Non-spinal orthopedic & peripheral nerve entrapments pages 12 to 18 Flashcards
(30 cards)
Shoulder conditions usually refer proximally or distally? bilateral or unilateral? aggravated by motion or prolonged postures?
distally
unilateral
motion
What joint lesion can masquerade as both a cervical and shoulder problem?
acromioclavicular joint lesions.
What are 3 types of proximal neurological entrapment?
- Greater Occipital Nerve
- Thoracic Outlet Syndrome (TOS)
- Brachial Plexopathy
What are 3 types of intermediate nerve entrapment?
- Dorsal Scapular Nerve
- Long Thoracic Nerve
- Suprascapular Nerve
What are 3 types of distal neurological entrapments?
- Radial Nerve entrapment
- Ulnar Nerve entrapment
- Median Nerve entrapment
63% of patients with non-diagnosed chronic non-resolving neck pain may have it be of what origin?
facet joint
Where will pain in C2-C3 facet joints refer to?
Upper cervical region, may go up to ear, forehead, or eye
Where will pain in C3-C4 facet joints refer to?
posterolateral cervical region to suboccipital region. follows course of levator scapulae
Where will pain in C4-C5 facet joints refer to?
Posterolateral pain extending to top of scapula
Where will pain in C5-C6 facet joints refer to?
Triangular distribution of pain from upper trap and down to the spine of the scapula.
Where will pain in C6-C7 facet joints refer to?
Extends beyond spine of the scapula. Covers upper trapezius like the C5-C6 distribution.
What is the most common causes of non-traumatic facet joint pain?
Age related causes such as loss of H2O and height in the IVD, loss of GAG’s and H2O in the facet, and osteophytes in the subchondral bone.
What is the most common traumatic cause of facet joint pain?
MVA’s. Hyperext: compression. Hyperflex: tear joint capsule. Axial loading from hitting roof of vehicle.
What does the sinuvertebral nerve supply?
It supplies the outer 1/3 of the disc at its segmental level and contributes to the innervation of the level above it. Also supplies dura mater at its level and 2 levels below and 1 level up.
What must you screen for 1st if you suspect Degenerative Disc Disease?
myelopathy
Why are X-rays not helpful in dx of DDD?
Because the incidence of disc degeneration (minimum of 1 level) in patients over the age of 40 is 25% and after 55 is 82%.
What are 4 treatment techniques for patients with DDD?
- Reassurance
- Postural correction exercises
- soft tissue techniques and joint manipulation (start with thoracic spine)
- Intermittent traction
Describe radicular pain.
Pain when nerve root is being compressed. Tends to travel in narrow bands, is intense and easy to localize.
What are the 2 ways the nerve root can be compressed? Describe them.
- Direct: mechanical compression of either a herniated disc or pressure from an osteophyte.
- Indirect: Venous congestion and edema from acute inflammatory state (with chemical irritation possibly)
True radiculopathy presents with what 5 signs/symptoms?
- Pain in dermatome at level affected
- Motor weakness in myotome at level affected
- Decreased reflexes
- Sensory changes (usually paraesthesia in UE due to overlap of dermatomes)
- Tenderness on palpation along dermatome
What is the 2 most common nerve roots affected by radiculopathy?
C6
C7
What motions and tests may be positive in cervical radiculopathy?
Motions: reduced ipsilateral cervical rotation, relief if symptoms with cervical distraction or placing arm over head
Tests: Spurling’s test and ULTT
Treatment for radiculopathy
Milder: Intermittent mechanical traction and NSAID’s
Severe: Surgery if neuro deficit and pain continue longer than 3 months
What are the 5 signs associated with poor outcome for radiculopathy patients?
- Hx of episodic occurences over 5 years
- > 3 previous episodes
- bilateral paraesthesia
- females over 50
- progressive worsening of symptoms
