cards for NMS Flashcards
(355 cards)
1
Q
What are 2 general causes of low back pain?
A
Pathological and Biomechanical.
2
Q
What is ROS?
A
Review of systems (this can be a paper that the patient fills out about there different body systems).
3
Q
What are the 2 types of information found in a case history?
A
Subjective and objective.
4
Q
What are the progress notes?
A
SAOP notes that show changes from visit to visit.
5
Q
What does SOAP stand for?
A
S- Subjective. O- objective. A- assessment (diagnosis) and Action (treatment). P- Plan
6
Q
What is the difference between Objective and subjective findings?
A
Subjective- things patient tells us like symptoms, problems, pain scale, etc.. Objective- Things the Dr. finds like exam findings.
7
Q
What are the different grades given for muscle strength tests?
A
1-5. 5- normal. 4- good. 3- fair. 2- poor. 1- trace. 0- zero. They are given as 5/5, 4/5, 3/5, etc.
8
Q
What type of muscle grade would be given for complete range of motion against gravity?
A
3/5 grade.
9
Q
What type of muscle grade would be given for complete range of motion against gravity with full resistance?
A
5/5 grade.
10
Q
What type of muscle grade would be given for complete range of motion with gravity eliminated?
A
2/5 grade.
11
Q
What type of muscle grade would be given for evidence of slight contractility and no joint motion?
A
1/5 grade.
12
Q
What type of muscle grade would be given for complete range of motion against gravity with some resistance?
A
4/5 grade.
13
Q
What are the % that go with Intermittent, occasional, frequent, constant?
A
I- <25% of time, O- 25-50%, F- 50-75%, C- 75-100%
14
Q
What is the tenderness grading scale like?
A
Grade1-IV. I- Mildly tender, but no physical response. II- Moderately tender with a grimace. III- Tenderness with withdrawl (jump sign). IV- Withdrawl to non-noxious stimuli.
15
Q
How are muscle spasms graded?
A
They are +1-+5.
16
Q
What type of muscle spasm grade would be given for Muscle rigidity with complete resistance to motion in some direction?
A
Grade- +3
17
Q
What type of muscle spasm grade would be given for Spasm present without external irritation, e.g. antalgic posture?
A
Grade- +5
18
Q
What type of muscle spasm grade would be given for Sustained contraction with moderate resistance to passive motion?
A
Grade- +2
19
Q
What type of muscle spasm grade would be given for spasm triggered by movement, palpation, etc.?
A
Grade- +4
20
Q
What type of muscle spasm grade would be given for sustained contraction with mild resistance to passive motion?
A
Grade- +1
21
Q
Radiographic findings should correlate with what?
A
Clinical findings.
22
Q
What is PSFS?
A
Patient specific functional scale. 0—10. 0 = complete inability. 10 = 100% ability.
23
Q
What are supportive findings?
A
Objectifying pain (VAS, Rate pain), Impact of daily living (ADL).
24
Q
What would a word in “” mean in chart notes?
A
That the patient said this and this would be subjective findings.
25
What is the abbreviation for pain?
A P that is circled.
26
what will a - circled mean?
Negative, normal, absent.
27
What will a delta sign mean?
Change.
28
What is AAROM?
Active assisted range of motion.
29
what is abd?
abduction.
30
What is the abbreviation for adjustment?
adj
31
What is ADL?
Activities of daily living.
32
What is B/B?
Bowel or bladder.
33
what is bid?
twice a day.
34
What is a C with a line above it?
with.
35
what is c/o?
Complains of.
36
What is C/T?
cervicothoracic.
37
What is CA?
cancer.
38
What is CAD?
cervical acceleration deceleration.
39
what is cc?
Chief complaint.
40
What is CFM?
Cross friction massage.
41
What is CHF?
Congestive heart failure.
42
What is CMT?
Chiropractic manipulative therapy.
43
What is COPD?
Chronic obstructive pulmonary disease.
44
What is CRAC?
Contract relax antagonist contract.
45
What is d/t?
Due to.
46
What is DJD?
Degenerative joint disease.
47
What is Dx?
Diagnosis.
48
What is EAM?
External auditory meatus.
49
What is ECG?
Electrocardiogram.
50
What is EEG?
Electroencephalogram.
51
What is EENT?
ear, eyes, nose and throat.
52
What is EHL?
extensor hallicus longus.
53
What is a chiropractic subluxation complex?
Abnormal anatomical or functional relationships of articular structures. Usually demostrate restricted movement and minimal to moderate tenderness. Often associated with other soft tissue injuries.
54
Name 3 ways to work on cross-linked collagen?
1. Cross fiber friction. 2. Adjusting. 3. Mobilization.
55
What is meniscoid?
Connective tissue that is a buffer between joints. It is like a meniscus. IT can get pinched between bones.
56
What is spondylosis?
DJD of the spine.
57
What is spondyloarthrosis?
DJD of the spines (facets).
58
What is spondylolisthesis?
Slipped vertebrae. Usually an anterior slip of L5 on S1.
59
What is an anterior spondlyolisthesis of L5 on S1 called?
L5 anteriolisthesis.
60
What is DDD?
Degenerative disc disease.
61
Can DDD be seen on x-ray?
Yes since the disc space would be gone.
