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MSK Exam 1 - Spring > Acute Internal Disc Derangement - Done > Flashcards

Acute Internal Disc Derangement - Done Flashcards

1
Q

Which is more common, acute IDD or persistent IDD?

A

Persistent

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2
Q

Where is acute IDD rare?

A
  • Rare in the thoracic spine
  • Greater consequences in the t-spine due to narrowest canal
  • Less than 1% of all symptomatic disc herniations
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3
Q

Where is acute IDD more common?

A

In the lumbar region

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4
Q

What percentage of IDDs are symptomatic?

A

1-3%

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5
Q

Persistent IDD is the source of pain in what percentage of LBP?

A

Less than 5%

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6
Q

What level is acute IDD most common in and in what age group?

A
  • 95% at L4-S1
  • Mostly 30 to 50 year olds
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7
Q

What is the most common area of the disc to be effected by acute IDD?

A

Posterolateral portion

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8
Q

What is weaker, thinner, with more vertical with less oblique annular fibers?

A

Posterolateral portion of the disc

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9
Q

The posterolateral portion of the disc is just lateral to the …

A

Posterior longitudinal ligament

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10
Q

What is the etiology of acute IDD?

A

Trauma such as axial compression, forward bending, or stooping without or with twisting/ lifting (lumbar spine does not full flex like you may think)

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11
Q

What is the resting lumbar lordosis?

A

20 - 45 degrees

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12
Q

Forward bending or stooping without or with twisting/ lifting leads to what?

A
  • Less circumferential disc compression
  • Unevenly distributed annular tension
  • Increased and asymmetrical stress on weaker and thinner posterolateral annular and end plate fibers
  • Less fixated end plate
  • More anterior segmental shearing force due to the above plus pull of gravity, except less at L5, S1
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13
Q

What structures are involved in an acute IDD?

A
  • More commonly outer annular tearing and end plate avulsion
  • Less commonly inner annular tearing and nucleus pulposus herniation
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14
Q

What is the normal disc structure and function?

A
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15
Q

What becomes immunoreactive once damaged?

A

Disc structures

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16
Q

What kind of large autoimmune inflammatory responses occur when acute IDD is present?

A
  • Excessive osmotic pressure or increased static fluid pressure in and around the disc and spinal nerve
  • Static fluid consists of increased inflammatory chemicals that sensitizes spinal nerves and structures to pressure/ tension
  • Radiculopathy/ Radicular signs and symptoms
  • No lymphatic vessels in PNS or CNS so drainage is poor on its own
  • Extended inflammatory phase
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17
Q

What are some typical posterolateral IDD symptoms?

A
  • Dull/ achy spinal pain
  • Radiculopathy
  • Referred pain into the glutes and groin
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18
Q

What causes decreased pain from posterolateral IDD symptoms?

A

Unloading (standing/ walking and lying)

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19
Q

What causes increased low back pain and paresthesias from posterolateral IDD symptoms?

A

Loading (forward bending, sitting, lifting, coughing, and sneezing)

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20
Q

What part of the disc is highly innervated?

A

The annulus (so it is very painful when damaged)

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21
Q

What has more swelling, cervical disc or lumbar disc?

A

Lumbar has significantly more swelling than cervical disc to due higher number of GAGs

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22
Q

A radiculopathy such as possible segmental paresthesias within 24 hours into the distal extremity is a worse situation when?

A

There is presence of coldness indicating greater circulatory compromise

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23
Q

When is pain worse with acute posterolateral IDD, in the morning or the evening?

A

Increased pain in the morning due to pooling of swelling from static sleeping position

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24
Q

As with other conditions, a lot of the early symptoms are due to what?

A

Pressure and chemicals from swelling

25
Q

What kind of observations might you see with acute posterolateral IDD?

A
  • May see a lateral shift of shoulders on pelvis
  • Side bend away from the pain
  • Counter contralateral SB to level eyes
26
Q

What kind of observations will you rarely see with acute posterolateral IDD?

A
  • Rarely see smaller calf girth
  • Wasting likely at 4-6 weeks and indicative of severe spinal nerve compression
  • More of a sign for a persistent radiculopathy
27
Q

What directions of ROM might cause pain for an acute posterolateral IDD?

A

All may increase pain

28
Q

Flexion and possibly side bending away from the injured area of disc that is likely most limited, increases extremity and LBP due to what?

A
  • Swelling being pushed toward spinal nerve like an H2O balloon
  • Tension on torn annulus, end plate, and dura
29
Q

Extension and possibly side bending towards the injured area of the disc that is possibly less limited may cause what?

A
  • May increase LBP due to increased hydrostatic pressure on end plate flexion and high osmotic pressure of disc
  • May centralize extremity pain (aka centralization), especially with repetition by squeezing swelling away from spinal nerve
30
Q

Does rotation cause notable issues with acute posterolateral IDD?

A

Rotation is not consistent

31
Q

What is centralization?

