Cervical Spine pathology Flashcards
(137 cards)
1
Q
How can nerve stretching occur
A
Fall on arm, pull on arm, and seat belt during an accident
2
Q
What is cervical stenosis
A
Narrowing of the intervertbral foramen or vertebral foramen
3
Q
What is on symptom of down syndrome in the cervical spine
A
Laxity of transverse ligament
4
Q
What should you not do with a person with down syndrome
A
Cervical spine manipulation
5
Q
What is DDD
A
Degenerative disc disease
6
Q
What is DJD
A
Degenerative joint disease
7
Q
What is spondylosis
A
Wear and tear
8
Q
What is tortocollis
A
Rye neck, side bending or distortion of neck
9
Q
What is an ataxic gait
A
An unstable staggering gait
10
Q
What causes acute tortocillis
A
Nerve impingment, muscle guarding, slept wrong, derangement of disc
11
Q
What is the estimated % of incidence of neck pain
A
10-20%
12
Q
What percent of people who experienced neck pain had neck pain in the last 6 months
A
54%
13
Q
What is the estimated % of population that will experience neck pain
A
22-70%
14
Q
When is the prevalence of neck pain most common
A
Women in the 5th decade of life
15
Q
Where should the center of gravity be for the cervical spine
A
Anterior to the OA joint
16
Q
What is postural syndrome
A
Only being in the specific posture causes pain
17
Q
When is the problem considered to be musculoskeletal
A
If pain or symptoms change with movement
18
Q
True or False:
Referred pain is more involved pain
A
True
19
Q
True or False:
Stenosis can cause radicular pain
A
True
20
Q
What are the 5 things to look for when clinically examining impaired posture
A
- A/PROM
- Strength and endurance
- Accessory motion test (joint play)
- Postural exam
- Ergonomics (work place)
21
Q
What are some examples of MOI for acute injuries (5)
A
- Violent flexion
- Impaction (compression)
- Lateral stretch injuries
- Extension
- Whiplash
22
Q
What is whiplash
A
Extension followed by flexion
23
Q
What are some factors that result in poorer chance of recovery from whiplash (4)
A
- Older than 35
- Higher level of disability
- Trouble sleeping
- Irritable: overly alerts, easily startled
24
Q
What is an insult
A
Injury
25
What is the order of soft tissue disruption with forward flexion injury (5)
1. Supraspinous ligament
2. Infraspinous ligament
3. Capsule
4. Disc (nucleus pulposus)
5. Bone insult possible
26
True or False:
| You should move in the direction that makes symptoms worse to promote healing
False
27
True or False:
| Finding the preferred direction of movement is key in the healing process
True
28
What is a high state of contractility
Spasm
29
What is it called when all muscles contract to hold muscles still
Guarding
30
What are the tissues insulted due to trauma (6)
1. Ligament
2. Musculotendonous units
3. Bone
4. Disc
5. Articular capsule
6. Nerves/Spinal cord
31
What makes up the brachial plexus
Anterior rami of C5-T1
32
What nerves make up the brachial plexus (9)
1. Subscapular
2. Suprascapular
3. Radial
4. Musculocutaneous
5. Median
6. Thoracodorsal
7. Long thoracic
8. Dorsal scapular
9. Median cutaneous nerve
33
What are the 3 classes of brachial plexus injuries
1. Class 1: Neuropraxia
2. Class 2: Axonotmesis
3. Class 3: Neurotmesis
34
What causes neuropraxia
No actual damage to the nerve, only compression, it is the most common, stinger
35
How long does pain last during neuropraxia
5 minutes - 25 hours
36
What causes an axonotmesis
Some axon and nerve damage due to a crush mechanism
37
What are symptoms of axonotmesis
Wallerian degeneration and muscle weakness
38
What is wallerian degeneration
Injury to nerve where part distal to injury loses axon, myelin, and conduction ability
39
How long do symptoms last for axonotmesis
10 days - 2 weeks
40
What causes neurotmesis
Partial tear or complete severance of all neural and connective tissue elements
41
How long does it take a neurotmesis to repair
For a partial tear up to a year
| For full tear there is little hope that function will recover
42
What are the 4 peripheral nerves that can have secondary trauma
1. Spinal accessory nerve
2. Suprascapular nerve
3. Axillary nerve
4. Long thoracic nerve
43
What causes injury of the spinal accessory nerve
Injury near clavicle
44
What causes injury of the suprascapular nerve
Blow to the base of the neck
45
What causes injury to the axillary nerve
GH dislocation or GH hyperextension
46
What does the spinal accessory nerve innervate
Trapezius and sternocleidomastoid
47
What does the suprascapular nerve innervate
Supraspinatus and infraspinatus
48
What does the axillary nerve innervate
Deltoid and teres minor
49
What does the long thoracic nerve innervate
Serratus anterior
50
What is stenosis
Narrowing
51
What is the diameter of the spinal canal
17-18 mm
52
What is the diameter of the spinal cord
About 10 mm
53
Where does a lateral stenosis occur
Intervertebral foramen
54
What type of problem does a lateral stenosis cause
LMN
55
What type of problem does a central stenosis cause
UMN
56
What is a primary stenosis
Congenital
57
What is a secondary stenosis
Degenerative condition
58
How do you view the intervertebral foramen on an x-ray
Oblique x-rays
59
How do you view the facets on an x-ray
Lateral x-rays
60
What does a lateral stenosis cause
Radiculopathy
61
What symptoms does a lateral stenosis come with (3)
1. Parathesias/dysathesias in a dermatomal pattern
2. Myotomal deficit
3. Hyporeflexive
62
What does a central stenosis cause
Myelopathy
63
What symptoms does a central stenosis come with (4)
1. Neck pain
2. Unsteadiness in gait or clumsiness
3. Extrasegmental distribution of parathesia
4. Hyperreflexive
64
What is the surgical repair for a lateral stenosis
Widening of the intervertebral foramen
65
What is the surgical repair for a central stenosis
Laminectomy
66
What are characteristics of DJD in older adults (4)
1. Increase of calcific deposits in and around the periphery of the joint