62
Secondary osteoarthritis is a product of what?
chronic mechanical stress leading to a mechanical degeneration of synovial joints.
63
How do chondrocytes get nutrients?
Through diffusion mainly from synovial fluid, but the deep parts can get some from the bones.
64
Where are chondrocytes located at?
Lacuna (chondro-condo).
65
How will fluid like synovial fluid be pulled into cartilage?
Through GAG's since they are so hydrophilic.
66
Is hyaline cartilage innervated?
No.
67
As cartilage degenerates what happens to the bones of the joint?
Fibrous adhesion may develop and possible bony ankylosis.
68
What happens to synovial fluid and why when cartilage starts to degenerate?
Decreased fluid since cartilage makes it and this leads to decreased lubrication and decreased nutrients.
69
Cartilage fatigue leads to what?
Breakdown of the bone matrix and chondrocytes.
70
What is fibrillation?
uncovering and fracturing of collagen fibers.
71
As fibrillation, erosion and fissuring happens in cartilage what is the result?
Production of foreign bodies in the joint, and exposure of the subcondral bone.
72
What is cartilages regeneration process like?
since it is poorly vascularized it has a very limited power to regenerate.
73
What are two general ways joint trauma comes about?
Overuse and immobilization.
74
What happens to a joint with overuse?
Laxity of periarticular ligaments--> Joint hypermobility ----> aberrant movement ----> Premature DJD
75
What happens to a joint with immobilization?
Ligamentous shortening. Periarticular fibrosis. Myofascial contracutre and atrophy----> chronic hypomobility ---> premature DJD.
76
Osteoarthritis is a type of what?
DJD.
77
What is the difference between a bulge and a herniation when talking about the IVD?
Bulge- is a general pushing back of the entire disc. Herniation- is a more localized event.
78
What is protrusion when talking about disc herniations?
nuclear material is still within the confines of the annulus.
79
What is prolapse when taling about disc herniations?
Nuclear material has extruded thorugh to outer annular fibers.
80
What are the different types of prolapsed disc hernitations?
Contained, noncontained, sequestered, dissecting, and pedunculated.
81
What is a contained vs. noncontained disc hernitation?
Contained- outer annulus or PLL intact. Noncontained- broken through annulus and PLL.
82
What is a sequestered disc herniation?
A fragmetn broken free.
83
What is a dissecting and pedunculated disc herniation?
Dissecting- migrating up or down. Pedunculated- like a sequestered bulge.
84
What is the difference between circumferential tears and radial tears?
Circumferential tears- outer part of disc. Radial tears- inside by the nucleus tears.
85
What is ankylosis?
Fusion of bone spurs.
86
What part of the IVD is innervated?
The outer 1/3.
87
When can more than the outer 1/3 of the IVD be innervated?
After damage to the IVD nerves and blood vessels can grow in and more of the disc can be innervated even to the nucleus.
88
Air space found in annular fibers of the IVD is known as what? When would this be more common?
Known as a vacuum phenomenon and is more often seen with extension.
89
With a disc herniation what ligament can be pulled away from the bone and what can this cause?
PLL and as it is pulled away from the bone it can build more bone (bone spurs) due to wolff's law.
90
After damage to an IVD nerves and blood vessels can grow in the disc, and what else can now be found there?
Infammatory mediators like mast cells, macrophages, etc.
91
What % of patients with chronic back pain had nerve growth into the inner 1/3 of the annulus?
46%.
92
What % of patients with chronic back pain had nerve growth into the nucleus of the IVD?
22%.
93
The IVD can refer pain to where?
Low back, thigh, and lower leg.
94
How can the IVD be an important source of low ack and referred leg pain even in the asence of herniation and radiculopathy?
This is because nerves can grow in the IVD after damage and can cause a somatosomato referral.
95
Referred pain from an IVD if strong enough can refer to where?
Below the knee.
96
What is usually more severe a strain or a sprain?
A sprain is usually more severe.
97
What is a strain and a sprain?
Strain- Muscle or tendon damage. Sprain- ligament damage.
98
What are the different grading scales of a strain?
Grade I-III.
99
What is a grade I muscle strain like?
pain with little resistance, little or no weakness, no defect, minimal swelling and brusing, no pain with PROM except when muscle is passively stretched.
100
What is a grade II muscle strain like?
Pain with resistance, mild to moderate weakness, possible small defect, moderate swelling and bruising, pain with passive stretching.
101
What is a grade III muscle strain like?
Pain/no pain with resistance, moderate to severe weakness, larger defects possible, rapid and extensive brusing and or swelling, muscle balls up retracts loses contour.
102
What are the different grading scales of a sprain?
Grade I-III.
103
What is a grade I sprain like?
Pain on stress of tissue only at end range, no pain with isometric muscle testing, local tenderness, mild swelling, no gross instability, minimal pain with weight bearing.
104
What is a grade II sprain like?
Pain on stress of tissue before end range, no pain with isometric muscle testing, generalized and marked tenderness, mild laxity no gross instability, localized brusing, moderate to marked ROM loss, moderate to severe pain with weight bearing.
105
What is a grade III sprain like?
