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Orthopedics I > ortho week 2 -QA > Flashcards

ortho week 2 -QA Flashcards

(72 cards)

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1
Q

what 5 general things can go wrong in the spine

A

tissue damage, pain, functional problems, associated symptoms, complicating factors.

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2
Q

if something is feeling week, rule out the most dangerous first

A

brain stem, spinal cord, nerve roots, perepheral nerves

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3
Q

muscle test is to test what?

A

perepheral nerve, muscle function

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4
Q

irritation of nerve root can do what

A

make it hyper reflex

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5
Q

rediculopathy

A

umbrella term for issues of the nerve root like compression and irritation

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6
Q

rediculitis

A

irritation of nerve root.

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7
Q

what percent have disk herniation without problems?

A

seventy to 80%

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8
Q

pain is caused by what three things?

A

nociceptive, peripheral sensitization, central sensitization

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9
Q

what are associated symptoms for cervical spine issues

A

like limping or compensating from pain that can cause other problems

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10
Q

what is a complacating factor?

A

something that would impede healing, surgery, fusion, tissue damage, etc

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11
Q

what does orthapedic testing do?

A

stress tissues

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12
Q

what is the first thing we do?

A

observe the person see how they are moving

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13
Q

what do we do after observation, the first movement thing?

A

Active range of motion, AROM.

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14
Q

why do we do AROM before passive or resisted?

A

so that we know where their limits are. This can change the rest of the tests., this way you are not touching them untill you think it may be safe.

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15
Q

what is PROM

A

passive range of motion, they lay down, you move their head.

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16
Q

from what position is RROM done

A

the head should be in neutral, sitting up.

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17
Q

Rusts sign is what?

A

this isn’t a test, it?s a sign where they have to hold their head up with their hands.

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18
Q

Bakodys sign is what?

A

this could be a test. Person has relief of pain if arm is relaxed on top of head.

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19
Q

what does bakodys sign relieve?

A

relieves nerve root irritation,

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20
Q

what if you can examine someone because they are in to much pain

A

Don?t diagnose. Wait. Send for imaging,

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21
Q

what is importaint about he cervical tests?

A

lots of false positives, classic positives and non classical positives, and non of the tests give diagnosis independently

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22
Q

what is importain about charting

A

super specific for location using doctor directions and metric.

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23
Q

what should be done with all positives?

A

they should be qualified, include nerve root number, type of pain, where it went, what its associated with.

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24
Q

why include pertentenet negatives, what are they.

A

they are what you are using to say it isn’t something more serious.

