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Musculoskel. II > Cervicothoracic Differential Diagnoses > Flashcards

Cervicothoracic Differential Diagnoses Flashcards

Week 3 (55 cards)

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1
Q

What musculoskeletal changes are associated with forward head posture?

A

Disk degeneration, vertebral wedging, ligamentous calcification, and reduction in cervical/lumbar lordosis.

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2
Q

How does forward head posture affect muscle activity?

A

Lengthened muscles have increased spindle activity, leading to reciprocal inhibition of their functional antagonists.

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3
Q

What cervical levels are most affected by forward head posture?

A

C5-C6 and C6-C7 due to increased facet joint weight-bearing and potential osteophytosis.

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4
Q

What exercises are recommended for forward head posture?

A

Deep cervical flexor and shoulder retractor strengthening, cervical extensor and pectoral muscle stretching.

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5
Q

What is mechanical neck pain?

A

A disorder where imaging fails to identify a relevant lesion; no cervical radiculopathy or non-musculoskeletal causes.

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6
Q

What are key biological factors in chronic mechanical neck pain?

A

Altered neural transmission, pressure pain sensitivity, and central pain processing changes.

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7
Q

What psychological models explain pain persistence in mechanical neck pain?

A

Fear-Avoidance, Misdirected Problem-Solving, and Self-Efficacy models.

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8
Q

At which level are disk herniations rare?

A

C2-C3

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9
Q

What is a common symptom of cervical disc herniation?

A

Neck and arm pain, usually insidious in onset, radiating along specific dermatomes.

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10
Q

What cervical disc herniation levels are most common?

A

C5-C6 and C6-C7.

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11
Q

What are common symptoms of zygapophyseal joint dysfunction?

A

Unilateral neck pain following sudden backward bending, side bending, or rotation.

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12
Q

What are more conservative interventions for Zygapophyseal Joint Dysfunction?

A

cryotherapy, electrotherapeutic modalities to control pain/inflammation
joint mobz w/ flex/ext and rotation w/ traction

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13
Q

What clinical prediction rule (CPR) predicts success with thoracic spine thrust manipulation (ZJD)?

A

Symptoms <30 days, no symptoms distal to shoulder, FABQ score <12, diminished upper thoracic kyphosis, cervical extension ROM <30°.

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14
Q

What can cause cervical instability?

A
  • trauma
  • surgery
  • systemic disease
  • degenerative changes to motion segment
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15
Q

What are signs of minor cervical instability?

A

History of trauma, catching/locking, unpredictable symptoms, subjective neck weakness, and muscle spasms.

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16
Q

What interventions are used for cervical instability?

A

Cervicothoracic stabilization programs to restore ROM, strength, and endurance.

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17
Q

What is whiplash?

A

A sudden acceleration-deceleration injury to the neck from external forces.

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18
Q

What interventions are recommended for WAD?

A

Neck-specific exercises, ROM exercises, gentle isometrics, scapular stabilization, and postural training.

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19
Q

What anatomical structures define the thoracic outlet?

A

First rib, clavicle, scapula, interscalene triangle, and costoclavicular space.

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20
Q

What is the most commonly compressed neural structure?

A

C8-T1 nerve roots

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21
Q

What are the three types of TOS?

A

Neurogenic (95%), Venous (4%), Arterial (1%).

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22
Q

How to tell if it is Neurogenic TOS?

A

compression of brachial plexus at scalene triangle

local or extremity pain exacerbated by lifting the arms overhead

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23
Q

How to tell if it is Venous TOS?

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A

compression of subclavian vain by structures making up costoclavicular junction

24
Q

How to tell if it is Arterial TOS?

