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MSK 2 > 1e - Cspine Dx Part 2 > Flashcards

1e - Cspine Dx Part 2 Flashcards

1
Q

what is fibromyalgia syndrome (FMS)

A

chronic widespread pain disorder commonly associated w comorbid sx, including fatigue and nonrestorative sleep

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2
Q

what are 5 characteristic s/sx of FMS

A

widespread pain
TTP at multiple points
morning stiffness
fatigue
sleep disturbance

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3
Q

what 2 pt populations is FMS common in

A

female
military population
- component of stress

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4
Q

trigger vs tender point

A

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

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5
Q

how many tender points are associated w FMS

A

18

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6
Q

what is a tender point

A

localized tenderness to palpation

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7
Q

what is a trigger point

A

hyperirritable spont
w/i taut band of skeletal ms
nodules palpable w/i ms

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8
Q

what is an aggravating factor to trigger points and how can the pain present

A

painful on compression or ms contraction
- may respond w referred pain pattern distant from spot

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9
Q

what is the difference from the old ACR FMS dx criteria to the updated criteria used today

A
  1. widespread pain index (0-19 score)
  2. Sx Severity Score (0-3 score)
    - fatigue
    - sleep
    - cog sx
    - somatic sx
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10
Q

what is the significance of the dx criteria for FMS

A

no specific tes for it
- important to r/o other things

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11
Q

what is a differential dx for FMS

A

lyme dz

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12
Q

score ranges for dx criteria of FMS

A

WPI >7 and SSS >5

  • or -

WPI 4-6 and SSS >9

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13
Q

what is fibro-fog

A

cog issue, problems concentrating
- see as a result of non restorative sleep that can be seen in FMS

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14
Q

what are the 3 conditions to be met for a FMS dx

A
  1. WPI >/=7 and SSS >/=5 -or- WPI 4-6 and SSS >/=9
  2. generalized pain present in at least 4 / 5 defined regions regions
  3. sx present at similar level for at least 3mo
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15
Q

what should be kept in consideration about a dx of fibromyalgia

A

doesn’t exclude presence of other clinically important illnesses

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16
Q

what are 5 likely exam findings in FMS

A
  1. tender points
  2. allodynia
  3. may also be trigger points
  4. dec ROM
  5. dec strength and endurance
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17
Q

what is allodynia and how can it be assessed

A

pain in response to non-nociceptive stim

assessed cutaneously by brushing skin

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18
Q

what type approach should be taken for FMS interventions and what are 4 ex

A

multidisciplinary, holistic approach

aerobic conditioning
strengthening
mind-body connection (ie yoga, pilates, breathing)
pharm (meds)

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19
Q

what needs to be balanced in your approach to interventions for FMS and why

A

balance b/w overly vigorous approach (exacerbate sx d/t low pain threshold) and under activity (disuse atrophy and inc sx)

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20
Q

what is a consideration of appt scheduling in FMS and why

A

see them in afternoon/later in day appts

lots of fatigue
poor sleep
better in quiet clinic

21
Q

what is the focus of interventions for FMS

A

aerobic conditioning
strengthening

(consistency is key)

22
Q

what should you educate FMS pts on

A

pacing selves
manage energy levels
neuropathic pain management
- nociplastic pain experience
- educate ab threshold and limits

23
Q

prognosis and PT treatment frequency

A

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

24
Q

what is congenital muscular torticollis (CMT)

A

postural deformity of neck evident at birth or shortly thereafter

25
Q

what is CMT characterized by

A

head tilt to one side or lateral neck flexion (ipsilateral), w neck rotated to opposite side d/t unilateral shortening/fibrosis of SCM ms

26
Q

what comorbidities can accompany CMT (4)

A

cranial deformation
hip dysplasia
brachial plexus injury
distal extremity deformities

27
Q

how does R torticollis present

A

head contracted in R SB, L rotation and a little flexion

named by side of affected ms (R SCM)

28
Q

what are 3 types of CMT

A

postural
muscular
SCM mass

29
Q

how does postural CMT present

A

infant’s postural preference but w/o ms or PROM restrictions
- mildest presentation

30
Q

what type of CMT has the mildest presentation and which has the most severe

A

postural
SCM mass

31
Q

how does muscular CMT present

A

SCM tightness
PROM limitaitons

32
Q

how does SCM mass CMT present

A

fibrotic thickening of SCM
PROM limitations

33
Q

what 2 factors are highly predictive of time required to resolve ROM limitations in CMT

A

type of CMT
age of initial dx

34
Q

what are 7xs to refer an infant treating CMT w PT to MD

A
  1. non-muscular cause of asymmetry (ie poor visual tracking, abnormal ms tone, extra-ms masses)
  2. associated conditions (cranial deformation)
  3. asymmetries inconsistent w CMT
  4. if infant >12mo and facial asymmetry and/or 10-15def of difference in PROM to AROM in cervical rotation or lateral flex
  5. infant 7mo+ w SCM mass
  6. side of torticollis changes
  7. size or location of SCM mass inc
35
Q

why is early identification and treatment of CMT key

A

critical for:
- early correction
- early identification of secondary or concomitant impairments
- prevention of future complications

36
Q

infants identified w CMT later (3-6mo) and have SCM mass CMT is correlated w what

A

longest episodes of conservative treatment

undergo more invasive interventions
- surgical lengthening/release of SCM
- botox injections

37
Q

what is plagiocephaly, how is it often caused, and how is it treated

A

cranial asymmetry w flattening of 1 side of head

if babies lay in one position or on back a lot

lots of tummy time!

38
Q

what info do we want from the parent report during the pt exam of CMT

A

pregnancy hx
infant hx
family hx of torticollis/plagiocephaly

39
Q

what are systems review components to assess in the pt exam of CMT

A

visual function
hip screen
neuro screen
pain assessment
skin screen

40
Q

what are components of the physical assessment during the pt exam of CMT

A

clinical observations
anthropometrics
ROM
ms palpation

41
Q

what can untreated CMT lead to and how is this often treated

A

positional plagiocephaly

cranial orthosis

42
Q

what is the primary emphasis of interventions for CMT

A

how you handle them -> asymmetrical handling to activate weak nect ms
- can’t really do ROM

43
Q

what are 5 interventions for CMT

A

neck PROM
neck/trunk AROM
- feeding from alternate sides
development symmetrical mvmt
environmental adaptations
pt/caregiver ed

44
Q

how should supervised tummy time be utilized in interventions for CMT

A

when infant is awake
- 3+x/day
- for more than 1 cumulative hour to prevent neck asymmetry

45
Q

at what point is an infant not progressing as anticipated and you should seek consultation

A

asymmetry of head, neck, and trunk not starting resolve 4-6wks of comprehensive intervention

after 6mo of intervention w plateau in resolution

46
Q

when should infants be reassessed after dc PT for CMT

A

3-12mo following discontinuation from direct PT intervention or when child initiates walking

47
Q

when should you dc PT for CMT (4)

A

full PROM w/i 5deg of non-affected side
symmetrical active mvmt pattern
age-appropriate motor development
no visible head tilt

48
Q

what is an important ed piece for parents w dc PT for CMT

A

what to monitor as child grows

MSK 2 (20 decks)

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