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1
Q

What is myotagenous pain?

A

Pain referred from muscle source

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2
Q

Aetiology of MTrP’s

A

Microtrauma
Macrotrauma
Sustained muscular contraction due to postural dysfunction

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3
Q

What is the Jump sign?

A

Associated with Myotagenous pain
Local pain is out of proportion of the pressure applied
This can be so intense that it causes the patient to “jump” and note significant pain

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4
Q

What is the local twitch response?

A

Rolling palpation over a MTrP’s causes the muscle in question to twitch

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5
Q

T or F

Neurological findings will be present with MTrP’s

A

False

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6
Q

T or F

Fibromyalgia is considered a disease

A

False

Syndrome not a disease

  • chronic widespread muscular pain
  • fatigue
  • tenderness
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7
Q

What causes Fibromyalgia?

A

There is no known cause

Genetics also appear to play a role leading to a familial tendency to develop the syndrome

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8
Q

What is the criteria for dx of Fibromyalgia?

A

Patient must exhibit tender points in 11 or more out of 18 standardized sites
*tender point = a point that becomes PAINFUL and not just tender when approx 14 kg of pressure is applied to the spot

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9
Q

When addressing Musculoskeletal complaints what is important in the decision making process? What do we need to rule in/out?

A 
Acute traumatic pain?
- fracture
- dislocation
- gross instability 
OR
Non traumatic pain?
- tumors
- inflammatory arthridities
- infections
- visceral referred pain patterns
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10
Q

Aching pain = ?

A

Muscle, tendon, ligament

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11
Q

Bounding pain = ?

A

Vascular, circulation

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12
Q

Burning pain = ?

A

Nerve root
Arterial
Visceral

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13
Q

Cramp = ?

A

Muscle
Nerve
Vascular

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14
Q

Boring deep pain = ?

A

Cancer

Bone Pain

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15
Q

Unrelenting deep pain = ?

A

Cancer

Visceral

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16
Q

Dull pain = ?

A

Musculoskeletal

Visceral

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17
Q

Gnawing pain = ?

A

Ulcer

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18
Q

Radiating (well delineated) pain = ?

A

Nerve

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19
Q

Radiating (diffuse) pain = ?

A

Scleratogenous or myotegenous

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20
Q

Sharp/localized pain = ?

A

Facet (at the spine)

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21
Q

Stabbing pain = ?

A

Visceral

Nerve Root

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22
Q

Shooting pain = ?

A

Nerve root entrapment

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23
Q

Tearing pain = ?

A

Aneurysm or severe pain

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24
Q

Throbbing pain = ?

