Pathoanatomical Diagnosis/Illness Scripts Info Flashcards Preview

NAIOMT Cervical Spine Exam C-516 > Pathoanatomical Diagnosis/Illness Scripts Info > Flashcards

Flashcards in Pathoanatomical Diagnosis/Illness Scripts Info Deck (61)
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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?

1. prolapse
2. extruded
3. sequestered


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
-paresthesia common
-weakness of key muscles common
-neurological signs common


Differential Diagnosis of C6 root pain

-thoracic outlet
-carpal tunnel syndrome
-lateral epicondylitis
-acute subacromial bursitis


Pathological conditions that can affect cervical nerve roots other than disc herniations

-viral neuritis
-plexitis secondary to trauma
-neural scarring
-hypertonicity of scaleni muscle groups
-neural sensitization
-nerve degeneration conditions/diseases


Intervertebral disc as primary pain generator

-cervical HNP
-posterior lateral
-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
-segmental reference
-peripheral nerve = clear border of symptoms/atrophy/anesthesia
-conduction deficits
-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"


Prolapse HNP

-nuclear material is contained and more in periphery than in center of disc


Extrusion HNP

-outer annular wall disrupted, more disc material out than in


Sequestration HNP

-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

sinuvertebral nerve


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

-triceps tendonitis
-winging of scapula
-calcified tendonopathy


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?

-shoulder pain
-rhomboid strain
-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


Definition of polyarthropathy?

-any type of arthritis that involves 5 or more joints simultaneously
-it is usually associated with autoimmune conditions and is not age or sex-specific