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Spine Test 1 > Lecture 10 > Flashcards

Lecture 10 Flashcards

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1
Q

KNOW: Central and foramenal stenosis can cause radiulopathy (putting pressure on the nerve root)

KNOW: Inflammation can cause radioculoathy (puts pressure in nerve root)

A
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2
Q

3 + =

A
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3
Q

KNOW: Central stenosis may result in myelopathy and radiolopathy

A
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4
Q

When is radiating pain a high risk factor (when are we super worried about it)

A

After some traumatic event - they need imaging

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5
Q

Is cervical myelopathy common?

A

No. But its easy to rule out so why not go ahead and rule it out

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6
Q

How do we treat moderate to severe myelopathy?

A

Surgery

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7
Q

How do we treat minimal / mild myelopathy?

A

Supervised trial of structurized thearpy and then surgery if that doesnt work

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8
Q

What are the 5 things that rule in cervical myelopathy? How many do we need

A

Age > 45 years old
Unsteady gait
Positive Horrman reflex
Inverted supinator sign
Positive babinski

3 or more to rule it in

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9
Q

Does hyper or hypo reflexia go along w/ cervical myelopathy?

A

Hyper

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10
Q

KNOW: Bowel and bladder disturbances can go along w/ cervical myelopathy

A
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11
Q

What 3 tests do we do for upper cervical instability?

A

Modified Sharps-Purser
Alar Ligament Test
Transverse Ligament Stress Test

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12
Q

Modified Sharps-purser, Alar ligament Test, Transverse ligament stress tests are all done to test for upper cervical intability. Which of these 3 tests is a symptom provicator (brings on symptoms)

Would you do this test first?

A

Transverse ligament stress test

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13
Q

What is the main symptom were looking to bring on when doing a transverse ligament stress test?

A

This is to test for cervicial instability. Were looking to bring on BILATERAL parasthesis because this is essentially compressing the spine

Might also feel a lump in thraot

Anterior tilt stress transverse
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14
Q

What test is this?

Does it bring on or take away symptoms?

Done w/ anterior tilt
A

Transverse ligament stress test

Brings on symptoms

NOTE: Posititve symptoms = bilateral numbness / lump in throat (compression of spine)

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15
Q

What test is this

Does it bring on or take away symptoms

A

Alar ligament test

Neither brings on or takes away symptoms

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16
Q

What test is this?

Does it bring on or take away symptoms

A

Modified Sharps Purser

Takes away symptoms

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17
Q

What does the modified sharps - purser bring on or take away

A

Takes away numbness / tingling because its putting the transverse ligament on slack meaning there is less compression

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18
Q

NOTE: For upper cervical insufficency we don’t start w/ the test that brings on symptoms. What is the order of opperations between the midified sharps purser, alar ligament test, and transverse ligament stress test?

A

Alar Ligament test –> Modified Sharps purser –> transverse ligament stress test

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19
Q

If we get a positive sharps purser test do we continue to test transverse ligament stress test to confirm findings? (practical question)

A

No, we don’t do a stress test when we’ve already gotten a posititve on a test that thatkes away symptoms

Theres no reason to continue poking the bear if we’ve already seen that we can take away symptoms

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20
Q

Does the Alar ligament test in any way influence the two transverse ligament tests?

A

No

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21
Q

KNOW: Thoracic outlet syndrome affects the space between the collarbone and first rib

A
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22
Q

Where does thoracic outlet syndrome affect?

unilateral or bilateral

A

C8/T1 - unilateral numbness down the inside of the arm down to the pinky (ulnar nerve distribution)

Sometimes it can even feel like a glove on hand

ITS UNILATERL
subclavianartery also affected

NOTE: Muscles being tight can cause this - its some kind of neuro compression around the start of the bracial plexus

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23
Q

NOTE: Its hard to differeinate thoracic outlet syndrome from cervical radioculopathy - we have special tests for this

A
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24
Q

What typically causes a thoracic outlet syndrome style injury?