Gross instability, variable response to isometric muscle testing: no pain; pain during initial set phase; or significant weakness, generalized swelling, disruption of tissue, pain ranges from minimal to severe, possible hemarthrosis and extensive bruising, marked ROM loss, abnormla motion and or pain wth muscle contraction.
106
Fibrosis = ?
Scar tissue.
107
What is myofibrosis?
Scar tissue forming in muscles.
108
What is tendinitis?
Inflammation of the muscle tendon unit.
109
Tendinitis usually results from what?
Traumatic tears in the tendon.
110
What is chronic tendinits?
Tears microscopic and macroscopic may coalesce to completely bridge the tendon with a fibrous scar.
111
What is calcific tendonitis?
Deposition of calcium slats in chronically inflamed and or necrotic tendonous tissue.
112
What is tenosynovitis?
inflammation of the tendon sheath.
113
What is myofascitis?
Inflamed muscle and fascia and this term is often used interchangeably with myofascial pain syndrome.
114
What is myofascial syndrome? And it is aka?
aka MFTP. Pain and associated referred phenomena associated with myofascial trigger points.
115
What is primary fibromyalgia syndrome?
Form of nonarticular rheumatism manifested by diffuse musculoskeletal aching and tender points at characteristic sites with absence of underlying condition.
116
Primary fibromyalgia syndrome is aka?
Myofascial syndrome.
117
What is the current theory of primary fibromylagia syndrome?
associates distribution of non REM sleep with producing and perpetuating this condition.
118
What is the muscle tissues ability to regenerate like?
Muscle does not possess the ability to regenerate.
119
What happens to injured muscle tissue?
it undergoes fibrous tissue repair resulting in connective tissue cross linkage and an inelastic scar.
120
What is Rheumatism?
A general term for acute and chronic conditions characterized by inflammation, soreness, and stiffness of muscles and pain in joints and associated structures. This is an impercise term that includes many different specific pathophysiologic processes like RA, etc.
121
What does syndes mean?
Ligament.
122
What is syndesmitis?
Inflammation of ligamentous tissue, often resulting from chronic mechanical stress.
123
What ligaments are often involved in syndesmitis?
Supra and interspinal ligaments and are demonstrated by marked tenderness with palpation.
124
Syndesmitis are a like ligament _____.
Spurs.
125
What is capsulitis?
Inflammation of joint capsule resulting from acute or chronic trauma.
126
What is periarticular fibrosis?
Fibrous repair applied to the periarticular ligamentous tissue. Typically resulting in joint fication and dysfunction.
127
What is adhesive capsulitis?
Fibrous repair of injured joint capsule leading to adhesions, joint fixation and chronic inflammation.
128
What is bursitis?
Inflammation of the bursa.
129
Bursitis most commonly involves what areas?
Shoulder and knee.
130
Traumatic bursitis is usually caused by what?
chronic repetitive trauma leading to irritation of the synovial membrane, excessive production of serous fluid and distention.
131
What is periosteitis?
Inflammation of membrane investing a bone, the periosteum.
132
Traumatic periosteitis typically results from what?
A blow to the periosteum or a tearing injury to the ligamentous attachments.
133
What is a contusion?
Injuries produced from direct blows resulting in tissue damage, capillary rupture and hemorrhage (bruise).
134
A contusion may involve what type of tissue?
Connective tissue.
135
Nerve root radiculopathy can be caused by what things?
Nerve root irritation and nerve root compression.
136
What causes intermittent neurogenic claudication?
Nerves are not getting enough blood supply.
137
What will spinal stenosis cause?
Narrowing of the spinal canal leading to direct nerve root entrapment of indirect nerve root dysfunction through altered blood supply.
138
What can cause myelopathy?
Altered spinal cord function secondary to degenerative spinal stenosis, orthopedic space occupying lesion, traumatic compression and or traction.
139
What are 2 ways injury can occur to the spinal cord causing a myelopathy?
direct damage and secondary through interuption of blood supply.
140
What is a peripheral neuropathy?
Functional disruption of peripheral nerves like carpal tunnel syndrome.
141
Will peripheral neuropathy be dermatomal?
No since it is not the nerve root.
142
What is polyneuritis and polyneuropathies?
Multiple sites of peripheral nerve inflammation and or dysfunction.
143
Polyneuritis and polyneuropahties can be caused by what?
Some systemic metabolic or inflammatory disorder and is not the product of local mechanical irritation or injury.
144
What is neuralgia?
Pain in the distribution of a peripheral nerve not necessarily peripheral nerve inflammation may be referred pain.
145
What are most changes like that occur in the vertebral joints?
Usually benign minor orthopeics caused by changes to the musculoskeletal system.
146
What is the annual incidence of LBP and what is the lifetime incidence?
annual- 56%. Lifetime- 70%.
147
With LBP will more people go to CAM or PCP?
CAM.
148
LBP is the ____ chief presenting complaint to health care provider.
2nd.
149
what is the outcome of LBP?
80-90% recover in 6-8 weeks with or without treatment.
150
How much money is spent on LBP treatment a year?
50-100 billion.
151
How associated to increasing age is LBP?
not necessarily associated.
152
What was the Manga report about?
Effectiveness of chiropractic management of LBP.
153
What are the 3 stages of spinal degeneration?
dysfunction, instabillity, stabilization.
154
Name 5 tissues that are not pain sensitive?
