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MSK > Cervicothoracic spine 2 > Flashcards

Cervicothoracic spine 2 Flashcards

1
Q

what is the etiology of TOS

A

forward head posture creates upper thoracic joint hypomobility into extension

scalenes compress

trauma (WAD)

differential diagnosis

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2
Q

how does FHP influence TOS

A

increased tension of subclavian fascia on axillary artery which doesn’t allow clavicle to roll anteriorly

issues specifically with overhead activities bc of the need for the clavicle to roll

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3
Q

how does chest breathing influence TOS

A

excessive use of accessory respiratory muscle

scalenes guard and press downward on inferior structures

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4
Q

what are spinal nerve symptoms

A

segmental, related to the segment that the nerve exits
slower onset of numbness

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5
Q

what are peripheral nerve symptoms

A

nonsegmental, several segments contribute
quicker onset of numbness

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6
Q

what are thoracic outlet syndrome symptoms

A

UE glove/sleeve-like paresthesia’s
coldness and swelling with vascular compromise

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7
Q

what activities increase TOS symptoms

A

raising arms for prolonged perior
sleeping
poor sitting posture

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8
Q

what would you expect to observe during the scan for TOS

A

FHP
possible UW discoloration d/t degree of artery involvement

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9
Q

what muscle groups are expected to be weak with TOS

A

posterior shoulder nad posterior throacic

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10
Q

what is expected during the scan for TOS

A

ROM: indications of upper thoracic restriction
RST: decreased strength/endurance in post. shoulder/scap
Neuro: non-segmental hypoactivity, ULTT +

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11
Q

what is the cause of dural tension restriction

A

decreased elasticity or inflammation

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12
Q

what is the PT rx with acute dural tension restriction

A

paresthesia’s at rest

POLICED - NO C
motion w/o resistance/symptoms
STM over segmental level

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13
Q

what is the PT rx with persistent dural tension restriction

A

paresthesia’s at resistance

motion with resistance
neural mobilization with resistance at end range once acuity settle

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14
Q

what are the S&S of dural tension restriction

A

paresthesia’s increased from both ends

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15
Q

what are the S&S of dural gliding restriction

A

paresthesia’s increased from one end but relieved from the other

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16
Q

what is the cause of dural gliding restriction

A

adhesion

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17
Q

what is the PT rx for acute dural gliding restriction

A

POLICED - no C
motion w/o resistance/symptoms
STM over segmental level

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18
Q

what is the PT rx for persistent dural gliding restriction

A

motion with resistance
neural mobilizations at mid range

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19
Q

what factors about the pt determine if the neural mobilizations will be successful

A

absence of neuropathy
older age
small ROM deficits with median nerve

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20
Q

what is expected in accessory motion tests with TOS

A

more often a unilateral upper thoracic hypomobility

less often limited 1st rib inferior glide

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21
Q

what is included with PT rx of TOS

A

postural/ergonomic changes

diaphragmatic breathing

MT/MET in cervicothoracic region to improve mobility

MET to increase strength/endurance in post shld/scp muscles

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22
Q

what is dowager’s hump

why does it develop

A

fat pad over upper C/t junction that develops with atrophy and shearing

wedging of vertebra d/t osteoporosis with persistent FHP

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23
Q

what are common thoracic restrictions

A

bilateral loss of thoracic extension that causes lower cervical instability

unilateral loss of upper thoracic extension contributes to unilateral TOS

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24
Q

what is the general rx for sitting FHP

A

MT/MET with local muscle focus to improve posture

posture education

ergonomic improvements

breathing training

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25
Q

what is the cause of an acute internal disc derangement

A

trauma

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26
Q

what is the most prevalent IDD

A

chronic or persistent

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27
Q

what sections of the annulus are hyper-/hyponeural

what type of cartilage is each section made of

A

hyperneural: outer portions, type 1 collagen

hyponeural: inner portion, type 2 collagen

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28
Q

t/f
the inner annulus is vascular

A

false
Th outer portion of the annulus is vascular

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29
Q

what is the function of the nucleus

A

resists compression
dense connective tissue
avascular

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30
Q

t/f
the annulus and nucleus move independently of each other

A

false
the annulus and nucleus move as a unit

deformation but not migration of the nucleus with motion

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31
Q

describe the vertebral end plate

A

highly innervated and vascularized
assists with nutrient diffusion for disc
covers nucleus and most of annulus with connective tissue
weak link of intervertebral joint
may calcify which limits diffusion