A

Abolition of distal and/ or spinal pain in a distal to proximal direction in response to repetitive motion(s) or sustained position(s)

32
Q

What might you see in your scan with acute posterolateral IDD?

A
  • Resistance testing and MMT: variable
  • Stress tests: possible positive with compression/ distraction/ PA pressures/ and torsion
  • Neuro tests: possible positive depending on severity and timing
  • Diminished dermatomes
  • Hyporeflexive DTRs
  • Myotomal fatigue
  • Positive Neurodynamic mobility tests
33
Q

What might you see in your biomechanical exam with acute posterolateral IDD?

A

Possible positive stability tests

34
Q

What are some unique signs and symptoms of central and posterior IDD?

A
  • Cord or cauda equina signs and symptoms depending on the level
35
Q

What is the typical lowest level of the cord

A
36
Q

What are the PT implications of central and posterior IDD?

A

Immobilization and Emergency Referral

37
Q

What are classic spinal cord signs and symptoms

A
38
Q

Mechanical diagnosis and therapy was based on and developed by?

A
  • Developed by Robin McKenzie, PT
  • Based on the belief that most spinal pain comes from injuries to the disc which is not supported in the research
39
Q

The classification system of mechanical diagnosis and therapy is depending primarily on what?

A
  • Symptoms
  • Specifically location of symptoms and positions that decrease symptoms
40
Q

What is the most common directional preference (>70%)?

A

Extension/ Hyperextension

41
Q

What should you match you mechanical diagnosis and therapy with?

A

Exercise and ADL positions

42
Q

Directional preferences may be associated with what?

A

Centralization, decreasing severity, and improving function

43
Q

What are the 3 classification syndromes and what do they focus on?

A
  • Postural: focus on correcting poor posture
  • Dysfunction: focus on stretches to improve end range motion
  • Derangement: focus on using end range motion to improve the theoretical nucleus deformation in disc herniations
44
Q

What is the dynamic disc theory?

A
  • Deformation not migration in a normal disc
  • Only predictable in asymptomatic lumbar spines when the annulus is intact and with normal hydration
  • Limited and contradictory finding in the symptomatic disc and age-related disc disease with annular changes
45
Q

What does flexion/ sitting do to anterior and posterior disc height and nucleus deformation?

A
  • Anterior disc height: decreased
  • Posterior disc height: increased
  • Nucleus deformation: posteriorly
46
Q

What does extension/ standing do to anterior and posterior disc height and nucleus deformation?

A
  • Anterior disc height: increased
  • Posterior disc height: decreased
  • Nucleus deformation: anteriorly
47
Q

When is the dynamic disc theory predictable?

A

Only predictable in asymptomatic lumbar spines when the annulus is intact and with normal hydration

48
Q

Dynamic disc theory has limited and contradictory findings in what?

A

The symptomatic disc and age-related disc disease with annular changes

49
Q

What might cause altered fluid dynamics leading to acute IDD?

A
  • High osmotic pressure with large autoimmune swelling response
  • Increasing hydrostatic pressure through repetitive motions,
    most often extension
50
Q

Repetitive motions can lead to what?

A
  • Spine pain initially increases from the resistance of high osmotic
    pressure being overcome by increased hydrostatic pressure
  • Swelling squeezed away from spinal nerve into the nucleus and the end plates for draining
  • Centralizes pain, LE symptoms decrease, which is a priority
51
Q

Is mechanical diagnosis and therapy the best treatment option for acute IDD?

A
  • No RCTs comparing MDT to controls
  • Not superior to other treatments for acute LBP/disability
  • More needs to be done
52
Q

Along with POLICED what directional preferences should you focus on for acute IDD?

A

Directional preference, likely ext, with centralization- 10-20 reps every 1-2 hrs. or as needed

53
Q

Intermittent traction may be helpful for acute IDD with radiculopathy,
especially, if there is no what?

A

No centralization

54
Q

What might help acute IDD if there is a directional preference?

A

Postural/ergonomic education/taping or bracing for likely ext preference
◦Limited to no sitting
◦Limited to no driving/FB

55
Q

You should provide someone with acute IDD with a possible HEP for 1-2 weeks to avoid what?

A

Counterproductive sitting while driving

56
Q

What is the ultimate goal for MET for acute IDD?

A
  • MET ultimately for tissue proliferation and stabilization, particularly of local muscles
  • Keeping the jelly or nucleus in a better location is NOT supported in the research
57
Q

Does unweighted walking, lessening over time help with acute IDD?

A

Yes, Ex: Unloader, Aquatic, Anti-gravity systems (Altered G)

58
Q

What is the prognosis for acute IDD?

A
  • Refer to ligament and cartilage notes on healing and extend the timelines due to likely prolonged inflammatory phase
  • 90% start to improve by 6 weeks and symptoms resolve by 12 weeks
59
Q

What percentage of people with acute IDD will need surgery and what do the outcomes look like?

A
  • Most will not require surgery
  • Slower but the same overall outcomes without sx after two years

MSK Exam 1 - Spring (9 decks)

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