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MSK Spine > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

rare but serious health conditions

A

Neoplasm
Infection
Ankylosing Spondylitis
Rheumatoid Arthritis (RA)
Klippel Feil Syndrome
Cervical Arterial Dysfunction (CAD)

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2
Q

Lead Kettle (PB KTL)

A

prostate, breast, kidney, thyroid, lung

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3
Q

Rheumatoid arthritis

A

synovial hypertension, destruction of articular cartilage and bone, synovial cysts and ligamentous laxity
likely develops prior to 6th decade
women> men

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4
Q

ankylosing spondylitis

A

Ossification ligaments of spine, IV discs/ end-plates, facet structures
men>women
observed in 3rd decade
improves with activity, worse at night

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5
Q

klippel feil syndrome

A

congenital; failed C spine segmentation
fusion of C2-C3 is most common

<50% have short neck, low posterior hairline, and limited ROM
>50% have scoliosis

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6
Q

cervical arterial dysfunction

A

intimal (inner) tear with penetration of circulating blood into the vessel wall and formation of intramural hematoma

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7
Q

consequences of cervical arterial dysfunction

A

Retinal or brain ischemia
Compression or stretching causes local symptoms
Subarachnoid or intra-cerebral hemorrhage

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8
Q

underlying abnormality of the vessel wall for CAD

A

vertebral arteries
internal carotid arteries

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9
Q

symptomology of cervical arterial dysfunction

A

neck pain
face pain
headache
pain is severe
extremity dysesthesia, motor dysfunction, pain
pulsatile tinnitus

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10
Q

Ds and Ns of CAD

A

dizziness
dysarthria
dysphagia
diplopia
drop attack
nystagmus
nausea
numbness

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11
Q

horners syndrome

A

Ptosis (dropping of upper eyelid)
Miosis (constriction of pupil)
Enophthalmos (sinking of the orbit)
Anhydrosis (dry eyes)

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12
Q

symptomology of cervical myelopathy

A

Neck pain/ stiffness
Shoulder pain
Imbalance/ fall Hx
(UE) Dysesthesia
May involve LEs first (gait, weakness)

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13
Q

clinical prediction rule for cervical myelopathy

A

Gait Deviation
Hoffmann’s Sign
Inverted Supinator Sign
Babinski Sign
Patient age >45 years old

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14
Q

upper cervical instability has an increased risk associated with

A

history of trauma
throat infection
congential collagenous compromise
inflammatory arthritides
recent neck.head/dental surgery

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15
Q

common special tests for upper cervical instability

A

Modified / Sharp-Purser Test
Alar Ligament Stability Test
Lateral Shear Test
Tectorial Membrane Test
Posterior A-O Membrane Test

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16
Q

jefferson fracture of C1

A

atlas fracture
4 part burst fracture of atlas
2 fractures at each arch

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17
Q

spondylolysis

A

defect of pars interarticularis

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18
Q

spondylolysthesis

A

anterior displacement of vertebral body
degenerative process that is most common at C3/4 and C4/5

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19
Q

3 factors of canadian C spine rule

A
  1. Any high risk factor that mandates radiography?
  2. Any low risk factor that allows safe assessment of range of motion?
  3. Able to rotate neck actively?
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20
Q

NEXUS low risk rule

5 criteria in order to be classified as having a LOW probability of injury

A

no midline cervical tenderness
no focal neurologic deficit
normal alertness
no intoxication
no painful, distracting injury

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21
Q

spondylosis

A

affects vertebral bodies and discs
degenerative process where osteophyte complexes form around margin of bodies

