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61

Consider the nerve supply to the supraspinatus muscle. This nerve:

a) Arises from the upper trunk of the brachial plexus and also supplies the skin over the shoulder and clavicle

b) Arises from the upper trunk of the brachial plexus and has no cutaneous branches

c) Arises from the middle trunk of the brachial plexus and also supplies the skin over the shoulder and clavicle

d) Arises from the middle trunk of the brachial plexus and has no cutaneous branches

b) Arises from the upper trunk of the brachial plexus and has no cutaneous branches

62

• The spinothalamic tract projects to S1 and S2. Sluka, pg 47 “Spinothalamic tract”

• “The VPL projects to the primary (S1) and secondary (S2) somatosensory cortex, and this pathway is thought to be involved in the sensory–discriminative component of pain (i.e., its location, duration, quality, and intensity).”

63

Specificity theory

Chapter 1 Sluka - Pain Theories:

“The specificity theory suggests that there are separate nerve endings for each variety of sensation arising from cutaneous stimulation, that is, touch, cold, warmth, and pain. For pain, the theory suggests that there are “pain receptors” that when stimulated always produce the sensation of pain and only pain.

64

Polyneuropathy is defined as?

  1. A relatively homogeneous process affecting many peripheral nerves, with the distal nerves usually affected  most prominently
  2. A relatively heterogeneous process affecting many peripheral nerves, with the distal nerves usually affected  most prominently
  3. A relatively homogeneous process affecting many peripheral nerves, with the proximal nerves usually affected  most prominently
  4. A relatively heterogeneous process affecting many peripheral nerves, with the distal nerves usually affected  most prominently

A relatively homogeneous process affecting many peripheral nerves, with the distal nerves usually affected  most prominently

65

C) Sensory discriminative, motivational affective and cognitive evaluative dimensions

66

According to the international study of pain, neuropathic pain is defined as

  1. Pain that arises as a direct consequence of a disease affecting the somatosensory system 
  2. Pain that arises as a direct consequence of a lesion affecting the somatosensory system 
  3. Pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system 
  4. Pain that arises as a indirect consequence of a disease affecting the somatosensory system 

Pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system 

67

During sacral nutation, the sacral promontory moves in an:

Anteroinferior direction, and there is anterior rotation of the ilium on the sacrum 

Anteroinferior direction, and there is posterior rotation of the ilium on the sacrum

Posterosuperior direction, and there is anterior rotation of the ilium on the sacrum

Posterosuperior direction, and there is posterior rotation of the ilium on the sacrum

Anteroinferior direction, and there is posterior rotation of the ilium on the sacrum

68

List the contents of the carpal tunnel

  1. Its bound by the Carpal bones (trapezium, trapezoid, capatate, hamate) 
  2. median nerve 
  3. 9 flexor tendons in flexor retinaculum - flexor pollicis longus, 4x flexor digitorioum superficialis, 4 flexor digitorium profundus 

69

During neuropathic pain, what changes occur at the cellular level?

  1. decreased response to suprathreshold stimulation, recruitment of low threshold, high threshold and silent nociceptors   
  2. Increases response to suprathreshold stimulation, recruitment of silent nociceptors   
  3. decreased response to suprathreshold stimulation, recruitment of low threshold, low threshold and silent nociceptors  
  4. Increased response to suprathreshold stimulation, recruitment of low threshold, low threshold and silent nociceptors  

Increases response to suprathreshold stimulation, recruitment of silent nociceptors   

70

The suboptimal tissue loading hypothesis is best described by which rationale

  1. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of nociceptive afferents with ot without tissue injury and ultimately pain
  2. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of agonist muscle and their associated non-nociceptive afferents with or without tissue injury and ultimately pain
  3. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of agonist muscle and their associated non-nociceptive efferents with or without tissue injury and ultimately pain
  4. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of agonist muscle and their associated nociceptive afferents with or without tissue injury and ultimately pain

The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of nociceptive afferents with ot without tissue injury and ultimately pain

71

A) Typically intermittent, sharper on movement and duller at rest, local to the injury, Relates proportionately to the injury and aggravating and relieving factors (stimulus dependant pain).

72

Differentiate between the terms spondylolysis, spondylolisthesis and spondylosis

  1. spondylolisthesis: slippage of a vertebra most common C5/S1
  2. spondylolysis: # pars interarticular 
  3. Spondylosis: degeneration of a vertebral disc or joint 

73

• C Fibres
Week 2 Lecture slide 12

74

A disc herniation in which the displaced material has lost all connection with the disc of origin is called a:

Disc sequestration

Disc protrusion

Disc extrustion 

Intravertebral herniation 

Disc sequestration

75

During  neuropathic pain, what changes occur at the dorsal ganglion?

