1e - Cspine Dx Part 2 Flashcards
what is fibromyalgia syndrome (FMS)
chronic widespread pain disorder commonly associated w comorbid sx, including fatigue and nonrestorative sleep
what are 5 characteristic s/sx of FMS
widespread pain
TTP at multiple points
morning stiffness
fatigue
sleep disturbance
what 2 pt populations is FMS common in
female
military population
- component of stress
trigger vs tender point
trigger point = objective
- respond well to STM
tender points
- no twitch response
- no palpable nodule
- not responsive to STM
- aren’t included in new guidelines
how many tender points are associated w FMS
18
what is a tender point
localized tenderness to palpation
what is a trigger point
hyperirritable spont
w/i taut band of skeletal ms
nodules palpable w/i ms
what is an aggravating factor to trigger points and how can the pain present
painful on compression or ms contraction
- may respond w referred pain pattern distant from spot
what is the difference from the old ACR FMS dx criteria to the updated criteria used today
- widespread pain index (0-19 score)
- Sx Severity Score (0-3 score)
- fatigue
- sleep
- cog sx
- somatic sx
what is the significance of the dx criteria for FMS
no specific tes for it
- important to r/o other things
what is a differential dx for FMS
lyme dz
score ranges for dx criteria of FMS
WPI >7 and SSS >5
- or -
WPI 4-6 and SSS >9
what is fibro-fog
cog issue, problems concentrating
- see as a result of non restorative sleep that can be seen in FMS
what are the 3 conditions to be met for a FMS dx
- WPI >/=7 and SSS >/=5 -or- WPI 4-6 and SSS >/=9
- generalized pain present in at least 4 / 5 defined regions regions
- sx present at similar level for at least 3mo
what should be kept in consideration about a dx of fibromyalgia
doesn’t exclude presence of other clinically important illnesses
what are 5 likely exam findings in FMS
- tender points
- allodynia
- may also be trigger points
- dec ROM
- dec strength and endurance
what is allodynia and how can it be assessed
pain in response to non-nociceptive stim
assessed cutaneously by brushing skin
what type approach should be taken for FMS interventions and what are 4 ex
multidisciplinary, holistic approach
aerobic conditioning
strengthening
mind-body connection (ie yoga, pilates, breathing)
pharm (meds)
what needs to be balanced in your approach to interventions for FMS and why
balance b/w overly vigorous approach (exacerbate sx d/t low pain threshold) and under activity (disuse atrophy and inc sx)
what is a consideration of appt scheduling in FMS and why
see them in afternoon/later in day appts
lots of fatigue
poor sleep
better in quiet clinic
what is the focus of interventions for FMS
aerobic conditioning
strengthening
(consistency is key)
what should you educate FMS pts on
pacing selves
manage energy levels
neuropathic pain management
- nociplastic pain experience
- educate ab threshold and limits
prognosis and PT treatment frequency
1-2x/wk for 6+wks
won’t see huge changes in short time
- gradual/graded progression
important to engage them & set up w resources
what is congenital muscular torticollis (CMT)
postural deformity of neck evident at birth or shortly thereafter
what is CMT characterized by
head tilt to one side or lateral neck flexion (ipsilateral), w neck rotated to opposite side d/t unilateral shortening/fibrosis of SCM ms
what comorbidities can accompany CMT (4)
cranial deformation
hip dysplasia
brachial plexus injury
distal extremity deformities
how does R torticollis present
head contracted in R SB, L rotation and a little flexion
named by side of affected ms (R SCM)
what are 3 types of CMT
postural
muscular
SCM mass
how does postural CMT present
infant’s postural preference but w/o ms or PROM restrictions
- mildest presentation
what type of CMT has the mildest presentation and which has the most severe
postural
SCM mass
how does muscular CMT present
SCM tightness
PROM limitaitons
how does SCM mass CMT present
fibrotic thickening of SCM
PROM limitations
what 2 factors are highly predictive of time required to resolve ROM limitations in CMT
type of CMT
age of initial dx
what are 7xs to refer an infant treating CMT w PT to MD
- non-muscular cause of asymmetry (ie poor visual tracking, abnormal ms tone, extra-ms masses)
- associated conditions (cranial deformation)
- asymmetries inconsistent w CMT
- if infant >12mo and facial asymmetry and/or 10-15def of difference in PROM to AROM in cervical rotation or lateral flex
- infant 7mo+ w SCM mass
- side of torticollis changes
- size or location of SCM mass inc
why is early identification and treatment of CMT key
critical for:
- early correction
- early identification of secondary or concomitant impairments
- prevention of future complications
infants identified w CMT later (3-6mo) and have SCM mass CMT is correlated w what
longest episodes of conservative treatment
undergo more invasive interventions
- surgical lengthening/release of SCM
- botox injections
what is plagiocephaly, how is it often caused, and how is it treated
cranial asymmetry w flattening of 1 side of head
if babies lay in one position or on back a lot
lots of tummy time!
what info do we want from the parent report during the pt exam of CMT
pregnancy hx
infant hx
family hx of torticollis/plagiocephaly
what are systems review components to assess in the pt exam of CMT
visual function
hip screen
neuro screen
pain assessment
skin screen
what are components of the physical assessment during the pt exam of CMT
clinical observations
anthropometrics
ROM
ms palpation
what can untreated CMT lead to and how is this often treated
positional plagiocephaly
cranial orthosis
what is the primary emphasis of interventions for CMT
how you handle them -> asymmetrical handling to activate weak nect ms
- can’t really do ROM
what are 5 interventions for CMT
neck PROM
neck/trunk AROM
- feeding from alternate sides
development symmetrical mvmt
environmental adaptations
pt/caregiver ed
how should supervised tummy time be utilized in interventions for CMT
when infant is awake
- 3+x/day
- for more than 1 cumulative hour to prevent neck asymmetry
at what point is an infant not progressing as anticipated and you should seek consultation
asymmetry of head, neck, and trunk not starting resolve 4-6wks of comprehensive intervention
after 6mo of intervention w plateau in resolution
when should infants be reassessed after dc PT for CMT
3-12mo following discontinuation from direct PT intervention or when child initiates walking
when should you dc PT for CMT (4)
full PROM w/i 5deg of non-affected side
symmetrical active mvmt pattern
age-appropriate motor development
no visible head tilt
what is an important ed piece for parents w dc PT for CMT
what to monitor as child grows
