neck

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9
Q

what is the C4-5 facet joint referred pain pattern

A

L back of neck over upper trap area
- some overlap w C2-3 referred region

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10
Q

what is the C5-6 facet joint referred pain pattern

A

R low back of neck over shoulder to delt and upper scap area
- some overlap with C3-4 area

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11
Q

what is the C6-7 facet joint referred pain pattern

A

L upper-mid back, over shoulder, upper arm, covers majority of scap
- some overlap w C4-5 area

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12
Q

what are expected ROM exam findings in neck pain w mobility deficits

A

limited cervical ROM

neck pain reproduced at end ranges of AROM and PROM

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13
Q

what are suspected segmental mobility exam findings in neck pain w mobility deficits

A

restricted cervical and thoracic segmental mobility (PPIVMS and PAIVMS)

intersegmental mobility testing reveals characteristic restriction

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14
Q

how are neck and referred pain reproduced in neck pain with mobility deficits

A

provocation of involved cervical or upper thoracic segments or cervical musculature

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15
Q

what other deficits might be found in the exam of subacute/chronic neck pain w mobility deficits

A

cervico-scapulothoracic strength motor control deficits

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16
Q

facet dysfunction (hypomobility) common hx and MOI

A

<50yo

MOI: onset of unilateral neck pain or locking
- unguarded/awkward movt or position

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17
Q

common sx of facet dysfunction (hypomobility)

A

localized pain

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18
Q

what tests and measures will be altered in facet dysfunction (hypomobility)

A

palpation - localized changes
PPIVMS and PAIVMS
- reveal altered segmental mobility patterns
ROM - combined movements restricted

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19
Q

how does a neuro exam present for facet dysfunction (hypomobility

A

usually normal

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20
Q

what are the 2 main groups of pts w hypomobility

A

1st: younger pts w MOI from waking up w it or turn head awkwardly
- can palpate where painful/stiff

2nd: older group w DJD, CS, OA
- slow changes over long period of time

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21
Q

how do degenerative changes in the spine present

A

start in intervertebral discs w osteophyte formation and involvement of adjacent soft tissue structures

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22
Q

what about imaging for DJD/CS/OA is important to consider

A

clinical signs don’t always correlated w imaging
- neck pain (axial)
- radiculopathy
- myelopathy