Vertebral body end plate, disc (nucleus), articular cartilage, synovial tissue, interarticular menisci.
155
What is myotomal referred pain?
Pain in the muscular layer.
156
What is sclerotomal pain?
Pain in the deep somatic tissues.
157
What are referred pain patterns like?
Non-dermatomal and are deep, dull, achy, hard to localize, diffuse.
158
What is 1 way to turn of a sensitized WDR?
Chiropractic manipulative therapy.
159
Referred pain happens how?
hyperconvergence, central sensitization LTP.
160
Name the Motor, reflex, and dermatome for C5?
M- deltoid. R- Biceps tendon. D- Lateral part of arm.
161
Name the Motor, reflex, and dermatome for C6?
M-wrist extensors. R- Brachioradialis tendon. D- Lateral part of forearm.
162
Name the Motor, reflex, and dermatome for C7?
M- Wrist flexors. R- Triceps tendon. D- Middle finger/hand.
163
Name the Motor, reflex, and dermatome for C8?
M- Finger flexors. R- none. D- medial part of forearm.
164
Name the Motor, reflex, and dermatome for T1?
M-interossei. R- none. D- medial part of arm.
165
Name the Motor, reflex, and dermatome for L4?
M- tibialis anterior. R- patellar tendon. D- Medial leg and malleolus.
166
Name the Motor, reflex, and dermatome for L5?
M- Extensor digitorum longus. R- Medial hamstring. D- Middle foot.
167
Name the Motor, reflex, and dermatome for S1?
M- Peroneus longus and brevis. R- Achilles tendon. D- lateral foot and lateral leg.
168
What could be the cause of the lateral part of the thigh going numb, but not dermatomal?
Neuralgia paresthetica- from problems with the lateral femoral cutaneous nerve.
169
Most chronic patients have a mix of what type of pain?
Organic and psychogenic pain.
170
What is psychogenic pain?
referred pain.
171
What is central modulation?
Pain can be modified by higher cortical centers inhibiting pain transmission or the individuals response to pain.
172
What are gate-peripheral clinical applications to treat pain?
Counter irritants like heat, cold, TENS, Vibrator, immobilization, massage, manipulation, etc.
173
What are central clinical applications to treat pain?
Personality, emotional status, motivation, past experinces, etc.
174
What is a malingerer?
A person who exaggerates for attention, money in a settlment, or for personal gain.
175
Name 2 tets used to measure psyche?
Minnesota multi plastic personality inventory, and basic depression index.
176
How are pain drawing forms used by the doctor?
There is a scoring pattern you add up points for certain things 1= normal and greater than or equal to 5 is a bad thing.
177
What is the thermocouple device?
A device used by some gonstead doctors.
178
What are 2 inflammatory diseases that would be contraindications for manipulation?
RA and AS.
179
Name 3 vascular disorders that would be contraindications for manipulation?
Aneurysm, bleeding disorders, vertebral artery insufficiency.
180
What type of muscle weakness would be a contraindication for manipulation?
Marked muscle weakness.
181
Manipulation would be what grade of mobilization?
Grade 5.
182
What are the 5 general areas that manipulation will help in?
Mechanical, Neurological, vascular, placebo, and unknown
183
What are the 3 areas in which manipulation can help in the mechanical area?
myofascial, ligamentous, and intra-articular.
184
What are the effects of manipulation on myofascial and ligamentous structures?
Increased flexibility, control fibrosis, reverse effects of adhesions, minimize abnormal collagen cross-link formation.
185
What are the effects of manipulation on intra-articular structures?
Release entrapped meniscoids, unlocking joint surfaces, improve nutrition to articular cartilage, minimize DJD, reposition dynamics of nucleus, reposition herniation, alter tension or load on annular fibers.
186
What are the 2 different parts of neurological items that can be helped by manipulation?
Compression of nerve root, reflexes.
187
What are the effects of manipulation in the neurologicla area of compression?
Increase IVF space, change constant compression to intermittent, improve axoplasmic flow, improve circulation to the nerve root.
188
What are the effects of manipulation in the neurologicla area of reflex?
Muscle relaxation (arthrokinetic reflex), co-activation, viscerosomatic/ somatovisceral, sympa activity normalization, Endorphins.
189
Name 8 categories and effect of physical therapy?
1. Soft tissue manipulation. 2. mechanotherapy. 3. Hydrotherapy. 4. ultrasound. 5. electrotherapies. 6. diathermy. 7. light therapy. 8. Nutritional therapy.
190
Name 3 ways to do mechanotherapy?
Traction, braces, exercise.
191
What are the effects of heat?
Relaxation, increases circulation by vasodilation, counter irritant (gate mechanisim), increases elasticity of CT.
192
When should heat be used?
in post acute which is after 48 hours.
193
What are the effects of cryotherapy?
analgesic, vasoconsrtiction to calm down the inflammatory process, slows nerve conduction, muscle relaxation.
194
How long should cryotherapy be used for?
10-20 minutes.
195
When should a hot tub not be used?
Not used for acute conditions.
196
What are the effects of ultrasound?
deep heat, decreases adhesions, decreases fibrosis, increase molecular fluid movement, micro massage, Phonophoresis- push nutrients into tissues.
197
How deep can ultrasound go?