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22
Q

osteoarthrosis

A

zygapophysial joint and AA joints
osteophytes can cause joint narrowing

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23
Q

stenosis

A

narrowing of a vertebral canal

locations:
- central
- lateral

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24
Q

lateral canal stenosis can cause

A

radicular pain or radiculopathy

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25
central canal stenosis can cause
myelopathy
26
somatic referred pain
pain from an anatomic structure
27
radicular pain
pain in a spinal nerve (dermatome) distribution due to irritation
28
radiculopathy
conduction block, motor and sensory affected
29
pancoast tumor
Tumor at the apex of the lung May involve C8 and first thoracic nerve structures
30
symptomology of pancoast tumor
Chronic cough Bloody sputum Unexplained weight loss Malaise Dyspnea will examine fever and wheezing
31
classification of TLICS
Morphology Integrity of PLC - Supraspinous ligament - Interspinous ligament - Ligamentum flavum -Z-joint capsules Neurologic Status
32
traditional compression fractures
Stable injury Anterior column affected Spinal canal intact Common mechanism: axial loading in flexed position Traumatic High Energy Osteoporotic
33
burst fracture
Anterior and Middle columns 15-20% of all major vertebral body fractures Most common at T/L junction (T12, L1) Potential neural involvement; fragments may be found in canal Vertebral segment subjected to high force axial (and/or flexion load) - MVC - Falls from heights - High-speed sport injury
34
rotation/translation fracture
Associated with fall from a height or heavy object falling on body with bent trunk Torsion & Shear forces Horizontal displacement of one T/L vertebral body on another Dislocation: facet joints intact, but dislocated
35
distraction fracture
Separation in the vertical axis Anterior & posterior ligaments, anterior & posterior bony structures, both Potential Frx to posterior elements
36
red flags for vertebral fracture
Older age Significant trauma Corticosteroid use Contusion/ abrasion
37
recommendation for clustered findings with a vertebral fracture Henschke
Age > 70 years Significant trauma Prolonged corticosteroid use Sensory alterations from the trunk down
38
Roman CPR for identifying vertebral compression fracture quadas score?
QUADAS = 8 A cluster of findings to aid in identifying the presence of an osteoporotic vertebral compression fracture includes the following: Age > 52 years No presence of leg pain Body mass index
39
scheuermann's disease
Defective growth of vertebral endplate Poor diffusion of nutrients to un-vascularized disc Proposed Etiology - Genetics - Excessive stress on pre-disposed (weak) endplate
40
scheuermann's disease risk is increased among
Manual workers who begin at early age High intensity athletes? High BMI? “Short sternum”?
41
criteria for Scheuermann's disease diagnosis
Thoracic kyphosis > 45 deg Wedging x 3 adjacent vertebrae > 5 deg Thoracolumbar kyphosis > 30 deg
42
symptomology/exam findings of Scheuermann's disease
Thoracic pain, commonly apex of curvature (muscular tension, IV disc bulging/ spondylosis) exam: - Scoliosis (15% and 20%) - Excessive thoracic kyphosis (Compensatory hyperlordosis, rounded shoulders/ forward head, pelvic rotation) - Vertebral wedging, Schmorl’s nodes (16-48%), disc space narrowing - Limited thoracic ROM - Neurologic Complications (less common)
43
disc disease of thoracic spine symptomology
Back or chest pain - Radicular: band-like pain in affected level’s dermatome, paresthesia/ anesthesia, leg pain -Back pain at midline Progressive/ insidious (months to years)
44
thoracic spine myelopathy sympotomology and exam findings
Symptomology: Sexual dysfunction Bowel and bladder dysfunction Physical Examination: Sensory/ motor impairments UMN signs LEs
45
etiologies of intercostal neuralgia
Traumatic Injury Infection (e.g. herpes zoster) Mechanical Compression (disc protrusion, osteophyte complex, neuroma, Frx) Following thoracic Sx
46
symptomolgy of intercostal neuralgia
Burning pain/ paresthesia/ anesthesia along intercostal nerve path
47
exam findings with intercostal neuralgia
Focal tenderness of intercostal area Herpes zoster: dermatomal distribution of rash with grouped vesicles and pustules
48
T4 syndrome
Women > Men (4:1) Etiology unknown Theory: sympathetic reaction with hypomobile segment Can affect T2-T7 Primary pain generators Thoracic IV disks and Thoracic zygapophyseal joints
49
T4 syndrome symptomology
Glove-like paresthesias unilateral/ bilateral UEs Neck/ scapular/ bilateral upper extremity pain (constant or intermittent) Worsens with side-lying or supine positioning Generalized headache
50
T4 syndrome exam positive tests
Tender spinous process + Thoracic Slump Test + Upper Quarter Neurodynamic Tension Tests Hypomobile thoracic segment
51
scoliosis is named for the
convexity
52
etiology of scoliosis
congenital or acquired
53
zygapophysial arthropathy exam
Painful movement with closing of z-joints (AROM/ PROM) Painful spring testing/ Hypomobility with joint mobility testing
54
zygapophysial arthropathy symptomology
local and/or referred pain
55
rib fracture concern over stability
Brachial plexus/ vascular structures (3-15% of upper rib fractures associated with this) Laceration of pleura, lungs, abdominal organs
56
rib fracture symptomolgy
Focal pain, radiating pain Pain with inspiration Pain with coughing/ sneezing
57
rib fracture exam findings
Focal tenderness Possible palpable defect
58
costochondritis symptomology
