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Spine Test 1 > Lecture 10 > Flashcards

Lecture 10 Flashcards

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
Q

Whats a red flag that could cause Toracic outlet syndrome?

A

Pancoast tumor

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26
Q

Cervical spine radiculopathy refferal patterns

A
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27
Q

What is sequestration of a disc

A

The inner fluid slipping completely out

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28
Q

NOTE: If its a radiuclopathy we have dermatome / myotome / reflex / sensation involved following a usual dermaome myotome patterns

A
29
Q

With cervical radiculopathy do we have more arm pain or neck pain?

A

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
Q

What kind of pain is associated w/ radiculopathy?

A

Sharp shooting pain (normally down arm is worse than neck)

31
Q

Why would putting your hands in your pocket reduce symptoms w/ radiculopathy?

A

Because it takes pressure off that brachial plexues area (which could also be compressed) allowing some more of that signal to translate down

32
Q

Paresthesia/numbness has a high sensitivity for cervical radiculopathy. explain this

A

Snout

If they don’t have numbness and tingling they proably don’t have radiculopathy

33
Q

What does radiculopathy do to reflexes?

A

Decreases them (remember - it affects myotomes as well)

34
Q

Compare and contrast reffered pain and radiular pain. What kind of pain is each?

A

Referred pain = deep, achy, difficult to localize

Radicular pain = Sharp, electric-like, shooting pain - well localized in a dermatomal pattern

35
Q

What kind of pain patterns does radioculopathy follow?

A

Dermatomal

36
Q

What kind of pain patterns do reffered pain follow?

A

Facet joint, muscle to the UE from the neck, superior back

37
Q

Which affects sensation, radiculopathy or reffered?

A

radiculopathy (reffered almost never affects sensation)

38
Q

What causes muscle weakness - radiculopathy or reffered pain?

A

Radiculopathy

Reffered pain is coming from something deeper and doesnt really affect the muscle itself

39
Q

What does radioculopathy do to reflexes

A

Can make them hyper (irritable) or hypo (porlonged) reflexs

40
Q

What does referred pain do to relfex?

A

Nothing

41
Q

What do nerve tension tests do to referred pain? what about radicular pain?

A

Reffered = nothing

Radiculopathy = Positive ULTTA/B/C

42
Q

What 3 things contitiute a posititve adverse neural dynamic test (on test)

A

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
Q

KNOW: The disc itself can refer pain (its not the nerve root)

Facets / muscles can also refer pain

A
44
Q

What facets refer to the lower skull?

A

C2-C3

45
Q

What facets refer to upper scapula?

What facets refer to lower scapula

A

C6-7

C7-C8

46
Q

KNOW: disc refferal patterns (referred pain) (C5-C8)

A
47
Q

where do discs C5-C8 all refer

A

Medial border scapula

48
Q

**What is the referal pattern of C5-C8 disc to the medial scapula called? **

A

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
Q

How would we differentiate the clowards sign from a romboid issue or some kind of rotator cuff issue?

A

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
Q

A C7 isue leads to the deminishing of what reflex?

A

Elbow extension

51
Q

Do we want to centeralize or peripheralize symptoms

A

centralize

52
Q

KNOW: medial scapular pain = discogenic / radicular symptoms

A
53
Q

What is Spurling’s A?

A

Lateral flexion + Axial loading (pressing straight down)

54
Q

What is the Wainners clustor for? What are the 4 items in wainers cluster? (test)

How many do we want?

A

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
Q

Do we tension nerves?

A

No - a stretched nerve is not a happy nerve

56
Q

For someone w/ cervical radiculopathy whah would be 1 really great intervention to do (not counting ex / edacation)

A

Mobilize the nerve (don’t stretch it but move it around)

57
Q

Can you move your head and neck w/ a buldging cervical disc

A

Yes! buldging discs often heal on their own and moing around / EX help them heal faster

58
Q

What makes disc pain worse - flexion or extension?

A

Flexion (pinches down on them)

59
Q

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

A
60
Q

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?

A

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
Q

What is the point of neurodynamic interventions?

A

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
Q

How far can nerves be stretched before they fail?

A

Around 20% stretch - nerves do not like to be stretched

63
Q

KNOW: We don’t want to stretch the nerve at all in the acute stage

A
64
Q

What are nerve sliders and when are they used (neurodynamics)

A

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
Q

What are nerve tensioners? (neurodynamics)

A

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
Q

What is a contralateral Apprach to neurodynamics

A

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
Q

Is manipulation good for a fresh radiculopathy (numbness / tingling etc.)

A

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
Q
A

Spine Test 1 (14 decks)

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