A

Some kind of arm traction event

The arm is pulled down and the nerve is taut

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25
Whats a red flag that could cause Toracic outlet syndrome?
Pancoast tumor
26
Cervical spine radiculopathy refferal patterns
27
What is sequestration of a disc
The inner fluid slipping completely out
28
NOTE: If its a radiuclopathy we have dermatome / myotome / reflex / sensation involved following a usual dermaome myotome patterns
29
**With cervical radiculopathy do we have more arm pain or neck pain?**
Arm pain I'm guessing this is because the further u go down that compressed nerve the worse signal it gets causing symptoms to intensify
30
**What kind of pain is associated w/ radiculopathy?**
Sharp shooting pain (normally down arm is worse than neck)
31
Why would putting your hands in your pocket reduce symptoms w/ radiculopathy?
Because it takes pressure off that brachial plexues area (which could also be compressed) allowing some more of that signal to translate down
32
Paresthesia/numbness has a high sensitivity for cervical radiculopathy. explain this
Snout If they don't have numbness and tingling they proably don't have radiculopathy
33
What does radiculopathy do to reflexes?
Decreases them (remember - it affects myotomes as well)
34
Compare and contrast reffered pain and radiular pain. What kind of pain is each?
Referred pain = deep, achy, difficult to localize Radicular pain = Sharp, electric-like, shooting pain - well localized in a dermatomal pattern
35
What kind of pain patterns does radioculopathy follow?
Dermatomal
36
What kind of pain patterns do reffered pain follow?
Facet joint, muscle to the UE from the neck, superior back
37
Which affects sensation, radiculopathy or reffered?
radiculopathy (reffered almost never affects sensation)
38
What causes muscle weakness - radiculopathy or reffered pain?
Radiculopathy Reffered pain is coming from something deeper and doesnt really affect the muscle itself
39
What does radioculopathy do to reflexes
Can make them hyper (irritable) or hypo (porlonged) reflexs
40
What does referred pain do to relfex?
Nothing
41
What do nerve tension tests do to referred pain? what about radicular pain?
Reffered = nothing Radiculopathy = Positive ULTTA/B/C
42
**What 3 things contitiute a posititve adverse neural dynamic test (on test)**
1) reproduces pts comparable pain 2) Side to side difference greater than 10 degrees (upper measures at elbow flexion / extension) 3) Censitize / desensitize symptoms (move elbow to change shoulder pain)
43
KNOW: The disc itself can refer pain (its not the nerve root) Facets / muscles can also refer pain
44
What facets refer to the lower skull?
C2-C3
45
What facets refer to upper scapula? What facets refer to lower scapula
C6-7 C7-C8
46
KNOW: disc refferal patterns (referred pain) (C5-C8)
47
where do discs C5-C8 all refer
Medial border scapula
48
**What is the referal pattern of C5-C8 disc to the medial scapula called? **
Cloward sign (both start w/ C) So this cloward sign is a great way to differentaite that disc reffered pain from radiculopathy pain that goes down the arm
49
How would we differentiate the clowards sign from a romboid issue or some kind of rotator cuff issue?
If we move the head and neck and produce a comprable sign then were thinking its a cervical disc issue reffering pain to the medial border scapula
50
A C7 isue leads to the deminishing of what reflex?
Elbow extension
51
Do we want to centeralize or peripheralize symptoms
centralize
52
KNOW: medial scapular pain = discogenic / radicular symptoms
53
What is Spurling's A?
Lateral flexion + Axial loading (pressing straight down)
54
**What is the Wainners clustor for? What are the 4 items in wainers cluster?** (test) How many do we want?
For cervical radiculopathy 1) Spurling A positive (compariable sign?) 2) ULTT1 - Median N 3) Distraction Test = takes away symptoms (positive) 4) Cervical ROM < 60 degrees We want 4/4 to rule it in NOTE: Other symptoms that go along w/ radiculopathy are muscle weakness (proably from prolonged disuse / radflexes being gone / medial scapular pain / follow dermatomal pathway) Extremely high specificity --> if its posititve we rule it in****
55
Do we tension nerves?
No - a stretched nerve is not a happy nerve
56
For someone w/ cervical radiculopathy whah would be 1 really great intervention to do (not counting ex / edacation)
Mobilize the nerve (don't stretch it but move it around)
57
Can you move your head and neck w/ a buldging cervical disc
Yes! buldging discs often heal on their own and moing around / EX help them heal faster
58
**What makes disc pain worse - flexion or extension?**
Flexion (pinches down on them)
59
KNOW: cervical lateral glide / cervical traction /cervical manip / mobilization / mechanical traction / EX KNOW: Start w/ manual traction (you do it) before mechanical distraction (robot) - just to check and make sure it actually helps before wasting 15 minutes * DONT EVER QUICKLY RELEASE * NOTE you dont have to traction straight on - you can move to the left or right
60
What are the 5 things (its a rule) that let us know if they're going to be a posititve responder to **mechancial **traction? (note were doing this to allievate radiculopathy symptoms) We want how many?
1) Patient reports peripheralization with lower cervical spine (C4-C7) with CPA / UPA mobility testing - aka when I poke on that area the symptoms start to go down their arm 2) Positive shoulder abduction test (putting hand on head alliviates symptoms in arm [ipsilateral]) 3) Age greater than 55 (becuase these pt are more likely to have some kind of stneosis / forminal change) 4) Posititve ULTTA (posititve nerve root issues [median / ulnar / radial]) (upper limb tension testing is posititve) 5) Positive distraction test (we did a manual distraction test [PT litteraly stood there and did it] and it felt better for the pt) they want to have **4** or more This tells us that they will respond well to MECHANICAL traction for radiculopathy
61
What is the point of neurodynamic interventions?
Mobilize the nerve by moving it within its sheath * by moving it we calm down its mechanoreceptors - meaning when we move it its less likely to be provoked by any other movement * Increases the amount of blood going to that nerve (nerves love blood supply!) (and axional flow which gives better nutrition / healing to the nevre) * Decreases pain due to these things
62
How far can nerves be stretched before they fail?
Around 20% stretch - nerves do not like to be stretched
63
KNOW: We don't want to stretch the nerve at all in the acute stage
64
What are nerve sliders and when are they used (neurodynamics)
Moves the nerves back and forth. In the person below their symptoms are in the head and neck. You would slide toward where the elongation is initating - aka don't push from pain and pull and make it taut (the goal isnt to stretch the nerve) - we mobilize back and forth mobilizing away from stretch - just moving the nerve back and forth so its getting that increased blood flow / other effects metioned earlier DONE IN THE ACUTE PHASE - we don't want to stretch the nerve at all
65
What are nerve tensioners? (neurodynamics)
Tensioning nerve at both ends (bend head contralateral while making ipsilatearl arm with pom flat = tensioning the nerve) - nerves dont like this and don't like to be stretched - used in rare circumstances
66
What is a contralateral Apprach to neurodynamics
Tensioning the left side (stretching left nerve) so that the other side is pulled and moved - because they're all interconntected (moving the good side or putting it on tension so that the bad side moves as well)
67
Is manipulation good for a fresh radiculopathy (numbness / tingling etc.)
No. Nervey symptoms don't typically scream "MANIPULATE ME". Also one of our contraindication for manipulation is new neurlogic symptoms / neurologic symptoms in general However, you mobilize different segments and see if you can get regional interdependence
68

Spine Test 1 (14 decks)

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