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MSK 1 - Cervicothoracic > Cervicothoracic Spine V > Flashcards

Cervicothoracic Spine V Flashcards

(74 cards)

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1
Q

What is acute internal disc derangement due to?

A

Trauma

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2
Q

What is acute internal disc derangement?

A

Annular end plate tear
Acute herniations (LEAST COMMON)

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3
Q

Disc changes due to numerous variables allow herniations to ____________ develop over time

A

Gradually

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4
Q

Most common internal disc derangement type is?

A

Chronic or persistent

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5
Q

What are the components of the intervertebral disc?

A

Annulus (inner and outer)
Nucleus pulposus
End plate
Body

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6
Q

What is the most innervated part of the annulus?

A

The outer annuluus

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7
Q

What collagen type is greater in the outer annulus? Why?

A

Type I to resist tension

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8
Q

What type of collagen increases into the nucleus of the annulus? Why?

A

Type II to resist compression

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9
Q

What does the annulus stabilize like?

A

A ligament

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10
Q

Are the annulus and nucleus very distinct in a healthy disc?

A

No

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11
Q

The annulus has concentric rings with ______ fibers?

A

Layered/overlapping

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12
Q

The annulus is avascular so it depends on what?

A

Diffusion

Depends on movement compression and decompression

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13
Q

Can compression produce tension and vice versa?

A

YES

think of a water balloon sides get tense with force
tension can create compression (ex- rotating towel and hands get closer)

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14
Q

The majority of fibers in the annulus are where?

A

deeply embedded into end plate

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15
Q

What does the nucleus do?

A

Resists compression

high # of GAGs for hydrostatic pressure

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16
Q

What is the nucleus made up of?

A

Dense connective tissue

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17
Q

Does the nucleus have innervation?

A

No avascular and aneural

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18
Q

Do the annulus and nucleus move as a unit?

A

Yes normally

Movement can cause deformation but not migration of nucleus

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19
Q

Is the vertebral end place innervated? Vascular?

A

Highly innervated and vascularized

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20
Q

What does the vertebral end plate do?

A

assists with nutrient diffusion for disc

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21
Q

What does the vertebral end plate cover?

A

Covers nucleus and MOST of annulus

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22
Q

What types of cartilage is the vertebral end plate made up of?

A

Articular cartilage (Type II) towards vertebral body

Fibrocartilage (Type I) towards disc

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23
Q

What type of collagen is the vertebral body?

A

Bone - type I collagen

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24
Q

Is persistent or acute IDD more common?

