IDD - Exam 2 Flashcards
what parts of the disc tear in acute IDD?
annulus
end plate
persistent IDD is disc changes that allow for herniations that develop ________
gradually over time
is acute or chronic IDD the most prevalent?
chronic
the layers of the annulus are more like a _______ which means the annulus and nucleus move ____(together or separate)___
gradient
together
the outer annulus has greater type _____ collagen and resists _______
type I
tension
the inner annulus has greater type _____ collagen and resists _______
type II
compression
true or false. from outer to inner annulus, it goes hyper to hyponeural
true
annulus:
- vascular or avascular?
- concentric rings w/ ________ fibers
- compression produces _______ and vice versa
- avascular
- perpendicular
- tension
nucleus:
- resists _______
- type ____ collagen
-high # of _______
- vascular or avascular?
- compression
- type II
-GAGs - avascular (depends on diffusion to get nutrients)
Vertebral endplate: “pipeline of body and disk”
-highly _____ and _______
-assists w/ ________ for disk
-covers the _____ and MOST of annulus with __________
-_________is (type?) toward the vertebral body
-_________is (type?) toward the disc
-innervated and vascularized
-nutrient diffusion
-nucleus; specialized connective tissue
-articular cartilage type II
-fibrocartilage type I
The __________ is the weakest link of the intervertebral joining, especially at the annular connection.
vertebral end plate
What is made up of type I collagen and 6x stiffer and 3x thicker than a disc?
bone
Is IDD more often times persistent or acute?
Rare in what spinal region?
persistent
thoracic spine
(most common in lumbar spine)
Why is it rare to have internal disc derangement (IDD) in the T-spine?
because the t-spine is the narrowest canal which means it has less room to accept change.
Why is it rare to have IDD in the C2-C6 region?
because of the additional stability from the UV jts.
-creates more stability
What portion of the disc is the MOST common area
-Why?
posterolateral
-weaker, thinner, with more vertical and, less oblique annular fibers
The transition of the annulus into _______is the weak spot
endplate
Acute IDD is more commonly _______ tear and _______ avulsion
Less commonly ______________ herniation
-annular and end plate
-nucleus pulosus
Does the immune system respond when disc structures are damaged? why?
Yes
large autoimmune inflammatory response occurs –> more water –> spinal nerve and disc swelled –> spinal nerve sensitized to pressure/tension –> radiculopathy/radicular S&S –> excess water has no where to go because poor drainage = extended inflammatory phase
typical postlat IDD acute symptoms:
dull/achy spinal pain
– annulus highly innervated
– less swelling due to less GAGs
radiculopathy
– segmental paresthesias within 24 hours into distal extremity because of additional water buildup
referred pain
decreased pain laying supine/unloaded
increased neck pain looking down (due to tension)
increased pain in morning
how does S&S of acute IDD differ from age related joint changes and lateral stenosis? (regarding flexion and extension)
age & stenosis = pain increased looking up
acute IDD = pain increased looking down
what are you going to find in a scan for postlat acute IDD?
ROM?
MMT?
stress test?
neuro?
ROM:
flx & contralateral SB/RT limited w/ increased extremity & spinal pain due to pressure toward spinal nerve
ext & SB/RT less limited w/ decreased extremity pain but may increase spinal pain due to increased hydrostatic pressure on disc
MMT:
variable
Stress test:
possible + with compression/distraction/PA pressures
neuro:
+ depending on severity and timing
myotomal fatigue
DTR- hyporeflexive
diminished dermatomes
+ dural mobility tests
what is centralization?
abolition of distal and/or spinal pain in a distal to proximal direction in response to repetitive motions or sustained positions
what are you going to find in a biomechanical exam for postlat acute IDD?
+ stability tests