A

Vascular

Inflammation

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25
Tingling (segmental) pain = ?
Nerve root | Peripheral nerve
26
Tingling (non segmental) pain = ?
If bilateral: cord compression, MS, Metabolic | If unilateral: plexus
27
T or F | A concentric muscle strain/rupture is when the muscle is lengthened
False ``` Lenghthened = eccentric Contracted = Concentric ```
28
List some pathological processes that can occur in joints
``` Arthritis Subluxation Synovitis Infection Medical dislocation/subluxation ```
29
What are some pathological processes that occur in the bone?
Tumor Fracture Infection Bone Loss
30
T or F Scleratogenous pain sharp and well definded
False Dull, achy non descript pain **pain at the site of origin may be sharp but the referred pain is said to be dull and achy. The patient will sometimes have difficulty describing the sensation.
31
T or F Scleratogenous pain does NOT follow a dermatomal pattern
True
32
T or F Scleratogenous pain will typically cross over the shoulder joint and travel down the arm.
False In cervical spine it does not cross the GH joint
33
Pain derived from nerve root is called?
Dermatogenous | "Dermatomal pain"
34
T or F Dermatogenous pain is well localized
True
35
What does radiculopathy mean?
Pathology of the nerve root | Pain that follows a dermatomal pattern
36
Pathology of any nerve is known as?
Neuropathy
37
T or F Diabetic neuropathy is a compressive neuropathy
False ``` Diabetic = metabolic Median = compressive ```
38
What is the IVD composed of?
Annulus Fibrosis Vertebra end plate Nucleus pulposis
39
Name the major stresses that the disc goes through
Axial compression Shearing Bending Twisting
40
Innervation of the disc is provided by?
Sinuvertebral Nerve
41
T or F The Sinuvertebral nerve is a branch of the Ventral Ramus and the Parasympathetic trunk
False Sympathetic trunk
42
Name all the parts that are innervated by the Sinuvertebral nerve
Outer half of IVD Posterior Longitudinal Ligament Dura Mater Spinal Canal Vessels.
43
Protrusion aka ?
Bulge
44
Is a protrusion contained or non-contained?
Contained
45
T or F You will generally experience leg symptoms with a Disc Protrusion
False No leg symptoms
46
Will pain be worse with sitting or standing for a Protrusion
Sitting because the nociceptors within the AF are irritated by the protrusion
47
What is the disc problem when the nuclear material remains attached but escapes the AF or PLL
Extrusion
48
T or F Extrusions will NOT leg pain associated with it
False Leg pain generally is present
49
When the migrating disc material escapes the disc all together and becomes a free floating fragment this is known as?
Sequestration
50
The NP makes up about what percent of the disc in the cervicals and in the lumbars?
``` Cervical = no more than 25% Lumbars = 50% ```
51
What are some clinical presentations for a Lumbar Disc problem?
Lower back and leg pain | Pain Radiating from the lumbar spine to the extremity following a dermatomal pattern
52
T or F Medial disc protrusion pt leans away from the side of pain
False ``` Medial = towards Lateral = away ```
53
If there is pain before 30 degrees on the SLR what does that indicate?
Suggests a large disc protrusion
54
What is Sciatica?
Pain that radiates down the back of the leg regardless whether its associated with lower back or not.
55
Herniations account for what percent of cases in cervical spine?
20-25%
56
What are some common causes of extremity pain?
``` Local Lesions - contusion, spasm, strain Referred pain - myotagenous, dermatagenous, scleratagenous Claudication Peripheral nerve lesion Plexopathy ```
57
What is Claudication?
Reproducible ischemic muscle pain Cramp like feeling in the leg Can be Vascular or Neurogenic
58
Vascular Claudication aka ?
Peripheral Artery Occlusive Disease or Intermittent Claudication
59
What is the major cause of intermittent Claudication?
Atherosclerosis
60
T or F Vascular claudication is not relieved with rest
False Relieved with rest - standing, sitting or lying
61
T or F Burning or dysesthesias are common with Vascular Claudication
False None!
62
T or F Pulses in the lower extremity will be decreased or absent with Vascular Claudication
True
63
T or F With Neurogenic Claudication pain is increased with spinal flexion and decreased withs spinal extension.
False Decreased with flexion and increased with extension
64
T or F With Neurogenic Claudication pain is increased when recumbent
False Decreased
65
Will the pulses be affected with Neurogenic Claudication?
No
66
What is the common age group for both Vascular and Neurogenic Claudication?
40-60 yoa
67
T or F Pain with spinal stenosis will typically be unilateral
False Bilateral
68
T or F With spinal stenosis pain is decreased in flexion and increased with extension
True
69
What age group is spinal stenosis commonly seen?
Peaks around the age of 70
70
T or F We will see decreased pulses with spinal stenosis
False Pulses will be normal
71
Peripheral nerve lesions can mimic?
Disc lesions
72
What is the pattern of peripheral nerve lesions
Decreased muscle strength Impaired proprioception and sensory integrity Difficulty with manipulation skills
73
How will the patient describe the sensations with a peripheral nerve lesion?
Numbness Tingling Pins & Needles
74
Name the common pathologies for peripheral nerve lesions
``` TOS Cubital tunnel syndrome Carpal tunnel syndrom Deep perennial nerve entrapment Tarsal Tunnel Syndrome ```
75
What postures affect TOS?