2. Wearing away of hyaline cartilage
3. Thickening of the synovial lining and joint capsule
4. Thickening of subchondral bone
67
What are characteristics of DDD in older adults (4)
1. Dehydration of nucleus pulposus
2. Narrowing of intervertebral space
3. Weakening and degeneration of the annular rings
4. Approximation of the facet joints
68
How do you treat DJD (3)
Laminectomy, PT, and NSAIDS
69
How do you treat DDD (3)
PT, NSAIDS, and opening of intervertebral canal
70
How do you image DJD (2)
X-ray or bone scan
71
How do you image DDD (3)
X-ray, MRI, or CT
72
True or False:
| You should do manipulations of the neck for patients with RA
False
73
What is RA
Systemic autoimmune inflammatory disease
74
Most common group to get RA
Young-middle aged females
75
True or False:
| People with RA have joint laxity and deformity
True
76
How do you care for RA
PROM
77
True or False:
| Cervical rotation can cause rupture of the transverse ligament of the atlas
True
78
How many births result in a child with down syndrome
1 in 600 births
79
What is another name for down syndrome
Trisomy 21
80
What are characteristics of down syndrome (5)
1. Sloping forehead
2. Small ear canal
3. Absent bridge to nose
4. Low set ears
5. Dwarfed physique
81
True or False:
| Down syndrome patients have agenesis or hypoplasia of the odontoid process
True
82
What is torticollis or wry neck
Congenital muscular abnormality
83
What causes torticollis
Unknown but 40% of patients had a difficult birth
84
When is torticollis noticeable
The first few weeks of life
85
How does idiopathic torticollis present
Head laterally flexed to ipsilateral side and rotated to the contralateral side
86
What percent of people with torticollis have dsyplasia of 1 or both hips
20%
87
What is the most common treatment of wry neck
Stretching within the 1st month (90%)
88
What is the surgical treatment for torticollis
Muscle division and release (10%)
89
What are cervical headaches
Headaches which change as a result of movement and posture
90
Does dysfunction cause intermittent or constant pain
Intermittent
91
Does posture cause intermittent or constant pain
Intermittent
92
Does derangement cause intermittent or constant pain
Constant
93
What is another name for the mechanical diagnosis and therapy (MDT)
Mckenzie Approach
94
How are patients classified using MDT
According to patient response to repeated movements
95
What do MDT interventions rely heavily on
Patient generated forces
96
True or False:
Manual therapy is incorporated in the Mckenzie Approach once the patient plateaus with self treatment or is incapable of self treatment
True
97
What are the 3 types of classifications of Mechanical Diagnosis and Therapy
1. Postural syndrome
2. Dysfunction syndrome
3. Derangement syndrome
98
What is postural syndrome
Test movements do not reproduce complaint, symptoms brought on by sustained posture
99
What is dysfunction syndrome
Shortened or impaired CT, typically produces end range pain
100
What is derangement syndrome
Symptoms may dramatically change as a result of test movements
101
How are cervical spine derangements determined classified
Determined by the movement examination and history
102
How is cervical spine derangement pain characterized
Pain during movement or end range pain
103
What are the locations of cervical spine derangement pain
Centralized or peripheralized
104
What is centraliztaion
The progressive reduction and abolition of distal pain in response to therapeutic loading strategies
105
What did Werneke et al determine by categorization of changes in pain location
Mechanical assessment and treatment allowed identification of patients with improved treatment outcomes
106
What is direction of preference
An immediate, lasting improvement in pain from performing either repeated flexion, extension, or sideglide/rotation tests
107
1/2 identifies what type of derangement
Central
108
3/5 identifies what type of derangement
Posterolateral (peripheral)
109
4/6 identifies what type of derangement
Far lateral
110
7 identifies what type of derangement
Anterior
111
Which number derangements have deformities
2, 4, and 6
112
What type of derangement does 2 have
Kyphosis
113
What type of derangement does 4 have
Torticollis
114
What type of derangement does 6 have
Torticollis
115
Which number derangements do not have a derangement
1, 3, 5, and 7
116
What number derangements get worse with flexion
1-6
117
What number derangements effect the elbow and up
3 and 4
118
What number derangements effect the elbow and down
5 and 6
119
What number derangements cause central symmetrical
1, 2, and 7
120
What number derangements cause unilateral asymmetrical symptoms to the elbow
3, 4, and 7
121
What number derangements cause unilateral asymmetrical symptoms to below the elbow
5 and 6
122
Who gets acute torticollis
Usually adults
123
What does acute torticollis present with
Flexion and rotation to ipsilateral side
124
What causes acute torticollis
Age and derangement
125
What does a PT having an identification system provide patients
Better outcomes and more specific interventions
126
True or False:
| A 7 derangement can be anterior lateral as well as anterior medial
True
127
Do PTs treat based on pathophysiology or based on classifications
Classifications
128
True or False:
| You should always rule out a derangement first for safety resonses
True
129
True or False:
| You should test passive range of motion before active range of motion
False
130
Pain in center of spine
1,2,7
131
Pain of to side of spine
3,4,5,6
132
What responds better to retraction and extension
1
133
What responds to side bending or retraction depending on location
3 and 5
134
Pain below elbow worse with flexion
5
135
What causes a 7 derangement
Whiplash
136
What is a flexion responder
7
137
What gets worse with extension
7
