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Boards: Musculoskeletal > Spinal Conditions > Flashcards

Spinal Conditions Flashcards

1
Q

Muscle Spasm Medications

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

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2
Q

Muscle Spasm and PT

A

correct biomechanical faults, patient education and posture education, spinal manipulation for pain inhibition is generally indicated

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3
Q

Spondylolysis

A

fracture of the pars interarticularis w/ (+) scotty dog sign on oblique radiographic view

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4
Q

Spondylolisthesis

A

actual anterior or posterior slippage of one vertebra on another, following bilateral fracture of the pars interarticularis. Graded 1-4 (4 = complete slippage)

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5
Q

Spondy Dx

A

plain films w/ oblique and lateral views to see slippage and also (+) stork test

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6
Q

Spondy Medications

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

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7
Q

Spondy and PT

A

address biomechanical faults dynamic stabilization of trunk particular emphasis on abdominals avoid EXT, ipso side bending, and contralateral rotation Postural re-ed Braces - boston and TLSO ***Spinal Manipulations are Contraindicated)

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8
Q

Spinal Stenosis

A

congenital narrow spinal canal or iintervertebral foramen, coupled with hypertrophy of the spinal lamina and ligamentum flavum or facets as the result of age related degeneration - results in vascular compromise and/or neural compromise

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9
Q

Spinal Stenosis signs and Symptoms

A

bilateral p! and parasthesias in back, buttocks, thighs, calves, and feet p! decreases in spinal flexion and increases in extension p! increases with walking p! relieved with prolonged rest

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10
Q

Spinal Stenosis Dx

A

plain films, MRI, CT scan occasionally myelography, clinical exam to differentiate from intermittent claudication

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11
Q

Spinal Stenosis Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

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12
Q

Spinal Stenosis PT

A

address biomechanical faults flexion based exercise program dynamic stabilization avoid EXT and other positions that narrow canal ipsilateral side bending and rotation

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13
Q

Spinal Stenosis and Mechanical Traction

A

cervical: position 15 deg FLEX to provide optimum intervertebral foramen opening **Contraindications include joint hyper mobility, pregnancy, RA, down syndrome, or any other systemic dx affecting ligament stability**

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14
Q

Internal Disc Disruption

A

most common in lumbar region disc annulus disrupted, external structures remain normal Symptoms constant deep, achy pain and increased p! with movement. no objective neurological findings but may have referred pain in the lower extremities

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15
Q

Internal Disc Disruption Dx

A

CT discogram or and MRI, clinical exam

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16
Q

Internal Disc Disruption Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

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17
Q

Internal Disc Disruption PT

A

address biomechanical faults spinal manipulation is contraindicated body mechanics avoid receptive bending, OH lifting, twisting, sitting and heavy lifting

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18
Q

Posterolateral Bulge/Herniation and Anatomical Relationship

A

most commonly observe disc disorder of lumbar spine due to three structural deficiencies. Post disc is narrower in height than anterior disc. post long ligament is not as strong nd only centrally located in lumbar spine, posterior lamellae of annulus are thinner

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19
Q

Posterolateral Bulge/Herniation Etiology

A

overstretching and/or tearing of annular rings, vertebral end plate and/or ligamentous structures from high compressive forces or repetitive micro trauma Results in loss of strength, radicular pain, paresthesia and inability to perform activities of daily living

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20
Q

Posterolateral Bulge/Herniation Dx

A

MRI and clinical exam

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21
Q

Posterolateral Bulge/Herniation Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

22
Q

Posterolateral Bulge/Herniation PT

A

Dynamic stability to promote disc regeneration Positional Gapping for 10 min to increase space within region of space occupying lesion. Spinal Manipulation may be contraindicated Patient education regarding bending lifting twisting

23
Q

Posterolateral Bulge/Herniation and Mechanical Traction

A

Cervical Spine: 15 deg for opt intervertebral opening Efficacy of tx is currently under scrutiny **Contraindications include joint hyper mobility, pregnancy, RA, down syndrome, or any other systemic dx affecting ligament stability**

24
Q

Central Posterior Bulge/Herniation Etiology

A

More common in cervical spine but can also be lumbar Etiology: overstretching and or tearing of annular rings, vertebral endplate and or lig structures (post long ligament) from high compressive forces or long term postural malalignment

25
Q

Central Posterior Bulge/Herniation Symptoms

A

loss of strength, radicular pain, parasthesia, inability to perform activities of daily living and possible compression of the spinal cord. CNS symptoms

26
Q

Central Posterior Bulge/Herniation Dx

A

MRI, clinical exam

27
Q

Central Posterior Bulge/Herniation Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

28
Q

Central Posterior Bulge/Herniation PT

A

Dynamic stability to promote disc regeneration Positional Gapping for 10 min to increase space within region of space occupying lesion. Spinal Manipulation may be contraindicated Patient education regarding bending lifting twisting

