Disc Herniation Flashcards
What are 2 clues for which nerve root is affected? Which is most predictive?
Deficits, paresthesia (more predictive than pain distribution)
What is the order of deficits for C8 radiculopathy based on +LRs? (Don’t need to know +LR#’s)
- Sensory loss to little finger (41.2)
- diminished triceps reflex (28.3) (C7 or C8)
- weak finger flexion (3.8)
What are the pure patches that support disc herniation in order of +LRs? (Don’t need to memorize +LR#’s)
- C8 on pinky (41.8)
- C6 on thumb (8.5)
- C7 is poor
Which big 5 ortho tests for disc herniation are sensitive? Which are specific?
Specific
- max cervical compression
- cervical distraction
- valsalva
- shoulder abduction
Sensitive
- ULTT- median
What are test that close or open the IVF? What are tests that tension the nerve? How does each affect the arm sx?
Close/open
- AROM: extension, ipsi-rotation/lateral flexion (increase arm sx)
- AROM: flexion, contra-rotation/lat flex (decrease arm sx)
- cervical compression (increase arm sx)
- cervical distraction (decrease arm sx)
Tension
- ULTT (increase arm sx)
- shoulder abduction test/ Bakody’s sign (decrease arm sx)
What are the peak ages for C/S disc herniation
40-60 with peak age 50-54
What are the indications for radiographs?
- moderate to high load trauma(r/o fractures and structural instability)
- red flags for disease
- cord signs/symptoms (then MRI)
- radicular signs/symptoms
- nonresponsive case (perhaps after 1 month or more of filed care)
Indications for MRI?
- Lowest = signs/symptoms of radiculitis
- Moderate= only if there are deficits
- Highest = only if there is suspicion of myelopathy, progressive (motor) deficit, non-responsive to conservative care, pre-surgical exam, severe motor weakness on the first visit
Treatment for cervical disc herniation? How is each performed?
Day 1
- McKenzie (retraction, extension, other directions with/without overpressure for 10 repetitions)
- C/S traction
- adjustment
After a couple Weeks
- neuromobilization
What is the prognosis for conservative care of C/S disc herniations?
- 55% improvement in 2-4 ish weeks, 69% in 1 month, 86% in 3 months
- acutes responded better and faster, but more chronic cases also responded
What is the ddx of pain/paresthesia into medial hand?
- lower brachial plexus (TOS, tumor, stretch trauma)
- ulnar nerve entrapment
- MFTP’s (lats, serratus, pecs)
What are the 5 clues from the physical for disc herniation?
- arm symptoms may be improved by repetitive/ sustained end range movements (into chin retraction, extension, or some other direction)
- may have flexion load sensitivity
- may have a positive valsalva
- may be aggravated by cervical compression
- may be relieved by cervical distraction
- tenderness more midline than over facets
how might you alter motion palpation for a suspected cervical disc case?
- with long axis distraction distraction
-
Which muscles with MFTP project pain to the medial arm? What is the hand position to remember this?
- Thumb’s on pec major and minor
- palm on serratus anterior
- pinky finger on lat dorsi
Which muscles with MFTP project pain to the lateral arm? What is the hand position to remember this?
- thumb on scalenes
- palm on supraspinatus
- fingers on infraspinatus