5cm.
198
Name 5 types of electrotherapy?
Galvanic, muscle stim., interferential, microcurrents, TENS.
199
What is iontophoresis?
pulling nutrients into tissues by electrical means.
200
What is Russian stim. Used for?
Motor rehab.
201
What is microcurrent used for?
Tissue healing.
202
What is a TENS unit used for?
Pain control by endorphins. Not for tissue repair.
203
What are the 4 stages of healing?
1. Inflammation. 2. Consolidation. 3. Regeneration (repair). 4. Remodeling.
204
How long will the inflammation stage of healing last?
72 hours.
205
How will the inflammation stage of healing be started?
Cell membrane is disrupted and releases inflammatory agents.
206
When will the consolidation stage take place?
72 hours- 7days.
207
What is the consolidation stage like?
fibrolbasts and myofibroblasts organize around fibrin (clot) to begin synthesis of collagen.
208
When will the regeneration stage take place?
72 hours- 8 weeks.
209
What happens in the regeneration stage?
fibroblasts and myofibroblasts produce collagen, elastin, proteoglycans, etc. Where regeneration is not possible fibrosis forms. Macrophages clean up the debris. New vessels and nerves grow. Collagenase holds collagen synthesis in check to prevent over production.
210
When will the remodeling stage take place?
3 weeks- 12 months.
211
What happens in the remodeling stage?
contraction of collagen fibers. Collagen fiber diameter increases in response to forces applied, CT becomes stronger and oriented along lines of stress, final flexibility of healing and local funciton capcacity is determined.
212
What type of joint is the SI joint?
Synovial. Sacral side- thickhyaline cartilage. Iliac side- thinner fibrocartilage.
213
What type of joint is the pubic symphysis?
Fibrocartilaginous.
214
What SI ligament is very important in low back pain?
Dorsal sacroiliac ligament.
215
Name some things that can cause a SI subluxation syndrome/ SI sprain?
fall on buttock, misjudged step, unguarded movements, prolonged bending, pregnancy, lower extremityu etiologies, asymmetricla loading.
216
What will the pain be like for a SI subluxation syndrome/ SI sprain?
Local pain, possibly radiating to buttock or groin. Referred pain to thigh possible (usually not past knee), or paresthesias.
217
What activities can aggravate a SI subluxation syndrome/ SI sprain?
Weight bearing, moving from sitting to standing, bending, walking.
218
Name examinations done on the SI joint to determine if a SI subluxation syndrome/ SI sprain is present?
Tenderness aggravated by joint challenge, guarding or difficulty moving from sitting to standing, Gluteal muscle spasms and or myofascial trigger points, Plapatory and postural signs of misalignment, Evaluate for LLI, Alteration of SI motion, should do orthopedic tests.
219
What will a SLR test be like for SI subluxation syndrome?
Local Pain.
220
How is a scoliosis named?
Named for the side of convexity.
221
While doing a standing leg length evaluation how can we tell if there is a LLI?
Trochanteric line is uneven then there is an anatomical LLI.
222
Will a AS ileum or a PI ileum be associated with a longer or shorter leg?
AS- Longer. PI- Shorter.
223
What would a lumbar scoliosis be like for an AS ileum and a PI ileum?
AS- On the oppostie side. PI- same side scoliosis.
224
When doing a situp test what leg will be shorter and what leg will be longer a AS or PI ileum?
AS- Shorter. PI- longer.
225
Anatomical leg length discrepancies greater than what require lift therapy?
6-10 mm.
226
What type of inequality might require a higher percentage of lift correction a short tibia or femer?
Tibial shortening might require a higher percentage correction.
227
What is the 1:2:4 rule of logan?
1/2 inch heel lift will raise the ipsilateral femur head 1/2 inch, the ipsilateral sacral base 1/4 and inch, and the ipsilateral body of L5 1/8 an inch.
228
What should the difference in heel and sole be in a lift?
2:1 ratio of heel:sole.
229
How long will a lift need to be used for an adult with an anatomical LLI?
Probably forever.
230
Name some muscles that stabilize the pelvis?
Quadratus lumborum, abdominal muscles, TFL, Iliopsoas, latisimus dorsi, Erector spinae, hamstrings.
231
What is key to diagnosing a non-traumatic sacroiliac disorder?
History. Progressive insidious onset, pain less influenced by mechanical factors, migratory pain, non nms symptoms.
232
Name the 3 types of non-traumatic sacroiliac disorders specifically mentioned in the notes?
Ankylosing spondylitis, Reiter's syndrome, infectious sacroiliitis.
233
Ankylosing spondylitis is more common in whom?
Three times more likely in males usually age 20-40.
234
What would X-ray findings be for ankylosing spondylitis?
Si joint erosion or sclerosis, fuzzy joint margins, Bamboo spine.
235
What are the lab findings for ankylosing spondylitis?
Elevated ESR, positive HLA-B27.
236
Elevated ESR is caused by what?
Inflammation.
237
How can manipulation help with ankylosing spondylitis?
in the non-acute phase it can help to maintain mobility and slow progression.
238
What is reiter's syndrome?
Reactive arthritis that leads to conjunctivitis, urethritis, sacroilitis. Cant see, pee, dance with me.
239
Reiter's syndrome is more common amoung whom?
