Week 2 Flashcards
(34 cards)
What are the 3 origins of pain?
Nociceptive, peripheral sensitization, central sensitization
Also, mechanical & non-mechanical pain!
What is the 1 active PE procedure that will be performed on every pt with an NMS complaint, no matter what the region, mech of action, or severity?
AROM
What 3 motions, in combo, max stress the vertebrobasilar vascular complex?
Extension, Lateral Flexion, Rotation
What is Nociceptive pain?
Common understanding of pain… neurologic and physiologic understanding of pain. Tells us if the tissue is functioning or damaged.
What is peripheral sensitization pain?
Peripheral nervous system becomes more sensitive to sensation (i.e. stepped on nail, now that area is going to be more sensitive d/t this type of pain)
What is central sensitization pain?
We lose our ability to filter out info. Info more likely to be determined as threatening (i.e. things we would normally interpret as non-threatening sensation is now interpreted as threatening)
What can go wrong with the cervical spine (big picture things)?
Tissue damage, pain, functional problems, associated SSx, complicating factors
What tests did we learn for the cervical spine that you do for the whole spine?
Valsalva & Spinous Percussion
What are the 3 compression tests in the cervical spine? List in the order of stress on the pt! Which one is part of a diagnostic cluster?
- Cervical Compression Test
- Spurling’s Test
- Maximal Foraminal Compression Test
-Spurling’s Test
What is the least you should do when you are testing the nervous system (general)?
- Stretch nervous tissue
- Compress nervous tissue
- Valsalva
- Reflex, Motor, Sensory testing
What tests stretch nervous tissue in the cervical spine?
Cervical distraction test & Shoulder depression test
What are the 3 types of ROM?
Active, passive, resisted
What are the 2 signs when evaluating the cervical spine?
Rust’s and Bakody’s Sign
Describe Rust’s Sign
Observational finding! Pt is stabilizing their own neck, esp when moving from one position to the other (possible instability)
Describe Bakody’s Sign
Hx finding! Pt has relief from SSx when the raise the arm that they have SSx on over their head, which gives them relief of SSx (possible radiculopathy)
What 5 things do you need to note in doctor level charting regarding +/- of ortho tests?
- Be specific
- Use Dr level terminologies
- Don’t jump to conclusions
- Quantify ALL positives
- Include pertinent negatives
Spinous Percussion Test!
- What is it?
- What’s +?
- What’s -?
- What’s that mean?
Tap on spine w/reflex hammer
+ Exquisite point tenderness (esp. if it lingers)
- Nontender, generalized tenderness, no specific bony point tenderness
—Metastasis to spine, CA of spine, Fx of spine
Valsalva Maneuver
- What is it?
- What’s +?
- What’s -?
- What’s that mean?
Increases dural pressure
+Radicular/radiating SSx (weakness, numbness, tingling, pain, paresthesias), down the arm for neck/cervical
-no SSx or anything other than what is listed above
—-Radiculopathy
True/False. An appropriate response to an orthopedic test is, “Reproduction of a patient’s symptoms”.
FALSE! Be specific and quantify your positives.
Cervical Compression Test
- What is it?
- What’s +?
- What’s -?
- What’s that mean?
Compressing cervical spine puts axial compression on intervertebral foramen
+ Radicular SSx
- Feels good, No SSx
——RADICULOPATHY
This is the 1st compression test done!
Spurling’s Test
- What is it?
- What’s +?
- What’s -?
- What’s that mean?
- Is it sensitive or specific (what’s that mean)?
Pt laterally flexes neck, then pressure is applied to head straight down spine
+ Radicular SSx w/lateral flexion or pressure
- No radicular SSx
- —–RADICULOPATHY
SPECIFIC! If + we can RULE in a possible Radiculopathy (not a good screening test)
Maximal Cervical Compression Test
- What is it?
- What’s +?
- What’s -?
- What’s that mean?
- Is it sensitive or specific (what’s that mean)?
Passively place pt in neck extension, lateral flexion, & ipsilateral rotation. Then apply compression to head
+ Radicular SSx w/passive motion or compression
- No radicular SSx
- —–RADICULOPATHY
SPECIFIC! If + we can RULE in a possible Radiculopathy (not a good screening test)
Cervical Distraction Test
- What is it?
- What’s +?
- What’s -?
- What’s that mean?
- Is it sensitive or specific (what’s that mean)?
Pt head in neutral, lift head off of neck (distracting cervical spine, stretching)
+ Radicular SSx decrease
- Feels good, no change in radicular SSx, neck pain goes away, more painful, INC SSx
SPECIFICITY = 100% = Rule in radiculopathy
What 4 items are in the diagnostic cluster for cervical radiculopathy? How many do you need to diagnose with a cervical radiculopathy?
Active cervical rotation