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32
Q

where is IDD rare in the spine

A

throacic - narrowest canal
C2-6 - additional stability from UV joints

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33
Q

what area of the disc is IDD most prevalent

A

posterolateral portion of disc

(transition of annulus in to endplate is weak spot)

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34
Q

what structures are involved with acute IDD

A

most common - annular tear and end plate avulsion

least common - NP herniation

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35
Q

what happens once disc structures are damaged

A

large autoimmune inflammatory response
-increase in water to the area = increases osmotic pressure
-spinal nerve sensitized = paresthesias
extended inflammatory phase

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36
Q

what are typical postlateral IDD symptoms

A

dull/achey spinal pain
radiculopathy
referred pain to respective areas
decreased pain when unloaded
increased neck pain and paresthesia’s looking down
increased pain in morning

37
Q

what radiculopathy symptoms are common with postlateral IDD

A

possible segmental paresthesia

38
Q

what ROM is expected with IDD postlateral IDD

A

all motions can increase pain
FLX and possible contralateral SB and RT from injured area
EXT and possibly SB and RT toward pain less limited

39
Q

why is FLX and contralateral SB/RT away from injured area in IDD less painful

A

pressure from pushing swelling toward spinal nerve
tension on annulus and endplate tear dura

40
Q

what is centralization of symptoms

A

abolition of distal/spinal pain in distal to proximal direction in response to repetitive motions or sustained positions

41
Q

what are typical postlateral IDD signs

A

MMT and RST: vairable
ST: possible + with compression/distraction/PA pressures
Neuro: +

42
Q

what is the PT rx for acute IDD

A

aggressive nonsurgical treatment is successful
POLICED
intermittnet traction
neural mobilizations
MET

43
Q

what is the focus of MET with acute IDD

A

tissue proliferation and stabilization of local muscles

44
Q

what section of the spine most commonly has persistent IDD

A

lumbar

45
Q

what part of the cervical spine is most involved with persistent IDD

A

C5,6
C6 spinal nerve

46
Q

what is the etiology fo persistent IDD

A

acute IDD
sedentary lifestyle
genetics

47
Q

what is the pathogenesis of persistent IDD

A

in-growth of nocicpetive fibers from acute IDD healing can lead to persistent inflammation and nociplastic pain

persistent inflammation brings excessive and destructive proteins and low grade inflammation enters disc

48
Q

what is the process of gradual onset of persistent IDD

A

less GAGs - more fibrotic an dehydrated nucleus
more acidic disc which limited proliferation
annular disorganization
thinning/loss of cartilage at end plates
increased inflammation of fatty deposits in vertebra

49
Q

what are the categories of herniation per Miller

A

protrusion: nucleus migrates but remains contained in annulus
extrusion: nucleus migrates thru outer annulus
free sequestration: nucleus breaks away from annulus

50
Q

what are changes that are likely to happen with disc, facets, and/or foramen with persistent IDD

A

disc: instability can develop
facets: increased load bearing
foramen: stenosis can develop

all narrow, cards in deck with rubberband example

51
Q

is it common for pt to not have symptoms with persistent IDD

if not, why

A

no since the tissues have time to adapt/compensate for the structure changes

52
Q

what is the PT rx for persistent IDD

A

possibly like acute IDD

consider primary driver of symptoms

53
Q

what is the negative outcome predictor for persistent IDD

A

peripheralization

54
Q

what is the MD rx for acute and persistent IDD

A

antibiotic treatment
laminectomy
partial discectomy
cervical fusion
total disc replacement

55
Q

what is functional instability

A

instability that can be stabilized with muscle activity or positioning

56
Q

what is mechanical instability

A

instability that cannot be completely stabilized with muscle activity or positioning

57
Q

what portion of the cervical spine has the highest prevalence of functional/mechanical instability

A

C5-C7

58
Q

what is the etiology of functional/mechanical instability

A

traumatic or recurrent sprains
age related disc changes
repetitive extension activities
creep d/t poor posture
adjacent joint hypomobility
connective tissue disorder

59
Q

what structures are involved with mechanical/functional instability

A

passive restraints
active stabilizers or local muscles inhibited
neurological function