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23
Q

pain w hypomobility in younger vs older pts

A

younger = localized
older = generalized

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24
Q

DJD hx

A

> 50yo
gradual onset

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25
how does pain present in DJD
generalized chronic neck pain morning stiffness - loosen up w movement or hot shower
26
common posture of DJD pt
forward head posture inc thoracic kyphosis
27
what tests and measures will be altered in DJD
ROM - dec joint play - generalized hypomobility (not a specific pattern of up or downglides) palpation - adaptively shortened tissues - tender - inc tissue density - dec mobility
28
neuro exam of DJD pt?
no radicular s/sx
29
CPGs for acute neck pain w mobility deficits
thoracic manip neck ROM exercises scap-thoracic and UE strength may provide cervical manip/mob
30
CPGs for subacute neck pain w mobility deficits
neck and shoulder girdle endurance exercises may provide thoracic manip and cervical manip/mob
31
CPGs for chronic neck pain w mobility deficits
multimodal approach: 1. thoracic manip and cervical manip/mob 2. mixed exercise for cervical/scapulothoracic region: - NM (coordination, proprioception, postural training) - stretching - strengthening - endurance training - aerobic conditioning - cog affective elements 3. dry needling, laser, or intermittent mechanical/manual traction
32
what should the initial focus be of interventions for neck pain w mobility deficits
joint mob of hypomobile segments in cervical and thoracic
33
what should be included in the interventions for neck pain w mobility deficits
combo of education, manual therapy, and exercise
34
what are 5 interventions for neck pain w mobility deficits
joint mobs*** ROM exercises - C and T-spine - combined movements postural and ergonomic ed soft tissue mob strengthening/endurance program
35
direct vs indirect treatment mobs for mobility deficits
direct = unilateral PA - palpate right over facet and downglide indirect = central PA - get downglide on both sides - pt might tolerate better
36
what neck pain w mobility deficits patient population is mobilization movement esp good with
younger pts w lingering twinge after initial mobilization
37
common sx of neck pain w radiating pain (4)
1. neck pain with narrow band of lancing/burning/electric pain in involved extremity 2. nerve root irritation, inflammation, compression 3. may have referred pain from IV disc 4. UE dermatomal paresthesia or numbness
38
what is the most common cause of neck pain w radiating pain
cervical disc herniation - results in inflammation around nerve
39
location of most common cervical disc herniations
C5-6 C6-7
40
4 risk factors for a cervical disc herniation
smoking sedentary lifestyle poor posture excessive lifting
41
what are the most common sources of radiculopathy and why
C7 and C6 inc load at those levels
42
common pt age for radiculopathy
age 40-50yo
43
common causes of radiculopathy
herniated nucleus pulposis (HNP) spondylosis
44
5 differential dx for radiculopathy
peripheral n. disorders TOS brachial plexus disorder parsonage-turner syndrome (PTS) - brachial neuritis systemic dz
45
dx procedures for radiculopathy
radiographs MRI EMG and nerve conduction studies
46
what test has a high specificity w radiculopathy
distraction test
47
prognosis for radiculopathy and recovery timeline
good substantial improvements first 4-6mo post onset complete recovery 2-3yr in 80% of pts
48
MOI for radiculopathy
insidious or traumatic
49
radiculopathy pain aggravating factors
worse w coughing or sneezing - valsalva pressure -> inc interspinal pressure may refer to scap region
50
palpation of radiculopathy exam
ms guarding to protect area not one specific area
51
how does ROM present in radiculopathy
limited and painful - not a mechanical restriction - limited by pain - will improve w pain dec
52
what ab repeated motions are important in a radiculopathy exam
does it centralize or peripheralize sx cervical retraction = centralize
53
what is included in a neuro exam for a radiculopathy and what are common findings
myotomes/dermatomes/DTRs - myotomal ms weakness - sensory/reflex deficits associated w involved nerve roots
54
what r/i a cervical radiculopathy
r/i by presence of 4 (+) exams from the test item cluster: (+) spurling A test - SB and compression (+) upper limb tension test A - median n. (+) cervical distraction test (+) <60deg cervical rotation toward sx side with 99% specificity
55
what r/o a cervical radiculopathy
(-) ULTTA
56
what are other tests for cervical radiculopathy not included in the Test Item Cluster
valsalva test shoulder ABD test (badoky sign) arm squeeze test** - (+) good to r/i - (-) good to r/o
57
what are 3 things that nerves need to be healthy and thrive
blood supply space movement
58
CPGs for acute neck pain w radiating pain
may provide mobilizing and stabilizing exercises, laser, and short-term use of c-collar
59
when is a soft cervical collar appropriate to use in neck pain w radiating pain
acute radiculopathy - hot and irritated nerve where every move hurts - if difficult getting comfortable at night or hurts during certain activities *not long term
60
CPGs for chronic neck pain w radiating pain
mechanical intermittent cervical traction combined with stretching/strengthening exercises + cervical and thoracic mob/manip give pt ed to encourage participation in occupational and exercise activities
61
what is the initial focus of interventions for neck pain w radiating pain and why
centralize arm pain - indicates better prognosis if pain peripheralizing, that is a poor prognostic factor
62
what are 6 interventions for neck pain w radiating pain
1. pt ed - posture & ergonomics 2. shoulder girdle elevation or unloading or foraminal opening positions 3. cervical traction 4. centralization exercises 5. manual therapy 6. strengthening exercises
63
what pt pop is the intervention of shoulder girdle elevation appropriate for
for high irritability and very acute patients
64
what is the goal of cervical traction
unload nerve to give more space and centralize the sx
65
what is an important pt ed component for centralization interventions
pain may get more intense as moves prox, but this is part of healing process - should warn pts ab this
66
what are examples of centralization exercises
retraction = lower cervical ext/upper cervical flexion - repeated movement
67
what are manual therapy interventions for neck pain with radiating pain and when is this introduced in POC
cervical spine joint mob thoracic joint manip/mob later on in treatment
68
what strengthening exercises are appropriate for neck pain w radiating pain
deep neck flexor scapulothoracic ms
69
what are 3 types of traction
positional manual mechanical
70
what are modes of cervical traction and who are they appropriate for
static - joint and/or nerve root irritability/severe arm pain intermittent - acute joint derangement or pts needing joint mob
71
what pt pop is manual traction most commonly used with and why
more acute radiculopathy - more specific - can get feedback and adjust - won't spend a lot of time w traction initially
72
what position should the pt be in for manual traction
hooklying - take pressure off lower back elbows flex to take tension off nerve
73
what are 2 pros to manual traction
more specific easier to adjust force and neck position
74
why is head halter over door (a form of mechanical traction) rarely used now
compressing thru TMJ less relaxed in sitting than in supine
75
when do you transition from manual to mechanical traction
if pt doing well w manual - may be more efficient to put them on mechanical traction unit
76
what are 2 common mechanical traction units used today
sub-occipital grip (Saunders) pronex pneumatic traction unit
77
mechanical effects of spinal traction (4)
1. distraction/separation of vertebral bodies 2. distraction of facet joints 3. inc ligamentous tension/stretch joint capsules and tendons and spinal ms 4. widening of intervertebral foramen
78
physiological effects of spinal traction (esp intermittent) - 3
1. inc circulation 2. mechanoreceptor input 3. dec pain
79
what is the goal of spinal traction
maximum sx reduction and centralization of sx
80
4 indications of traction
HNP radiculopathy DJD facet/joint hypomobility
81
5 contraindications of traction
1. structural dz - tumor or infectious - fx, severe osteoporosis, TB of bone, bone tumors 2. vascular compromise (ie VBI, cervical vascular disorder) 3. any time movement is contraindicated - fx, recent fusion, ligamentous rupture, evidence of instability 4. impaired cog function 5. claustrophobia
82
angle of traction force to inc IV space at C1-C5
0-5deg flex
83
angle of traction force to inc IV space at C5-C7
25-30deg flex
84
what angle of traction force is needed for facet joint separation and what is an indication for this
24-35deg DJD, stiff neck
85
angle of traction force appropriate for HNP and why
0deg flex flex would further protrude disc post - could have trouble returning to neutral/ext after bc disc has moved
86
time on traction for acute conditions and HNP
5-10min
87
time on traction for non-acute conditions and not HNP
15-30min
88
minimum force needed for traction
8-10lbs or 7-10% of pt body wt
89
what does evidence show for the addition of mechanical traction to exercise in cercial radiculopathy
lower disability and pain, particularly at long term f/u compared to exercise alone
90
what is an repeated movements intervention mean
pt controlled repeated AROM movements at end-range or sustained posture - centralizes pain and diminish peripheral sx
91
what repeated movements are assessed in a pt exam (4)
retraction retraction + ext protraction flexion

MSK 2 (20 decks)

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