1e - Cspine Dx Part 2 Flashcards by Jenn Cantilli

what is fibromyalgia syndrome (FMS)

chronic widespread pain disorder commonly associated w comorbid sx, including fatigue and nonrestorative sleep

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what are 5 characteristic s/sx of FMS

widespread pain
TTP at multiple points
morning stiffness
fatigue
sleep disturbance

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what 2 pt populations is FMS common in

female
military population
- component of stress

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trigger vs tender point

trigger point = objective
- respond well to STM

tender points
- no twitch response
- no palpable nodule
- not responsive to STM
- aren’t included in new guidelines

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how many tender points are associated w FMS

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what is a tender point

localized tenderness to palpation

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what is a trigger point

hyperirritable spont
w/i taut band of skeletal ms
nodules palpable w/i ms

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what is an aggravating factor to trigger points and how can the pain present

painful on compression or ms contraction
- may respond w referred pain pattern distant from spot

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what is the difference from the old ACR FMS dx criteria to the updated criteria used today

widespread pain index (0-19 score)
Sx Severity Score (0-3 score)
- fatigue
- sleep
- cog sx
- somatic sx

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what is the significance of the dx criteria for FMS

no specific tes for it
- important to r/o other things

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what is a differential dx for FMS

lyme dz

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score ranges for dx criteria of FMS

WPI >7 and SSS >5

or -

WPI 4-6 and SSS >9

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what is fibro-fog

cog issue, problems concentrating
- see as a result of non restorative sleep that can be seen in FMS

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what are the 3 conditions to be met for a FMS dx

WPI >/=7 and SSS >/=5 -or- WPI 4-6 and SSS >/=9
generalized pain present in at least 4 / 5 defined regions regions
sx present at similar level for at least 3mo

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what should be kept in consideration about a dx of fibromyalgia

doesn’t exclude presence of other clinically important illnesses

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what are 5 likely exam findings in FMS

tender points
allodynia
may also be trigger points
dec ROM
dec strength and endurance

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what is allodynia and how can it be assessed

pain in response to non-nociceptive stim

assessed cutaneously by brushing skin

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what type approach should be taken for FMS interventions and what are 4 ex

multidisciplinary, holistic approach

aerobic conditioning
strengthening
mind-body connection (ie yoga, pilates, breathing)
pharm (meds)

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what needs to be balanced in your approach to interventions for FMS and why

balance b/w overly vigorous approach (exacerbate sx d/t low pain threshold) and under activity (disuse atrophy and inc sx)

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what is a consideration of appt scheduling in FMS and why

see them in afternoon/later in day appts

lots of fatigue
poor sleep
better in quiet clinic

what is the focus of interventions for FMS

aerobic conditioning
strengthening

(consistency is key)

what should you educate FMS pts on

pacing selves
manage energy levels
neuropathic pain management
- nociplastic pain experience
- educate ab threshold and limits

prognosis and PT treatment frequency

1-2x/wk for 6+wks

won’t see huge changes in short time
- gradual/graded progression
important to engage them & set up w resources

what is congenital muscular torticollis (CMT)

postural deformity of neck evident at birth or shortly thereafter

what is CMT characterized by

head tilt to one side or lateral neck flexion (ipsilateral), w neck rotated to opposite side d/t unilateral shortening/fibrosis of SCM ms

what comorbidities can accompany CMT (4)

cranial deformation hip dysplasia brachial plexus injury distal extremity deformities

how does R torticollis present

head contracted in R SB, L rotation and a little flexion named by side of affected ms (R SCM)

what are 3 types of CMT

postural muscular SCM mass

how does postural CMT present

infant's postural preference but w/o ms or PROM restrictions - mildest presentation

what type of CMT has the mildest presentation and which has the most severe

postural SCM mass

how does muscular CMT present

SCM tightness PROM limitaitons

how does SCM mass CMT present

fibrotic thickening of SCM PROM limitations

what 2 factors are highly predictive of time required to resolve ROM limitations in CMT

type of CMT age of initial dx

what are 7xs to refer an infant treating CMT w PT to MD

1. non-muscular cause of asymmetry (ie poor visual tracking, abnormal ms tone, extra-ms masses) 2. associated conditions (cranial deformation) 3. asymmetries inconsistent w CMT 4. if infant >12mo and facial asymmetry and/or 10-15def of difference in PROM to AROM in cervical rotation or lateral flex 5. infant 7mo+ w SCM mass 6. side of torticollis changes 7. size or location of SCM mass inc

why is early identification and treatment of CMT key

critical for: - early correction - early identification of secondary or concomitant impairments - prevention of future complications

infants identified w CMT later (3-6mo) and have SCM mass CMT is correlated w what

longest episodes of conservative treatment undergo more invasive interventions - surgical lengthening/release of SCM - botox injections

what is plagiocephaly, how is it often caused, and how is it treated

cranial asymmetry w flattening of 1 side of head if babies lay in one position or on back a lot lots of tummy time!

what info do we want from the parent report during the pt exam of CMT

pregnancy hx infant hx family hx of torticollis/plagiocephaly

what are systems review components to assess in the pt exam of CMT

visual function hip screen neuro screen pain assessment skin screen

what are components of the physical assessment during the pt exam of CMT

clinical observations anthropometrics ROM ms palpation

what can untreated CMT lead to and how is this often treated

positional plagiocephaly cranial orthosis

what is the primary emphasis of interventions for CMT

how you handle them -> asymmetrical handling to activate weak nect ms - can't really do ROM

what are 5 interventions for CMT

neck PROM neck/trunk AROM - feeding from alternate sides development symmetrical mvmt environmental adaptations pt/caregiver ed

how should supervised tummy time be utilized in interventions for CMT

when infant is awake - 3+x/day - for more than 1 cumulative hour to prevent neck asymmetry

at what point is an infant not progressing as anticipated and you should seek consultation

asymmetry of head, neck, and trunk not starting resolve 4-6wks of comprehensive intervention after 6mo of intervention w plateau in resolution

when should infants be reassessed after dc PT for CMT

3-12mo following discontinuation from direct PT intervention or when child initiates walking

when should you dc PT for CMT (4)

full PROM w/i 5deg of non-affected side symmetrical active mvmt pattern age-appropriate motor development no visible head tilt

what is an important ed piece for parents w dc PT for CMT

what to monitor as child grows