  1. Altered gene expression and ectopic firing
  2. Decreased inhibitory tone and altered signal transmission
  3. Decreased nociceptor sensitivity and altered signal transmission
  4. Increased inhibitory tone and increased glial activation

Altered gene expression and ectopic firing

76

  The nerve supply to cervical intervertebral discs includes which of the following?

 

Meningeal branches of cervical spinal nerves 

Transverse cervical nerve and ansa cervicalis

Spinal accessory nerve

Lesser occipital and great auricular nerves

Meningeal branches of cervical spinal nerves 

77

• Sluka, pg 18 “Cutaneous nociceptors”

78

Facet joints of the cervical spine (C2-C7) are oriented:

 

At 45 degrees, approximately halfway between the frontal and horizontal planes

At 45 degrees, approximately halfway between the frontal and sagittal planes

At 60 degrees, approximately halfway between the frontal and horizontal planes

At 60 degrees, approximately halfway between the frontal and sagittal planes

At 45 degrees, approximately halfway between the frontal and horizontal planes

79

Phantom limb pain
- neuromatrix explains phantom limb pain

Melzack and Wall:

The gate control theory of pain, proposes that a mechanism in the dorsal horns of the spinal cord acts like a gate that inhibits or facilitates transmission from the body to the brain on the basis of the diameters of the active peripheral fibers, as well as the dynamic action of brain processes. The gate control theory, however, is not able to explain several chronic pain problems, such as phantom limb pain, which require a greater understanding of brain mechanisms..

80

SBO6-WorkshopMaterialWeek4

81

C) Nociception is information transmitted about noxious or potentially harmful stimuli. Pain isn’t just a reporting system for tissue damage but a prediction and prevention system also

82

D) Nociception

Table 1.1 Sluka: Pain Terminology

Slide 38 – Week 2 “nociceptors transform the ‘energy of tissue damage’ (mechanical, thermal or chemical) into electrical energy for neural transmission”

83

Pheriperal and central nervous system lesions have been shown to sensitize primary afferent fibres by:

  1. Non-neural cells and high threshold nociceptor 
  2. activating spinal cord glial cells
  3. inhibiting chemokines
  4. activating high threshold nociceptors 

activating spinal cord glial cells

84

what rationale is argued to explain many chages in motor control after an injujry for example the early athrophy of multifidus muscle pain?

 

  1. non nociceptive efferent imput, via interneurons can  inhibit and facilitate motoneuros
  2. nociceptive efferent imput, via interneurons can  inhibit and facilitate motoneurons 
  3. nociceptive afferent imput, via interneurons can  inhibit and facilitate motoneurons  
  4. non nociceptive afferent imput, via interneurons can  inhibit and facilitate motoneuros

non nociceptive afferent imput, via interneurons can  inhibit and facilitate motoneuros

 

Sluka, Section: Pain/Injury Interference/Inaccuracy Hypothesis Start of 3rd paragraph.

85

The phrase "pain memories" is associated with which hypothesis about how pain affects motor control?

a)     Pain adaptation theory

b)     Classical conditioning 

c)     Pain spasm pain theory

d)     Hodges protection hypothesis

b)     Classical conditioning 

86

Which theory sugests that tactile stimulation can modulate pain A) specificity theory

B) Strong' theory

C) Sensory-discriminative theory

D) Gate control theory

D) Gate control theory

87

Choose the most correct response. Silent nociceptors are:

a)     Mechanically insensitive neurons which are likely activated by inflammatory mediators such as prostaglandins

b)     Mechanically sensitive neurons which are likely activated by inflammatory mediators such as prostaglandins

c)     Mechanically insensitive neurons which are likely activated by neuronal substances such as substance P and glutamate

d)     Mechanically sensitive neurons which are likely activated by inflammatory mediators such as substance P and glutamate

a)     Mechanically insensitive neurons which are likely activated by inflammatory mediators such as prostaglandins

88

Sluka, pg 24 “NONNEURONAL ACTIVATORS AND INFLAMMATORY MEDIATORS” middle of first paragraph

89

• SBO6 Week 6 Workshop Material “STEP 2 – TRANSMISSION/CONDUCTION

Once the PAN has been transduced, the action potential must be transmitted to the CNS and through the CNS before pain is perceived. Three steps are involved in nociceptive signal transmission: 1) projection to the CNS; 2) processing within the dorsal horn of the spinal cord; and 3) transmission to the brain. Each step in the transmission process is important to pain perception.”

90

Which of the following is NOT a feature of nociceptive pain presentations?

Deep pain

Shooting pain

Aching pain

Steady pain

Shooting pain