Males 5:1.
240
Reiter's syndrome may occur following what?
GI infection.
241
What are the X-ray and lab findings like for Reiter's syndrome?
X-ray- asymmetric SI involvment. Positive HLA-b27, increased ESR and white blood count.
242
What would the signs be of an infecitous sacroilitis?
Warm, acutely inflamed SI joint, non-responsive to conventional treatment for SI dysfunction.
243
What are the X-ray and lab findings like for infectious sacroiliitis?
X-ray- joint erosion or narrowing, juxta-articular osteoporosis. Elevated ESR and white count, Positive SI culture.
244
Will there be pain or no pain during Passive ROM, active ROM, isometric contractions for strains?
no pain for Passive ROM, but pain for active ROM and isometric contraction.
245
Will there be pain or no pain during Passive ROM, active ROM, isometric contractions for sprains?
pain for both passive and active ROM, but no pain for isometric contraction.
246
With a lumbar strain the rapidity of pain onset usually indicates what?
severity.
247
With a lumbar strain there will be limited range of motion in which direction?
The direction that stresses the muscle like bending away from the involved muscle.
248
What will muscle spasms do to lumbar lordosis?
The more the muscle spasm the less the lordosis.
249
What can be done to help the healing of a muscle strain?
The nutritional and botanical supplements that may promote and or support healing processes.
250
What will RICE or PRICE stand for when talking about strain treatment?
Rest, Ice, Compression, Elevation. P can be for protect.
251
Name a complication of a strain injury?
myofibrosis.
252
What is myofibrosis?
Fibrous repair of myofascial tissues that come as a result of trauma or significant immobilization.
253
What should the treatment goals of myofibrosis be?
Restore local elasticity and function, pain reduction, minimize risk of recurrent injury.
254
What should the treatment plan of myofibrosis be?
Local heat, stretching, trigger point therapy, ultrasound, regional exercises, aerobic conditioning.
255
Name some common ways to sprain the lumbar spine?
Lifting in full flexion, fall, sudden blow, jarring or partial fall, extension, postural or occupational loading.
256
What will lumbar sprain pain be like?
Usually more localized and sharper than strain, with referred pain into buttock and thigh, Pain that is intensified with movements like orthopedic tests.
257
What type of manipulation can be used to treat a sprain?
cautiously in a pain free direction.
258
What is a complication of sprain injury or prolonged immobilization?
Periarticular fibrosis.
259
Name the 4 stages of healing and how long they each last?
1. Inflammation- 72 hours. 2. Consolidation 72 hours- 7 days. 3. Regeneration (repair) 8 weeks. 4. Remodeling 3 weeks- 12 months.
260
Name some things that can inhibit or slow the healing process.
Diabetes, poor nutrition, corticosteroid use, concurrent infeciton, early heat application, smoking, poorly vascularized tissue.
261
How will bioflavinoids help with healing?
Restrict vascular permeability (limit swelling), Reduce capillary fragility and brusing.
262
How will proteolytic enzymes help with healing?
May reduce inflammatory response by breaking down inflammatory proteins. They may improve local circulation by breaking down cell debris and fibrin.
263
What is a myofascial pain syndrome?
Syndrome involving wide spread muscular aching and stiffness accompanied by localized sites of deep myofascial tenderness.
264
What is a myofascial trigger point?
hyperirritable locus within a taut band of skeletal muscle located in the muscluar tissue and or its associated fascia.
265
What is a histological study of long term trigger points like?
connective tissue infiltration, Fat-dusting and other morphological changes.
266
Name some things that can cause a myofascial trigger point?
trauma, emotional stress, immobilization, chilling, viscero-somatic reflexes, joint dysfunction, congenital anomalies, nutritional inadequacies.
267
Name 3 associated autonomic phenomena that are seen with myofascial trigger points and what are they?
Vasomotor- circulation change. Pilomotor- goose bumps. Sudomotor- sweat.
268
Name 9 treatments for trigger points?
Point pressure, massage, stretching, CMT, heat or ice, electrotherapies or ultrasound, injection of local anesthetic/steroid combo, home care, bo-tox.
269
What are the goals of point pressure/ digital compression of a trigger point?
ischemic compressino leading to increased vasodilation after, local stretch, counter irritanat, targeted effect, decreaseding adhesions, unlock sarcomers.
270
What are the 2 categories of myofascial pain?
myofascial pain syndrome (includes trigger points), fibromyalgia syndrome.
271
In general what is the difference between myofascial pain syndrome and fibromyalgia?
myofacial pain syndrome- specific muscle involvment with referred pain. Fibromyalgia- generalized aching and stiffness.
272
What is the onset of myofascial pain syndrome vs fibromyalgia like?
MPS- precipitated by trauma. Fibromyalgia- chronic, insidious course.
273
What will sleep be like for MPS vs fibromylagia?
MPS- no sleep disturbance. Fibromyalgia- chronic sleep disorder.
274
What is the difference in pain of MPS vs. fibromyalgia?
MPS- localized spasm and tenderness with local edema and decreased ROM. Fibromyalgia- cant palpate like a trigger point, but local tenderness is there and usually bilateral.
275
Who is more likely to get fibromyalgia vs. MPS?