A

Persistent

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25
Where is IDD rare?
Thoracic spine (<1% all disc herniations) C2-6 region due to stability from U joints
26
Where is the most common area for IDD on the disc? Why?
Posterolateral portion of disc Weaker thinner and more vertical with less oblique annular fibers
27
What are the most common structures involved with acute IDD? less common?
Outer annular tearing and end plate avulsion Less commonly inner annular tearing and nucleus pulposus herniation
28
Disc structures are _________ once damaged
Immunoreactive
29
What kind of immune response do we expect with IDD?
Large auto immune inflammatory response
30
What happens with the inflammatory response with IDD?
Excessive osmotic pressure or static fluid pressure in and around disc and spinal nerve Radiculopathy/radicular s&s extended inflammatory phase (static fluid consists of increased inflammatory chemicals that sensitizes spinal nerve and structures to pressure/tension )
31
What are some typical postlateral IDD symptoms?
Dull achy spinal pain radiculopathy referred pain
32
Why is the pain with postlat IDD dull and achy
Highly innervated outer annulus so very painful
33
What are the characteristics of radiculopathy with postlat IDD?
Possible segmental paresthesias within 24 hours into distal extremity
34
What does the presence of coldness with postlat IDD indicate?
Circulatory compromise
35
What are some typical postlat IDD symptoms?
Decreased pain upon unloading (lying down) Increased neck pain and paresthesias looking down Increased pain in AM due to pooling of swelling while sleeping
36
What would we find in our scan for postlat IDD?
all ROM may increase pain FLX and possibly contralateral SB/Rot likely limited and increases extremity and spinal pain Ext and possibly ipsilateral sb/rot less limited
37
Why would flexion and contralateral SB/Rot increase pain with postlat IDD?
Pressure pushing swelling toward sensitized spinal nerve tension on annulus and endplate tear and dura
38
Why would ext and ipislateral sb/rot be less limited with postlat IDD?
May increase spinal pain due to increased hydrostatic pressure on disc with high osmotic pressure May decrease pain esp with repetition by moving swelling away from spinal nerve
39
What is the centralization of symptoms?
Abolition of distal and/or spinal pain in a distal to proximal direction in response to repetitive motions or sustained positions
40
What would you find in your postlat IDD scan?
*resistance and MMT vary *Possible positive stress tests with compression/distraction/PA pressures *neuro tests possibly positive depending on severity -myotomal fatigue -DTR hyporeflexive -diminished dermatomes - positive dural mobility tests
41
What would we find in our biomechanical exam with postlat IDD?
Possibly positive stability tests
42
What can be done for acute IDD?
Mechanical diagnosis and therapy -(mckenzie)
43
What is directional preference?
A position, motion, and/or factor that alleviates symptoms irrespective of location
44
What is cervical directional preference?
May be associated with centralization with the addition of decreasing severity and improving function match up exercise and ADL positions
45
What can be helpful for acute IDD?
Intermittent traction MET for tissue proliferation and stabilization particularly of local muscles
46
What is persistent IDD also known as?
Degenerative Disc Disease
47
Are age related disc changes always only due to age?
NO
48
What is the incidence of persistent internal disc derangement?
Lumbar more than cervical
49
Why is cervical persistent IDD more common?
Largest diameter in lower cervical spine bc of numerous innervations for lateral and posterior cord in brachial plexus
50
What is the most common site for persistent IDD?
C5,6 and the C6,7 C6 spinal nerve
51
What is the etiology of persistent IDD?
Acute IDD sedentary lifestyle genetics
52
Is persistent IDD quick or gradual?
Gradual
53
What happens to cause persistent IDD?
Lost GAGs so more fibrotic more acidic disc annular disorganization modic changed
54
What are modic changes with persistent IDD? (changes seen on MRI)
Persistent bone marrow edema - nociceptive fibers that lead to nociceptive pain - excessive and destructive proteins and a low-grade infection likely enters disc
55
What does bone marrow do with persistent IDD?
changes from circulatory to fatty type
56
Now persistent herniations and nuclear migration ____________ develop per the miller classifications
Gradually
57
What is a protrusion?
Nucleus migrates but remains contained in annulus
58
What is the most common herniation?
Protrusion (buldge)
59
What is an extrusion?
Nucleus migrates through the outer annulus
60
What is free sequestration?
Nucleus migrates and breaks away from annulus
61
What likely develops where the nucleus migrates into the vertebral body as well?
Schmorl's Nodes
62
What develops with persistent iDD?
Instability disc space narrowing joint space narrowing (greater load on facets) foramen narrowing (stenosis may develop)
63
What are some signs and symptoms of persistent IDD?
Slow change allow tissues to adapt w/o symptoms for some time Gradual onset of symptoms - inner annulus is hyponeural and nucleus is aneural so wont produce much pain
64
What can be prescribed for persistent IDD?
Aggressive nonsurgical treatment - intermittent traction - specific therapeutic exercise -oral anti-inflammatory medication - pt education
65
What percentage of people with radiculopathy have good or excellent outcomes at 2 years?
70%
66
What percentage of people with radiculopathy have only mild symptoms at ~5 years?
90%
67
What are some CPR for radiculopathy?
Over 54 years old non dominant UE affected looking down does not worsen more than 30 degrees of flexion
68
What can we do as PTs for radiculopathy?
Intermittent mechanical traction multi-modal with MT and local muscle training thoracic thrust manipulation
69
When is traction most effective for Acute and persistent IDD?
Following CPRs added to other interventions such as exercise and MT
70
What is the negative outcome predictor for IDD?
Peripheralization
71
What is peripheralization associated with?
Mental distress/depression non-organic signs (tumor) pain behaviors somatisation (conversion of anxiety into bodily symptoms) fear of work
72
What can doctors do for IDD?
Antibiotics for infection decompressive surgeries - laminectomy - partial disectomy
73
What can a cervical fusion do?
Increase adjacent segment motion at the levels above and below
74
What does a total disc replacement do?
unload facets superior to TDR and increased loading at level of TDR

MSK 1 - Cervicothoracic (7 decks)

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