Anterior head carriage | Protracted and elevated scapulas
76
What nerve roots are most commonly 90% involved with TOS?
The lower 2 nerve roots C8 and T1 *this produces pain in the ulnar nerve distribution
77
When the upper 3 nerve roots are involved in TOS where will we see the symptoms refer to?
``` Neck Ear Upper chest Upper back Outer arm ``` *radial nerve distribution.
78
T or F In TOS vascular compression is more common that neural compression
False Neural more common than vascular
79
What is the most reliable test for TOS? Why?
``` Roo's (Elevated arm stress test) It evaluates all 3 types of TOS 1. Scalenicus anticus 2. Costoclavicular 3. Pectoralis Minor ```
80
What is the aka for the Radial Nerve?
Musculospiral Nerve
81
What is the most commonly injured nerve of the brachial plexus?
Radial
82
T or F The Radial nerve crosses the elbow immediately posterior to the radial head
False Anterior *it is also just lateral to the lateral epicondyle
83
T or F The superficial branch of the radial nerve is pure motor
False Sensory nerve Dorm of 1st-4th digit
84
After the deep radial nerve passes the supinator muscle it changes names and becomes...
Posterior Interosseous nerve
85
The deep branch of the radial nerve innervates what muscles?
Extensor carpi radialis brevis | Supinator
86
What are the muscular branches of the radial nerve?
Triceps Anconeus Brachioradialis Extensor Carpi Radialis Longus
87
Radial palsy aka ?
Wrist Drop
88
With wrist drop not only can you not extend your wrist but what other motion is impaired?
Abduction of the thumb
89
Where can the radial nerve get entrapped with radial tunnel syndrome?
Can be compressed by: - Fibrous band off anterior radial head - Sharp medial edge of the extensor carpi radialis brevis - Arcade of Froshe (thickened head of the superficial head of the supinator muscle)
90
The ulnar nerve is sensory to....
5th and medial 1/2 of the 4th digit
91
T or F The lateral part of flexor digitorum profundus is innervated by the ulnar nerve C8-T1
False The medial part!!
92
T or F The ulnar nerve innervates the abductor digiti minimi
True
93
What is Cubital Tunnel Syndrome
Compression of Ulnar nerve within cubital tunnel
94
T or F Cubital tunnel syndrome will cause weakness of the precision grip
False Power grip
95
What is the aka for Pisiform/Hamate Syndrome?
Guyon's Canal Syndrome
96
T or F Guyon's syndrome will cause paresthesia in the radial nerve pattern
False Ulnar
97
Will you have problems with the power or precision grip with Guyon's Canal Syndrome
Power grip
98
Claw hand deformity is a lesion of what nerve?
Ulnar nerve
99
Claw hand is paralysis and atrophy of what muscles?
Flexor carpi ulnaris ulnar portion of flexor digitorum profundus hypothenar muscles interosseous muslces *except first two lumbricals
100
The median nerve is formed from the union of what cords?
Medial and lateral
101
What are the deep muscles innervated by the median nerve?
Flexor Digitorum profundus Flexor pollicus brevis Pronator quadratus
102
Describe Ape Hand Deformity
Inability to oppose, flex or abduct the thumb due to intrinsic hand dysfunction
103
Causes of CTS
``` Pregnancy Renal Dysfunction Acromegaly Gout Mass or myxedema Amyotrophy Trauma Infection Collagen Disorders ```
104
Give some clinical presentations of CTS
``` Pain, numbness, tingling, itching Night pain (flexed wrist) Clumsiness with precision grips Feeling of swelling Numbness when bringing fingers together in a pinching motion ```
105
Tests for CTS
Tinel's Phalen's Prayer's Opponens Pollicus muscle test
106
What causes Pronator Teres Syndrome?
Edema or hypertrophy of the pronator trees muscle Entrapment between the pronator trees Repetitive pronation/supination
107
Deep Peroneal nerve entrapment occurs where and can be caused by...
``` Distal to the neck of the fibula (terminal branch of the deep peroneal nerve) Extensor Retinaculum = MC site - compression from tight footwear - ganglion cyst - pes cavus - direct trauma to the region ```
108
Where is the tarsal tunnel?
Located between the flexor retinaculum and medial malleolus
109
Aetiology for Tarsal Tunnel Syndrome
``` Post-traumatic Neoplastic Inflammatory Secondary to fluid retention Valgus foot deformity ```
110
T or F The DCML tract is descending
False Ascending
111
T or F The Anterior Spinothalamic tract is responsible for pain and temperature
False Touch and Deep Pressure
112
What sensations does the Lateral Spinothalamic tract sense?
Pain and Temperature
113
What is the Upper motor neuron pathway called?
Corticospinal
114
What tract is responsible for co-ordination
Spinocerebellar
115
What is an aka for Dysesthesia?
Hyperpathia
116
What is Dysesthesia?
Irritating sensation evoked by normal nociceptive stimuli such as light touch - normal stimuli will evoke pain in the patient
117
The Dorsal Columns carry what sensations?
Vibration Joint position sense Pressure Light Touch
118
What Neuro tests can we do to evaluate the Dorsal Column?
Two-point discrimination Pallesthesia (vibration) Romberg's Joint Position Sense
119
What neuro tests can we use to evaluate the Spinothalamic System?
Sharp vs. Dull | Pin Prick
120
Where in the CNS do the Upper Motor Neuron's synapse?
Anterior Horn Cell
121
Give some examples of an UMNL conditions
``` Cerebral Palsy MS Stroke (CVA) Tumor ALS ```
122
Where do LMN terminate?
The Neuromuscular Junction
123
What is known as the Final Common Pathway and why?
The Lower Motor Neuron because it is the final link between the CNS and voluntary muscles
