Flashcards in Pathoanatomical Diagnosis/Illness Scripts Info Deck (61)
Healthy nerve root irritation signs/sx
Mechanical Neck Pain [MNP]
-related to activity
-can reproduce and find relief positions
C6 radiculopathy due to "soft disc" herniation of CS at C5-6
-second most common level of HNP of cervical spine
-posterior lateral most common - medial foramen, motor sign > sensory
-material still contained within disc borders
Definition of "soft disc herniation"
-"non-degenerative" and the disc has not lost height or water content
The three basic types of disc herniations?
Sign/sx of classic C6 radiculopathy from C5-6 HNP?
-sharp, inter scapular pain that is higher on the scapula close to the superior angle
Common signs/sx of C6 root pain
-symptoms along volar aspect of forearm and radial side of hand into thumb, index finger
-weakness of key muscles common
-neurological signs common
Differential Diagnosis of C6 root pain
-carpal tunnel syndrome
-acute subacromial bursitis
Pathological conditions that can affect cervical nerve roots other than disc herniations
-plexitis secondary to trauma
-hypertonicity of scaleni muscle groups
-nerve degeneration conditions/diseases
Intervertebral disc as primary pain generator
-annular and nuclear herniations
-toxic to DRG
-compression not necessary
-chemicals in epidural space
Classic sign/sx seen with CS discography?
-referral of nociceptive pain into the medial scapula when the lower cervical intervertebral disc was stimulated
-this gives off referred pain that then turns into peripheral sensitization producing muscle and scapula pain due to lower thresholds producing allodynia or hyperalgesia
General cervical root symptoms & signs
-distal paresthesia proximal pain
-peripheral nerve = clear border of symptoms/atrophy/anesthesia
-motor = fatiguable
-DTR's = hyporeflexive
-UMN - hyperreflexive
Differentiation between C6 & C7 radiculopathy
-C6 = much less sensitive, want to "get rid of it"
-C7 = extreme sensitivity, seem "sick"
-nuclear material is contained and more in periphery than in center of disc
-outer annular wall disrupted, more disc material out than in
-annular or nuclear fragments
Consequences anatomically if material reaches the epidural space?
-the disc material (HNP's can consist of annular and nuclear material or both) can wrap around neural structures and move up and down the posterior longitudinal ligament and produce massive amounts of macrophages and cytokines when herniated
-the DRG which houses the cell bodies is extremely sensitive to pressure and inflammatory cells
Innervation of outer third of disc
Consequence of sinuvertebral nerve when disc is injured?
-the SN starts growing inward toward the inner third of the disc which has been postulated being a cause of chronic neck or low back pain
C7 root pain
-C7 root most sensitive of all cervical roots
-pain lower scapula, back of shoulder, arm into middle fingers
-weakness of elbow extension, long finger flexors
-rarely reduction of triceps reflex
Differential diagnosis of C7 root pain
-winging of scapula
Importance of PT with radiculopathy
-no MRI can diagnose radiculopathy
-PT's are able to based off of clinical exam
-ONLY profession that can do this with history, exam, etc.
Cervical primary disc lesions
1. less common than lumbar disc
2. most prominent levels: C6-7 > C5-6, C4-5
3. radiculopathy - clinical diagnosis confirmed by imaging
4. can resolve 3-4 months untreated
5. history = episodic inter scapular region with progression
6. age = uncommon below 30
7. common in 30-48 age group
8. following HNP disc height changes affects alignment, slightly flexed segment
9. evolution involves more distal symptoms and neuropathic pain
10. later stages (50-70 y/o) central or foramina stenosis
11. foramen is funnel shaped from medial to lateral
-anterior funnel osteophytes off uncovertebral joints, disc
-posterior funnel superior facet, lig flavum, neural cysts
12. paresthesia/weakness in dermatomal reference without neck pain = classic stenosis
Misdiagnosis of classic cervical primary disc lesions?
-previous history of neck pain
Treatment for HNP with radiculopathy in CS
-rest and medication
-traction #1 every day!
-manual (depending on severity of pain)
Key testing of HNP with radiculopathy
-sensation testing [toothpick, hyper or hypo-esthesia]
-fatiguable weakness: cannot hold initial resistance w/ triceps testing MMT
-remember: dermatomes can cross each other quite a bit
trauma to plexus
RTC differential dx signs/sx vs. CS
-age, pain with arm elevation
-unable to open a jar
-location of pain not as close to shoulder
Definition of arachnoiditis?
-type of chronic pain caused by inflammation in the spinal canal
-chronic pain disorder caused by inflammation of the arachnoid membrane and subarachnoid space that surround the nerves of the spinal cord