Pain and local tenderness at costochondral or chondrosternal articulations - At rest - Trunk movement - Respiration
59
costochondritis what is it, when does it resolve
May be related to upward of 30% of ED visits related to chest pain Involves >/= 1 rib Proposed Pathophysiology: Repetitive stress Typically resolves within a year
60
rib dysfunction (structural, torsional, and respiratory)
Structural: subluxation of joint (anterior or posterior) Torsional: Rib held in rotated position Respiratory: related to posture, may affect respiration
61
rib dysfunction symptomology
Aggravated with deep inspiration, trunk rotation, sneezing/ coughing
62
rib dysfunction exam findings
Diminished rib mobility (structural) Pain/ hypomobility with joint mobility testing Limited/ painful thoracic spine motion
63
Thoracic outlet syndrome compression
subclavian artery subclavian vein brachial plexus
64
thoracic outlet syndrome symptomology
UE pain, paresthesia, anesthesia/ weakness (Glove-like vs. particular distribution consistent with area of compression) Chest/ anterior shoulder pain Typically progressive/ insidious onset
65
potential areas of compression TOS
scalenes cervical rib pec minor first rib clavicle
66
thoracic outlet syndrome clinical presentation/history
history of neck trauma cervical rib raynaud's phenomenon
67
positive special tests for thoracic outlet syndrome
Roo’s Test Hyperabduction Test Adison’s Test Cervical Rotation Lateral Flexion Test: Restricted 1st Rib First Rib Spring Test: Restricted 1st Rib
68
pectoralis strain MOI
Direct trauma - Direct blow - Forced horizontal abduction with extension or ER mechanism (e.g., bench press gone wrong) Indirect trauma: - Increased tensile stress on lengthened muscle, especially eccentric loading - Common athletic injury (e.g., rugby); can be non-athletic(e.g., catching oneself when falling)
69
common history of pec strain
traumatic event with sudden onset of shoulder/ chest/ arm pain with audible “pop”
70
pec strain can be confirmed via
MRI ultrasound imaging
71
intercostal strain MOI
commonly excessive exertion of untrained muscle
72
serratus anterior strain who does it happen in and what do they feel
More likely with rowing and weightlifting Pain at medial scapular border, possible radiation to anterior chest Pain/ weakness with resisted scapular protraction
73
internal/external oblique strain MOI and what they feel
MOI: traumatic; eccentric contraction when muscle is lengthened Uncommon, though more likely with cricket (bowlers), javelin, rowing, swimming, or hockey Pain & TTP over lower 4 costal cartilages Resisted ipsilateral lateral flexion painful
74
SCHEUERMANN’S DISEASE interventions
Postural control muscle performance Modification of aggravating activities Strengthening and stretching of the trunk - Seated rotation - Extension in lying (prone press up, prone on elbows, etc.) - Thoracic extensor strengthening - Scapular abductor strengthening Bracing
75
ANKYLOSING SPONDYLITIS interventions
Spine extension & peripheral joint exercises Breathing exercises Prone lying several times/ day for spine/ hip extension Sleeping on firm mattress & avoidance of SL position Swimming
76
Adolescent Idiopathic Scoliosis thoracolumbar bracing
Prevention of curvature progression Correction of abnormal curvature
77
goal with exercise for scoliosis conservative management
Strengthen postural muscle Address muscle length impairments/ strength impairments of extremity musculature Maintain/ Improve respiration & chest mobility Address back pain impairments Resume functional tasks Strengthen abdominals
78
T4 Syndrome considerations
Thoracic manual therapy techniques (mobilization, thrust manipulation) Scapulothoracic motor performance Thoracic extensor strengthening
79
DISC LESIONS interventions
traction Continuous or intermittent Intermittent: twice as much separation proposed Pt positioned sitting or supine Duration recommendation 2 min – 24 hours Generally 20-30 min recommended
80
contraindications for traction with disc lesions
acute lumbago, instability, respiratory or cardiac insufficiency, respiratory irritation, painful reactions, large [disc] extrusion, medial disc herniation, altered mental state; this includes inability of the patient to relax
81
ZYGAPOPHYSEAL JOINT PAIN: interventions
Manual therapy interventions - Mobilizations - Oscillations - Stretch mobilizations Manipulation Exercise - Pain & guarding inhibition - Neuro re-education (postural stabilizers, osteokinematic mobilizers into painful planes
82
ZYGAPOPHYSEAL JOINT PAIN common impairments
Muscle Guarding Joint Hypomobility Acute irritation/ dysfunction Pain ROM: commonly motions that close joint (extension, ipsilateral flexion, rotation)
83
RIB DYSFUNCTION interventions
Manual therapy interventions - Rib mobilizations --> Oscillations -->Static stretch mobilizations - Rib manipulation - Soft tissue mobilization
84
THORACIC OUTLET SYNDROME considerations
- Work/ activity modification - Nerve glides - Shoulder, upper rib/ thoracic manual therapy techniques - Scapulothoracic motor performance - Address tissue extensibility anterior trunk musculature
85
mid trap exercises
Prone row Prone horizontal abduction with 90 deg shoulder abduction & ER
86
lower trap exercises
Prone full can Prone shoulder ER at 90 deg of shoulder abduction Prone horizontal abduction with 90 deg shoulder abduction & ER Bilateral shoulder ER in shoulder neutral
87
rhomboids and levator scap exercises
Prone Extension with shoulder ER Prone row Prone horizontal abduction with 90 deg shoulder abduction & ER
88

MSK Spine (3 decks)

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