60
Q

what are the symptoms of functional instability

A

predictable pain
recurrent spine and referred pain
decreased pain with position changes
increased pain with prolonged positions, looking up, sudden, and strenuous ADLs
catching
easy self manipulation

61
Q

what ROM is expective with functional instability

A

acute - aberrant motion
limited and painful with ext
better flexion

62
Q

what scan findings are expected with scan for functional instability (CM, RST, neuro)

A

CM: inconsistent block
RST: painful if acute
neuro: _-

63
Q

what is expected with accessory motion with functional instability

A

hypermobile accessory motion with possible adjacent ypomobility

64
Q

what muscles are inhibited with functional instability

A

local muscles

65
Q

what are the symptoms of mechanical instability

A

same as functional instability but worse with:
-unpredictable pattern
-worsening symptoms with more frequent episodes
- increased pain with trivial and lesser ADLs

66
Q

what is the PT rx with functional/mechanical instability

A

like ligamentous sprain
POLICED
postural education of sitting tall
bracing/taping PRN

67
Q

what is the focus of MET for functional/mechanical instability

A

stabilization of local muscles
hyperextension of contraindicated

68
Q

what cartilage is commonly affected with age related joint conditions

A

articular cartilage

69
Q

what are the most common sections affected by age related joint changes

A

C5-7
L4-S1

70
Q

what joints are most commonly affected by age related joint conditions

A

hip and knee

71
Q

what is the general funciton of type 2 collagen

A

resists compression

72
Q

what is the etiology of age related joint changes

A

prior trauma
sedentary lifestyle with underloading
genetics
other disease

73
Q

what happens with age related joint changes

A

articular cartilage thins and joint space narrows

fibrous capsule slackens and becomes more fibrotic and with persistent inflammation and then stiffens

synovial membrane produces less synovial fluid = increase friction

74
Q

what is pain attributed with age related joint changes

A

subchondral bone and injury to marrow
increased interosseous tissue
synovial membrane inflammation
periarticular tissue inflammation
persistent inflammatory response
foraminal narrowing on the spinal nerve

75
Q

what are the cervical symptoms with age related joint conditions

A

gradual onset of neck pain
pain with prolonged position (<30 mins)
morning stiffness
pain and limitation when looking in blind spot
possible paresthesia’s
some movements help and others increase pain

76
Q

what are the cervical scan components of age related joint conditions

A

ROM: P!/limitation with ext, ipsilateral SB/RT
CM: consistent bock in ext quadrant or opposing quadrant
RST: depends on acuity
ST: P! compression, PA (+)
Neuro: (-), could be (+) with radiculopathy

77
Q

what special test can be used for age related joint conditions in cervical region

A

spurlings to test for radiculopathy

78
Q

what is the PT for articular cartilage degeneration

A

improve integrity of cartilage and mobility
POLICED
JM for pain, tissue integrity, mobility

79
Q

what is the focus of MET for articular cartilage degeneration

A

improve motion
cartilage integrity
neuromusclular benefits

80
Q

where is RA most likely in the spine

A

c-spine

81
Q

what is the pathogensis of stenosis

A

narrowing of spinal canal d/t IDD, DJD or age related disc changes

fibrotic spinal nerve d/t persistent inflammation

narrowing form the outside in

82
Q

what population is most affected by stenosis

A

> 65 years

83
Q

does the CNS and PNS have lymphatic vv?

What is the significance?

A

no, longer inflammatory phase when nerve tissue is involved

slows healing process

84
Q

what are lateral stenosis symptoms

A

unilateral UE
spinal pain with segmental paresthesia’s

decreased pain when looking down, standing/walking

increased pain when sitting, looking up, turning to 1 side

85
Q

what would you expect to find in the scan for lateral stenosis

A

increased lordosis
ROM: flx/contralaterl SB/RT lower spinal UE pain
ext/ipsialteral SB/RT increase spinal/UE pain
ST: + compression, spurlings, PA level
neuro: possibly +

86
Q

what special tests are used to confirm lateral stenosis

A

spurlings
wainner’s CPR
stability test - excessive shearing

87
Q

what is the PT rx for stenosis

A

pt education
activity modification
MT - improve thoracic ext and neural mobilizations, mechanical traction

88
Q

what is the MET for stenosis

A

aerobic - improves circulation
local muscle stabilization

MSK (7 decks)

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