Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DPT MSK Fall 22' - Spring 23' > acute/persistent Internal Disc Derangement - exam 1 > Flashcards

acute/persistent Internal Disc Derangement - exam 1 Flashcards

1
Q

Acute IDD due to __________
_________ and _________tear
___________ LEAST common

A

trauma
annulus and end plate
acute herniations (nuclear migration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chronic or persistent IDD due to:

A

disc changes due to numerous variables allow herniations (nuclear migration) to GRADUALLY develop over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most prevalent IDD?

A

chronic/persistent > acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What spinal region is IDD most common?
-age group?

A

lumbar region (L4-S1)
30-50 yrs old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the resting range of lordosis?

What is the degree of motion for lumbar flexion?

What is the degree of motion for ant. pelvic rotation?

A

20-45º
45º
60º

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

There are greater consequences in ______ spinal region due to the narrowest canal

A

thoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

________ portion of the disc is the MOST common

A

posterolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is the posterolateral portion of the disc most commonly injured?

A

weaker, thinner with MORE vertical and LESS oblique annular fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What functional limitations a pt. with acute IDD will most likely have?

A

forward bending (FB) w/o twisting/lifting

-FB at the waist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lumbar spine DOES NOT flex as you think b/c of concurrent

A

anterior pelvic tilt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain the process of acute IDD:

A

FB creates less disc compression and unevenly distributed annular tension (causes less stability) –> LESS fixated end plate –>
more anterior segmental shearing –>
increased and asymmetrical stress on posterolateral annular and end plate fibers

  • water balloon example
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the MORE common structures involved with acute IDD

LEAST common:

A

outer annular tearing and end plate avulsion (resists tension)

inner annular tearing and NP herniation (resist compression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Acute IDD: disk structures are _____________ when damaged

A

immunoreactive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acute IDD process of LARGE Immune inflammatory response:

  1. Excessive ___________ or increased static fluid in/around the disc and spinal n.
  2. Static fluid has increased ____________ chemicals that sensitize spinal n. and structure to pressure/tension
    3.______________ S&S are present
    4.NO ________ in PNS or CNS —-> extended ________ phase
A
  1. osmotic pressure
  2. inflammatory
  3. radiculopathy/radicular
  4. lymphatic vv. ; inflammatory phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute IDD - L5 Annular tear - NO Nuclear migration what does this indicate?

A

avulsion; jelly not out of donut tear of attaching structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Typical postlat IDD:
-symptoms
-annulus
-more

A

dull/achy spinal P!
annulus high innervated so very P!
significant MORE swelling than cervical disc due to a higher # of GAGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Typical postlat IDD symptoms: worse situation

A

radiculopathy: segmental parathesis within 24hrs. into distal extremities

-presence of coldness bc vv. have rich anastomoses and high degree to ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Typical postlat IDD can cause referred P! ________

A

glutes and groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the functional inhibiting symptoms of typical postlat IDD:

-decreased P! when
-increased P! when
-24hr. behavior

A

decreased P!- unloaded or lying supported/standing/walking
–> puts tear in slack

increased P!- FB/sitting/coughing/lifting
–> pulls tear, more tension

increased P! in the AM due to pooling of swelling from a static sleeping position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

As a PT what will you see in your observation for a pt. with typical postlat acute IDD? (3)

*view pptx. slide 109

A

lateral shift of the shoulder on the pelvis
SB away from the P!
Counter contralateral SB to level the eyes

-rarely see smaller calf girth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

typical postlat acute IDD scan findings:
ROM

A

-all may movements maybe P!ful

-flx and possible SB away from the injured area of disc likely MOST limited and increased extremity P!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is P! provoked with FLX and SB in typical postlat acute IDD pts.

A

due to pressure being pushed towards the spinal n. and tension on the annulus and end plate tear and dura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Typical postlat acute IDD:
What movements relieve P! and LESS limited

A

EXT and possibly SB toward the injured area of disc LESS limited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

With repetition of _____________, centralization of extremity P! will often occur for pts. with typical postlat acute IDD

A

EXT and SB; (jelly back into donut)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

abolition of distal and/or spinal P! in a _________ to _________ direction in response to repetitive motions or sustained positions is known as centralization

for typical postlat acute IDD what motion will produce centralization?