MPS- female male ratio is equal. Fibromyalgia- 80% female.
276
What is the definition of fibromyalgia?
syndrome of widespread pain in muscles and other connective tissue and is associated with characteristic tender points, sleep disorder, and other systemic manifestations.
277
What are the 3 types of fibromyalgia?
1. Primary. 2. Secondary- reactive (SLE, sever DJD). 3. post-traumatic fibromyalgia.
278
There are lots of possible causes of fibromyalgia, but in general it is what type of disorder?
CNS pain processing disorder.
279
How will fibromyalgia effect sleep?
increased alpha waves during delta wave sleep.
280
What are the associated clinical features of fibromyalgia?
chronic fatigue, IBS, Muscle stiffness especially in morning, headaches, depression.
281
What do you need to diagnose someone with fibromyalgia?
subjective aching and stiffness for over 3 months, tender points, symmetrical bilateral tenderness, associated clinical features, fibromyalgia personality, normal- labs, x-rays and EMG studies.
282
Where are the common tender points found with fibromyalgia?
upper traps, supraspinatus, gluteal, pec. Major, inferior SCM, greater trochanter, medical kness, sub occipital, lateral epicondyle.
283
What are some of the nutritional ideas to treat fibromyalgia?
magnesium, malic acid, trytophan, B6, B12, SAMe, increase fluids, decrease caffine, check for allergies.
284
What is obstructive sleep anea?
Stop breathing while sleeping.
285
What are 4 Differential diagnoses for patients with widespread pain and fatigue?
Metabolic functional, musculoskeletal, medical-pathologic, classic fibromyalgia.
286
What is lumbar or lumbosacral posterior joint syndrome (facet syndrome)?
Pain and dysfunction arising primarily from the lumbar or lumbosacral zygapophyseal joints and adjacent soft tissues.
287
What are 4 things that can cause lumbosacral posterior joint syndrome aka facet syndrome?
1. Intrarticular- intradiscal block. 2. Articular strain. 3. Segmental muscle imbalance and in-corrdination. 4. Joint dysfunction as complication of associated soft tissue injury.
288
What will pain be like with facet syndrome?
Pain will be mild to marked unilateral and pain will increase with movement. May refer to buttock and posterior thigh.
289
How will patients present with facet syndrome?
Antalgia (move away from pain)- typically away in acute patients.
290
What will be observed during a facet syndrome examination?
Normal or slight flexion and lateral flexion antalgias.
291
What will ROM be like during an examination of a patient with facet syndrome?
Decreased globally and segmentally typically into extension and lateral flexion toward painful side or returning from flexion.
292
What will palpation be like during an examination of a patient with facet syndrome?
muscle spasm and tenderness possibly associated trigger point, decreased segmental motion, painful joint play.
293
Name 3 orthopedic tests that can be done to evaluate a facet syndrome?
Kemps, DSLR, SLR.
294
Will there be any neuro problems seen with facet syndrome?
no.
295
What would x-ray findings be like for facet syndrome?
lateral bending films may demonstrate aberrant or restricted motion.
296
Low back pain is caused by what things (give %)?
Disc- 40%, facets- 15-40%, SI joint- 13-30%.
297
How often will facets cause pain in the cervicals?
more than 50%.
298
How many points do you need on a facet syndrome diagnostic scorecard to have the test claim it is facet syndrome?
60 or more.
299
Will back pain with associated thigh or groin pain be associated with facet syndrome?
yes.
300
What is an orthopedic test that is extension-rotation?
Kemps.
301
Will pain below the knee be associated with facet syndrome?
No.
302
With facet syndrome when might the low back be stiff?
In morning or after decreased activity.
303
What will the SLR test be like for a facet syndrome pateint?
Hip, buttock, and or back pain.
304
What motion will induce pain for facet and disc problems?
Facet- extension. Disc- flexion.
305
What postion will induce pain for facet and disc problems?
Facet- standing. Disc- sitting.
306
What is the difference in pain for facet and disc problems?
Facet- localized facet pain. Disc- deeper pain.
307
What will happen to the lordotic curve with facet and disc problems?
Facet- Hyperlordosis. Disc- hypolordosis.
308
What things might aggravate facet and disc problems?
Facet- kemp's test. Disc- dejerine's triad.
309
What is dejerine's triad?
Coughing, sneezing, straining (valsalva).
310
What is tropism and will it be associated with facet or disc problems?
uneven facet joints and is associated with facet syndrome.
311
What are 3 goals for treatment of facet syndrome?
1. Control pain and associated inflammation. 2. restore joint mobility if restrictions persist after acute stage. 3. address predisposing and perpetuating factors.
312
What are ways to control pain and associated inflammation with facet syndrome?
Distractive CMT, cryotherapy, electrotherapies.
313
What are ways to restore joint mobility with facet syndrome?
CMT.
314
What are ways to address predisposing and perpetuating factors with facet syndrome?
Improve fitness with aerobic conditioning. Stretching, posture, weight control.
315
What will cause chronic facet syndrome?
previous trauma or reoccuring mechanical injuries producing tissue derangement, chronic inflammation and persistent joint restrictions.
316
What will the history of a typical patient with chronic facet syndrome be like?
prolonged with reoccuring painful episodes and catches. Dull ache or sense of weakness, and is aggravated by weight bearing postures especially in extension.