124
Give some examples of UMNL
``` IVF encroachment SOL Piriformis Syndrom Bell's Palsy ALS Myasthenia Gravis Polio ```
125
T or F LMNL will give you spastic muscles
False Flaccid
126
T or F LMNL will give you a decrease in DTR
True
127
T or F UMNL will show signs of pathological reflexes
True
128
Will LMNL be hypo or hypertonic?
Hypotonic
129
What type of neuron lesion will give you atrophy?
LMNL
130
T or F Fasciculations are not present with UMNL
True
131
T or F LMNL will have no trophic changes
False
132
What part of the brain co-ordinates motor activity?
Cerebellum
133
The cerebellum will determine these characteristics of muscle movement
Range Velocity Strength
134
What part of the brain deals with procedural memory
Cerebellum
135
What is the main function of the Basal Ganglia?
Modulates and adjusts the tone of the motor system
136
T or F The Basal Ganglia is part of the UMN
False It is NOT part of the Upper or Lower Motor Neuron
137
The mental status exam will alert and orient a patient on these 3 planes...
Who they are Where they are When they are
138
What neuro tests can we use to evaluate the Cerebellum
Dysmetria Diadochokinesia Gait - forced & tandem
139
What tests can we use to evaluate the somatosensory system?
Stereognosis Graphesthesia Baragnosis
140
A patient should be able to recognize two-point separation on their finger pads by how many mm?
2-4mm
141
What is the degree of separation that a person should be able to recognize two-point separation on the dorsal of the hand?
20-30 mm
142
What is Ataxia?
Lack of voluntary coordination of muscle movement
143
T or F Sensory ataxia is a problem with the cerebellum
False Dorsal Columns Motor = cerebellar
144
Vestibular ataxia has a problem with what nerve?
CNIII vestibular portion
145
What are some clinical findings associated with motor ataxia?
Patient is unstable with eyes open or closed Worse when lying down Patient will tend to lean or stagger towards the side of the cerebellar lesion
146
How is the gait when a person has motor ataxia?
Wide based Reeling Staggering Drunken in appearance
147
Vestibular ataxia stems from problems with what structures?
Labyrinth of the inner ear Vestibular portion of cranial nerve III Brainstem vestibular nuclei
148
T or F Vestibular ataxia is gravity dependent
True
149
T or F Lack of coordination of limb movements is not seen in supine position with Vestibular ataxia
True
150
T or F With vestibular ataxia we will see bilateral nystagmus
False Unilateral
151
Sensory ataxia is caused by lesions in the proprioceptive pathways of...
peripheral sensory nerves sensory roots posterior columns of spinal cord
152
With sensory ataxia a patient will have impaired sensation of?
Joint position sense | Diminished vibration sense
153
T or F Sensory ataxia will have a positive Romberg's Sign
True
154
What is Syringomyelia?
An idiopathic disease of the brain stem and spinal cord associated with cavitation (filled with thick yellow fluid)
155
Where in the spine is Syringomyelia common?
Lower cervical/upper thoracic
156
T or F Syringomyelia will casue a shallow like distribution of loss of pain and temperature but will preserve light touch and proprioception
True
157
We often see Syringomyelia with scoliosis. What is the pattern of scoliosis that we often see this develop?
Left thoracic - right lumbar pattern
158
This condition is caused from tertiary syphilis and damages the dorsal roots and posterior columns
Tabes Dorsalis
159
T or F Tabes Dorsalis will cause vestibular ataxia
False Sensory
160
What neurological test will be positive with Tabes Dorsalis
Romberg
161
What presentations are commonly seen with Cerebellar dysfunction?
Hyptotonia - loss of resistance offered by muscle to palpation or passive ROM Disequilibrium - loss of balance, trunk and motor ataxia Intention Tremors Dysmetria Dysdiadochokinesia Dysarthria
162
Past pointing phenomenon of Holmes is a test for?
Dysmetria - inability to estimate distances accurately - overshoots intended goal - lack of smooth voluntary motions
163
What is dysdiadochokinesia?
The inability to perform rapid alternating movements
164
What is Dysarthria?
Slurred or scanning speech
165
T or F Cerebellar lesions will cause resting tremors
False Cereballar = intention Basal Ganglia = resting
166
Basal Ganglia problems will have what clinical presentations?
Resting Tremors Chorieform Movement Athetoid Movement
167
T or F Chorieform moments are involuntary, ceaseless, irregular slow continuous writing wormlike motions
False This is describing Athetoid Chorieform = rapid, abrupt, highly complex jerky movements that appear to be well coordinated but are perfumed involuntarily.
168
Increased muscle tone and increased resistance to passive movement is describing?
Rigidity
169
What are the two types of rigidity and their characteristics?
Cogwheel - underlying tremor, seen in parkinson | Lead Pipe - smooth, no underlying tremor
170
When we are evaluating if weakness is neurologic what must we check?
The distal extremities for strength as the smaller muscle groups will be more sensitive
171
What are some cases of weakness?
``` Infection Depression Hormonal Chronic Fatigue Metabolic ```
172
An intrinsic disease of skeletal muscle that is not caused by nerve disorders is called?
Myopathy
173
Myopathy can be related to?
Inherited Inflammatory Endocrine Related Chemical Poisoning

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