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A

compression due to abnormal bony or ligamentous structures at thoracic outlet region

25
What is the primary intervention for TOS?
Postural correction, strengthening of scapular stabilizers, first rib mobilization, and muscle stretching.
26
What is the clinical presentation of TOS?
diffuse arm and shoulder pain, especially when the arm is elevated beyond 90 degrees Potential symptoms include pain localized in the neck, face, head, upper extremity, chest, shoulder, or axilla; and upper extremity paresthesias, numbness, weakness, heaviness, fatigability, swelling, discoloration, ulceration, or Raynaud phenomenon
27
What is cervicogenic dizziness?
A clinical syndrome characterized by dizziness and neck pain due to altered cervical proprioception.
28
What symptoms differentiate cervicogenic dizziness from other causes of dizziness?
No aural fullness, tinnitus, or hearing loss; dizziness is linked to neck movements.
29
What interventions are used for cervicogenic dizziness?
Cervical spine stabilization, manual therapy, and deep neck flexor endurance training.
30
What is the definition of a cervicogenic headache?
Referred pain perceived in the head from cervical musculoskeletal dysfunction.
31
What are key diagnostic criteria for cervicogenic headaches?
Pain localized to neck and occiput, aggravated by neck movements, and associated with reduced cervical ROM.
32
What interventions are used for cervicogenic headaches?
Postural correction, manual therapy, cervical strengthening, and scapular stabilization.
33
Where are thoracic disc herniations most common?
Lower thoracic spine (T8-T12).
34
What symptoms suggest thoracic disc pathology?
Mid-back pain with radiating symptoms along intercostal nerves.
35
Symptoms of Rib Dysfunction?
pain w/ deep breathing, trunk rotation, sneezing, coughing
36
What is best for confirming a rib dysfunction diagnosis?
CT scans
37
What is T4 Syndrome?
A condition involving sympathetic nervous system dysfunction due to hypomobile thoracic segments, typically affecting T2-T7. (but always T4)
38
What are common symptoms of T4 Syndrome?
Glove-like upper extremity symptoms, nocturnal pain, and positive slump/ULTT tests.
39
What is idiopathic scoliosis?
A progressive lateral curvature of the spine with vertebral rotation.
40
What classification system is used for scoliosis?
James Classification: Infantile (<3 years), Juvenile (3-9 years), Adolescent (puberty-onset).
41
Key facts about Infantile Idiopathic Scoliosis?
80-90% of these curves spontaneously resolve, but the rest will progress into childhood severe deformity if it does not resolve ***most common curve pattern is right thoracic***
42
Key facts about Juvenile Idiopathic Scoliosis?
found more frequently in girls > boys high risk for progression to more severe curves
43
Key facts about Adolescent Idiopathic Scoliosis?
manifests at or around onset of puberty accounts for 80% of all idiopathic scoliosis cases
44
What factors influence the probability of progression for adolescent idiopathic scoliosis?
• Younger the patient at diagnosis, the greater the risk of progression • Double-curve patterns have a greater risk for progression than single-curve patterns • Curves with greater magnitude are at a greater risk to progress • Risk of progression in females is approximately 10 times than that of males with curves of comparable magnitude • Greater risk of progression is present when curves develop before onset of menstruation
45
What is the Adam’s Forward Bending Test?
A visual assessment where the patient bends forward to check for rib hump asymmetry. Used for scoliosis
46
What is the Cobb Angle?
The angle between the upper and lower vertebrae in a scoliosis curve, used for severity classification.
47
What interventions are used for scoliosis?
Bracing (if Cobb Angle 25-45° in skeletally immature patients), postural correction, respiratory training, and spinal mobility exercises.
48
How is scoliosis confirmed radiographically?
AP spine radiographs with Cobb Angle measurement.
49
What is the Risser Sign?
A grading system (1-5) that measures skeletal maturity based on iliac apophysis ossification.
50
What is Risser Grade I?
When the ilium is calcified at or close to 25%, it corresponds to early or pre-puberty
51
What is Risser Grade II?
the pelvic rim (ilium) calcification process has progressed to 25-50%. It represents the stage of an active growth spurt.
52
What is Risser Grade III?
the ilium is calcified at 50-75%; it corresponds to the slowing of the growth spurt.
53
What is Risser Grade IV?
descriptive of slowing down of the growth spurt. Calcification of the ilium is said to be between 75-100%.
54
What is Risser Grade V?
The iliac apophysis (ilium or pelvic rim) is fully fused, forming a single bone. Grade 5 corresponds to 100% growth completion.
55
Children with which Risser Grades can use orthoses for their scoliosis?
Grades 0-2

Musculoskel. II (8 decks)

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