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25
what is the spinous percussion test?
tapping reflex hammer on cervical spinous processes to see if it causes lingering pain.
26
what could a positive spinous percussing indicate?3
vertebral fracture if there was trauma, metastic disease if history of cancer or constitutional symptoms., or disk impingment.
27
what is the valsalva maneuver used to confirm?
suspicion of herniated disc or space occupying lesion in spinal cord or IVF
28
how is the valsalva maneuver done?
patient is to bear down for 2-3 seconds.
29
what does the valsalva maneuver do?
increases intrathecal and intradical pressure which increases expansion of herniated nucleus pulposus and increases peripherial signs or symptoms.
30
what could cause a positive Rusts sign?
structural instability from trauma, odontoid fracture, sprain of transverse ligament, and antlanto axial instability.
31
what can atlantoaxial instability be associated with?
Rheumatoid arthritis pain or neurological dysfunction.
32
what can post traumatic cervical sprain and subluxation result in?
rigidity and torticollis.
33
what to do about Rusts sign,
stabalize neck, Xray, and referral to surgen, ambulance.
34
what is the cervical compression test?
placing increasing axial compression on top of patients head untill it stops.
35
what should cervical compression test do?
if there is a problem, it should reproduce symptoms,
36
what is a positive cervical compression test?
pain, paresthesia, numbness radiating to upper extremity or between shoulder blades.
37
what may positive cervical compression test indicate?
cervical disk herniation, spinal stenosis, arm symptoms indicate C6-C8 nerve root, foraminal encroachments, space occupying lesions.
38
how specivic is cervical compression test?
only 30%, pretty bad all on its own, only 30% are truly negative.
39
what are the three cervical compression tests?
1-cervical compresson test, 2-spurling's test, 3-maximal foraminal compression test.
40
what is spurlings test
patient actively laterally flexes, then press down axial, do not flex head more.
41
how sensitive is spurlings test
11-90% so maybe good
42
how speccific is spurlings test?
75-100% so really good at ruling it out.
43
what is the maximal foraminal compression test?
rotation to symptomatic side with extension and lateral flexion, ie looking back over shoulder.
44
how sensitive is maximal foraminal compression test?
30-50% so can only rule in less than half
45
how specivic is maximal foraminal compression test?
92-100%, so its really great at confirming a negative.
46
how are the three compressions done?
you keep going and then stop when you get first positive, no need to go further.
47
what do you do after the compression tests?
the cervical distraction test to see if pain you caused will go away.
48
what does a positive cervical distraction test, less pain/symptoms indicate?
may indicate nerve root irritation from intra vertebral foramina encroachment from disc or osteophytic compression/spinal stenosis
49
what if cervical distraction causes more pain?
ligamentous sprain, facet capsular sprain, Muscular strain.
50
how specific is the cervical distraction test?
100% specifit, rule out.
51
How sensitive is the cervical distraction test?
26-43% not very sensitive.
52
what is the purpose of the shoulder depression test?
to stretch the brachial plexis,
53
what is a positive for the shoulder depression text?
causes or exerbates radicular symptoms like pain, parethesia and numbness in a dermatomal pattern.
54
what would a positive shoulder depression test indicate?
1-irritation or compression of nerver root, spinal nerve, brachial plexus, 2- foraminal encroachments, 3- adhesions, ligament or capisular sprain on side being stretched.
55
what is the diagnostic cluster for cervical radiculopathy?
99% specificity and a +LR of 30 for cervical radiculopathy when patient had the following: 1 + ULTT of median nerve, 2 active cervical rotation of less than 60, 3 + distraction stest, 4+ spurlings test.
56
what 4 tests make up the diagnostic cluster for cervical radiculopathy
ULTT of median nerve, AROM cervical of <60, + distraction test, + spurling test.
57
what does pain with PROM indicate?
probably non contractile tissue like ligament and joint capsule
58
What does pain only with AROM indicate?
contractile tissues like muscle and tendon problem
59
Pain with resisted only?
milder contractile tissue injury.
60
what is the soto hall test?
patient is supine, hand placed on sternum to keep chest down, other hand flexes head and neck
61
why is the soto hall test used?
to confirm suspicion of meningitis, Vertebral fracture, joint or ligament injury, cervicothoracic sprain, facet syndrom , disc derangement
62
what is a positive soto Hall sign?
pain, but if there is the brudzinki sign, of reflexive automatic hip and knee flexion it means meningitis.
63
what are the canadian C spine rules for Xrays?
change in awarness or neuro symptons, over 65, fearful of moving head, substantial injury, axial load injury (diving) midline palpatory pain.
64
how specific and sensitive is Canadian C spine rule
40-90% can rule out, 99-100 % to rule in. So good to not miss anyone.
65
what is VBI?
vertebro-basilar insufficiency that refers to insufficent blood flow through vertebral and basilar artery to midbrain, cerebelum and cerebrum
66
what can injury to vertebral arteries lead to?
stroke or syndromes related to stroke.
67
are there any safe reliable tests to rule out vertebral artery dissection in progress?
no, the current tests may aggrivate the problem.
68
what can be used to gage verrtebral arter dissection
history, of faining, unwell ness, oral controceptives, smoking etc, marfans syndrome, upper respiratory infectin
69
what are the 5 ds for VBI
double vison, sizziness, drop attacks numbness, dysarthria, dysphagia
70
what is the A and 3 Ns
ataxia of gait, nausea, numbness, nystagmus
71
what to do for post manipulative advers response?
911,
72
what is the best clinica lapproace for avoiding adverse response, stroke?
evaluate risk, look for signifigant history, observe for stroke before and after, if risks do non manupulate for cervical spine.

Orthopedics I (3 decks)

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