cervical disc disease

Question 1

what is the outer 1/3 of the annulus fibrosis innervated by

Answer 1

sinuvertebral

vertebral

Question 2

sinuvertebral arises from what?

vertebral arises from what?

Answer 2

sinuvertebral - ventral ramus - somatic root

vertebral - sympathetic chain - autonomic root

Question 3

what 2 age peaks are prevalent in radiculopathy

Answer 3

20s - disc herniation

60s - DJD - spurs/protrusion

Question 4

symptoms of a disc

Answer 4

referred pain
muscle spasm
myofascial pain
autonomic component

Question 5

annulus is made of what

Answer 5

collagenous lamella

Question 6

annulus collagen arranged how

Answer 6

35 degree angle from horizontal

Question 7

annulus is more susecptible to injury with what movements

Answer 7

rotation and translation

Question 8

annulus is what percent water

Answer 8

65

Question 9

what kind of collagen is in annulus

Answer 9

1 and 2

Question 10

what is seen near where the annulus attaches to the end plate

Answer 10

elastic fibers

Question 11

lamellae are made up of what

inner and outer?

Answer 11

type 1 and 2 collagen

inner - type 2
outer - type 1

Question 12

what are components of annulus

Answer 12

water 65
collagen 55
proteoglycans 20
elastic fibers at endplate

Question 13

what is the major component of nucleus pulposus

Answer 13

water 80

Question 14

what are the components of nucleus pulposus

Answer 14

water 80
proteoglycans 65
type 2 collagen 17
elastic fibers

Question 15

what traps and holds water which gives the nucleus pulposus its strength and resiliency

Answer 15

proteoglycans aggrecan

Question 16

cervical disc herniation of nucleus pulposus usually hits what root

Answer 16

the next numbered root

if herniation at c5-c6
c6 is affected

Question 17

referred pain

c6-c7 disc is felt where?
c5-c6 disc is felt where?
c4-c5 disc is felt where?
c3-c4 disc is felt where?

Answer 17

c6-c7 - inferior angle of scap
c5-c6 - medial scap border
c4-c5 - scap spine and superior angle
c3-c4 - c7 sp and posterior border of trapezius

Question 18

what is the most common cause of cervical radiculopathy

Answer 18

foraminal encroachment

Question 19

herniation of nucleus pulposus in cervical spine percentage

Answer 19

20-25 percent

Question 20

what is the most common NERVE ROOT LEVEL affected by radiculopathies

what is the most uncommon

Answer 20

c7

c5

Question 21

the disc begins to degenerate in the __ decade of life

Answer 21

2nd

Question 22

what causes degradation of the nucleus, which decreases rigidity

Answer 22

endplate cracks

Question 23

buckling of the annulus leads to what

Answer 23

circumferential tears for in osterolateral annulus

Question 24

circumferential tears will form ___ which will progress to what

Answer 24

radial tears

radial fissures

Question 25

what pathology dscribes annular fissuring within the disc without external disc deformation

Answer 25

internal disc derangement

Question 26

internal disc derangement occurs when?

Answer 26

trauma degradation cervical flex and rotation injury whiplash

Question 27

what serves as a major pain generator in herniation

Answer 27

outer annulus fibrosis

Question 28

degenerative disc disease may progress to what

Answer 28

internal disc derangement

Question 29

describe discogenic pain without nerve root involvement

Answer 29

vague, diffuse, distributed axially

Question 30

what irritates and alleviates discogenic pain

Answer 30

worse - increase in intradiscal pressure due to lifting or valsalva maneuver, vibration better - lying supine to decrease intradiscal pressure

Question 31

discogenic pain that is referred from disc to upper limb usually is what

Answer 31

nondermatomal

Question 32

pain generators - different types

Answer 32

chemical - inflammation, neurogenic ischemic mechanical - pressure or stretch

Question 33

describe radicular pain

Answer 33

deep, dull, achy, sharp, burning, electric

Question 34

radicular pain that is referred from disc to upper limb usually is what

Answer 34

myotomal or dermatomal

Question 35

cervical radicular pain most commonly radiates where

Answer 35

interscapular region but also can go to occiput, shoulder, arm

Question 36

what is present with radicular pain in regards to distal limbs and proximal limb

Answer 36

distal limb - numbness | proximal limb - weakness

Question 37

what are the two components of radicular pain

Answer 37

constant deep dull ache sharp lacerating theories - dural vs root ischemia vs stretch compression vs inflammation

Question 38

what is dynatome

Answer 38

area where pain is experienced with root pathology

Question 39

what is dermatome

Answer 39

area of sensory disturbance with root pathology

Question 40

radicular pain - decreased sensation to pain, touch, vibration may be present in the distal limb in what distribution

Answer 40

dermatome

Question 41

radicular pain - proximal limb weakness manifests when what is compromised

Answer 41

motor root

Question 42

patient with radicular pain experiences a decrease in what

Answer 42

range of motion

Question 43

what worsens a patient with radicular pain

Answer 43

neck extension and rotation

Question 44

what makes it better for the patient with radicular pain

Answer 44

neck flexion and abduction of affected limb (bakody)

Question 45

radicular pain may have diminished or absent reflexes where?

Answer 45

at the coresponding root level

Question 46

what signs suggest myelopathy and mandate evaluation

Answer 46

increased upper and lower limb reflexes UMN signs

Question 47

what cervical roots are clinical most important to ambulatory practice

Answer 47

c5-t1

Question 48

c5-t1 exit where

Answer 48

at the same numbered disc

Question 49

which cord segments are difficult to test clinically

Answer 49

c1-c4

Question 50

bicpes reflex indicates integrity of what

Answer 50

c5 neurological level

Question 51

c5 root exits the c4-c5 ivf and is often hit by

Answer 51

c4 disc

Question 52

c5 neurological level found where c6 neurological level found where c7 neurological level found where c8 neurological level found where

Answer 52

c5 - found at c4-c5 c6 - found at c5-c6 c7 - found at c6-c7 c8 - found at c7-t1

Question 53

c5 neuro level

Answer 53

motor - deltoid and biceps biceps c5-c6 reflex - biceps and inverted radial reflex sensation - superior lateral aspect of arm/shoulder

Question 54

c6 neuro level

Answer 54

motor - wrist extensors reflex - brachioradialis sensation - tips of thumb, index, and long finger

Question 55

pain is more ___ and paresthesia is more ___

Answer 55

pain is proximal paresthesia is distal

Question 56

c7 neuro level

Answer 56

motor - wrist flexion reflex - triceps sensation - posterior aspect of arm, poterolateral forearm, dorsum hand, ring finger, little finger

Question 57

c7 neuro dysfunction is associated with weakness of what

Answer 57

wrist flexors, triceps, pronators

Question 58

c8 neuro level

Answer 58

motor - finger flexion reflex - none sensation - medial forearm

Question 59

c8 neuro dysfunction is associated with weakness of what

Answer 59

interossei motor weakness

Question 60

t1 neuro dysfunction is associated with what

Answer 60

weak atrophy of intrinsic hand muscles | pain numbness tingling at or above elbow, may have horners syndrome from pregang fibers

Question 61

t1 neuro level

Answer 61

motor - interossei muscle reflex - none senstation - medial brachium

Question 62

why is MRI useful

Answer 62

great for imaging disc and relationship to thecal sac