29
Q

Anterior Bulge/herniation

A

very rare due to structural integrity of anterior intervertebral disc

30
Q

Degnerative Joint Disease Etiology

A

part of normal aging process due to the WBing properties of facets and intervertebral joints Results in bone hypertrophy, capsular fibrosis, hyper mobility or hypo mobility of joint and proliferation of synovium

31
Q

Degnerative Joint Disease Synovium

A

reduction in mobility of the spine, pain and possible impingement of associated nerve root resulting in loss of strength and parasthesias

32
Q

Degnerative Joint Disease Dx

A

plain film imaging and clinical exam including lumbar quadrant tests

33
Q

Degnerative Joint Disease Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

34
Q

Degnerative Joint Disease PT

A

Dynamic Stability Address biomechanical faults Spinal manipulation may be useful

35
Q

Facet Entrapment (acute locked back)

A

caused by abnormal movement of fibroadipose meniscoid in facet during extension (from flexion). meniscoid does not properly reenter joint cavity and bunches up, becoming a space occupying lesion, which distends capsule and causes p! Flex is most comfortable for patient and extension increases pain

36
Q

Facet Entrapment (acute locked back) Dx

A

clinical exam including lumbar quadrant test helps to identify this condition

37
Q

Facet Entrapment (acute locked back) Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

38
Q

Facet Entrapment (acute locked back) PT

A

Manipulation Positional Gapping for 10 min to increase space within region of space occupying lesion.

39
Q

Acceleration/Deceleration injuries of cervical spine: Etiology and Injured Structures

A

“Whiplash” occurs when excess shear and tensile forces are exerted on cervical structures. Injury results in facet joint capsules, ligaments, disc, ant/post ms, fx to odontoid process and SP, TMJ, sympathetic chain ganglia, spinal and cranial nerves

40
Q

Acceleration/Deceleration injuries of cervical spine: Symptoms

A

HA, neck pain, limited flexibility reversal of lower cervical kyphosis vertigo change in vision and hearing irritability to noise and light dysesthias of face and bilateral upper extremities nausea difficulty swallowing and emotional lability -Late Symptoms chronic head and neck p! limitation in flexibility, TMJ dysfunction, limited tolerance to ADLs, dysequillibrium, anxiety and depression

41
Q

Acceleration/Deceleration injuries of cervical spine - DX

A

Common clinical findings include postural changes, excessive ms guarding with soft tissue fibrosis, segmental hyper mobility and gradual development of restricted segmental motion. cranial and caudal to the injury (segmental hypo mobility) –plain films, CT, MRI

42
Q

Acceleration/Deceleration injuries of cervical spine Meds

A

Acetaminophen, NSAIDs, Corticosteriods, Muscle Relaxants: Flexeril (cyclobenzaprine) or Valium (diazepam) or trigger point injections

43
Q

Acceleration/Deceleration injuries of cervical spine PT

A

Spinal Manipulation generally indicated Correct ms imbalances Address biomechanical faults progression to fxn training patient education manual/mechanical traction (15 deg)

44
Q

Hypermobile Spinal Segments

A

an abnormal increase in ROM at a joint due to insufficient soft tissue control

45
Q

Hypermobile Spinal Segments: Dx

A
  • plain film imaging - dynamic flexion/extension views
  • clinical exam
46
Q

Hypermobile Spinal Segments: Meds

A
  • acetaminophen
  • NSAIDs
  • muscle relaxants
  • trigger point injections
  • sclerosing injections
  • corticosteroid injection/mouth
47
Q

Hypermobile Spinal Segments: PT

A
  • pain reduction modalities to reduce irritation
  • passive ROM within normal range
  • passive stabilization - corsets, splints, etc
  • increase strength/endur/coordination - multifidus, abdominals, extensors, gluteals to control posture
  • regain ms imbalance
  • patient education regarding postural reeducation
48
Q

SIJ Conditions:

A
  • cause and pathology are unknown
  • considered a jt subject to inflammation, degeneration, or developabnormal mvmnt patterns
  • anatomically, funx related to limbar spine
    *
49
Q

SIJ Conditions: Dx

A
  • tests
    • plain film
    • MRI
    • double blind injection (“same” pain w/ 1st injection, and decreased pain w/ 2nd = SIJD)
  • gillets test
  • ipsilateral anterior rotation test
  • gaenslens test
  • long sitting- supine test
    • goldthwait’s test
50
Q

SIJ Conditions: Meds

A
  • acetaminophen
  • NSAIDs
  • Muscle relaxers
  • trigger point injection
  • corticosteroids
51
Q

SIJ Conditions: PT

A
  • spinal manip - SIJ gapping to dec p!
  • correct ms imbalance
  • biomechanical faults
  • patient education/posture
  • SIJ belts
52
Q

Repetitive/Cummulative Trauma to back:

A
  • disorders of nerves, soft tissues and bones precipitated or aggravated by repeated exertions or mvmnts of the back, occuring most often in workplace
  • accounts for 48% of all occupational dx
  • up to 85% of back pain not dx
  • vocational factors:
    • physically heavy static postures
    • lifting
    • frequent bending and twisting
    • repetitive work
    • vibration

Boards: Musculoskeletal (18 decks)

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