317
What will motion palpation be like for a chronic facet syndrome patient?
may be restricted due to fibrosis or muscle splinting in the painful unstable joint.
318
What will cause osteoarthrosis?
Acute or repetitive trauma leading to permanent joint derangement and egeneration.
319
What will a patient with osetoarthrosis presentation be like?
similar to chronic facet syndrome patient.
320
Will the degree of degeneration seen with osteoarthrosis directly correspond to symptoms an individual may have?
No.
321
What are the x-ray findings like with osteoarthrosis?
joint thinning, joint erosion, joint sclerosis, osteophytosis, bony remodeling, alterations in lines and angles.
322
Osteoarthrosis is aka?
Spondyloarthrosis, DJD.
323
Name 3 types of treatment for osteoarthrosis?
CMT, STM and mobilization, patient education and home care.
324
What are the categories for treatment parameters for common NMS conditions?
I-IV.
325
How many weeks of treatment will go with the different categories of treatment for common NMS conditions?
I- 0-6 weeks. II- 2-12 weeks. III- 1-6 months. IV- 2-12 months.
326
What will be found in category II for the most part?
things with moderate or marked pain. Including some chronic conditions.
327
What will be foind in category III for the most part?
Marked pain. Chronic conditions.
328
acute and chronic facet syndrome will be in which categorie?
acute- I. Chronic- II and III- if associated with clinical vertebral instability.
329
What will category IV be like for the most part?
Marked pain and neurological complications are also found in the list.
330
What is lumbosacral instability?
segmental aberrant (deviating from the ordinary, usual, or normal type; exceptional; abnormal) motion, or increased movement.
331
What can cause lumbosacral instability?
injury or elongation of supportive ligaments, spondylolisthesis (pars defects), damage or dysfunction of articular mechanoreceptors and proprioceptors, Deconditioning, DJD.
332
What will the pain be like for lumbosacral instability?
Chronic low back pain, back gives out, locks up, or catches suddenly.
333
What can make pain from lumboscaral instability worse?
worse when muscles are relaxed.
334
What is seen with an active ROM examination on a patient with lumbosacral instability?
visible catch or alteration in active ROM.
335
What will the SP palpation be like for sponylolisthesis?
Step-off defect.
336
What are the x-ray findings like with lumbosacral instability?
marked segmental malpositions or listhesis, DJD, increased translation, positive traction/compression test.
337
Name 4 goals for treatment of lumbosacral instability?
1. Minimize forces and loading to involved joints. 2. Relieve acute episodes of joint locking to control pain. 3. improve support of unstable area and normalize and balance muscle tone. 4. improve balance, posture, proprioceptive control, coordination.
338
How can you minimize forces and loading to involved joints found in lumbosacral instability?
CMT of restricted joints above and below unstable segments.
339
How can you relive acute pain episodes of joint locking to control pain found with lumbosacral instability?
Specific manipulation to area of instability in a pain-free direction.
340
How can you improve support of unstable area and normalize and balance muscle tone that is found with lumbosacral instability?
Bracing as needed, muscle strengthening of entire low back and trunk muscles. Self stabilization techniques. Stretching.
341
How can you improve balance, posture, and proprioception?
Proprioceptive rehabiliation, balance exercises, exercise ball, endurance techniques.
342
What is an engram?
A persistne change in the brain that is formed in response to a stimulus, and is the neuronal substrate for memory aka memory trace.
343
What are the goals of exercise?
Improved muscle strength, improved muscle endurance, improved coordination and proprioception, and retrain the CNS.
344
What are some orthopedic things that can cause nerve root compresison syndrome (radiculopathy)?
Disc, spondyloarthrosis, ligamentous, tractional injury, nerve root adhesions, marked facetal subluxation coupled with posterior joint degeneration or instability.
345
What are some pathophysiology of nerve injury?
Compression, direct trauma, inflammatory.
346
What are the 2 types of compression seen with nerve injury?
direct- physical deformation of nerve root fibers. Indirect- disruption of blood supply.
347
What are the different types of direct trauma seen with nerve injury and how long will they take to heal?
primary (neuropraxia)- 2 weeks- 2 months. Secondary (axontomesis)- 2 months- 6 months. Tertiary (neurotmesis)- 6 months- 2years.
348
What will inflammation of the nerve root cause?
Pain without inflammation you really wont have pain.
349
How will the IVD name correspond with the vertebral body levels?
The IVD is named for the vertebral body above it. So IVD L4 will be between vertebral body L4-5.
350
What is the difference between Lower motor neuron and Upper motor neuron?
LMN- final common pathway of the nerve and is in the PNS. UMN- in spinal cord or CNS.
351
What are the nerve roots that make up the sciatic nerve?
L4-S3.
352
What will travel in the spinalthalamic tract and how?
Pain and temperature and it decessates and travels up the opposite side in the anterolateral tract.
353
What will travel in the posterior column of the spinal cord and how?
Fine touch and vibration travel up the same side (no decessation).
354
What would happen with minimal compression or irritation of a nerve root?
muscle hypertonicity and muscle tenderness.
355
What would happen with marked compression of a nerve root?
Decreased muscle strength, decreased or absent DTR, Atrophy.