A

distal to proximal

ext or hyperext.

26
Q

Typical postlat IDD sign; Scan

  1. resistant & MMT:
  2. stress test:
  3. neuro test:
  4. stability test:
A

1.variable
2. (+) with compression/distraction/PA pressures/torsion *annulus
3. (+) depending on the severity and timing
—-myotomal fatigue
—-DTR hyporeflexia
—-diminished dermatomes
—-(+) dural mobility test

  1. (+)
27
Q

Central IDD is MORE common than postlat IDD? T or F

A

False

28
Q

What are classical cord S&S of rare Central Acute IDD:
a. DTRs:
b. UMN test:
c. Superficial reflexes:
d. Multi or non-segmental:
e. MD referral:

A

a. hyperactive
b. (+)
c. hypoactive
d. multi-segmental
e. immobilize w/ emergency referral

29
Q

based on the belief that MOST spinal P! comes from injuries to the disc which the research says is NOT the case

A

Mckenzie Method

30
Q

What is the classification system of the McKenzie Method?

A

location of symptoms
positions and motions that decrease symptoms

31
Q

The Mckenzie Method determines ____________ ____________ which may be associated with _________ with the addition of decreasing the severity and improving function.

A

directional preference
centralization

32
Q

____________is the MOST common directional preference (>70%)

A

Extension

33
Q

Mckenzie Method 3 classification syndromes for Acute IDD:

A

postural: correct poor posture
dysfunction: stretched the improve end-range motion
derangement: using end range motion to improve the THEORETICAL nucleus migration in the disc

34
Q

____________ Method: strong evidence of benefit with ________symptoms and when _________ occurs with Acute IDD

A

McKenzie
LE
Centralization

35
Q

McKenzie Method:
1. dynamic theory w/herniation is unproven but states that _________ repositions centrally

A

nucleus

36
Q

McKenzie Method:
2. What is the process of fluid dynamic or w/o disc herniations:

_____________pressure with a large ___________ swelling response

___________ __________ ________through repetitive motions, MOST often _________

Spine P! initially __________ from the resistance of high osmotic pressure being overcome by increased hydrostatic pressure

Swelling squeezed—— away or towards —- spinal n. into the nucleus and the end plates for draining?

What is PRIORITY?

A

high osmotic; auto-immune

increasing hydrostatic pressure; extension

increases

away

centralize P!; decrease LE symptoms

37
Q

PT Rx: acute IDD (5)
-sets and reps?

A

-POLICED
-directional preference OFTEN extension 10-20 reps every 1-2 hrs prn
-intermittent traction may be helpful w/radiculopthy if no centralization
-postural/ergonomic edu/taping or bracing for ext. preference

38
Q

What should you tell pt. to limit or not do if possible? (2)

Possible ________ for 1-2 weeks to avoid counter-productive sitting w/driving

A

limited to no sitting
limited to no driving/FB

HEP

39
Q

What are the ultimate MET goals for Acute IDD:

–examples:

A

tissue proliferation and stabilization, particularly of local mm.

unweighted walking
unloader
aquatic
anti-gravity systems (ALTERED-G)

40
Q

How should we squat and pick up items to minimize excessive stresses and maximize stability and prevent an acute IDD?

A

MORE circumferential disc compression and evenly distributed annular tension w/ lumbar flexion and posterior pelvic tilt

MORE fixated end plate

LESS ant. segmental shearing and possible rotation with the additional influence of gravity

41
Q

Persistent IDD aka:

A

degenerative disc disease or age related disc changed though NOT always due to age

42
Q

Etiology of Persistent IDD: (7)

A

Acute IDD
Age (mixed findings)
Lower strength
Sedentary lifestyle
Heavy occupational lifting
Smoking
Genetics

43
Q

Though it has been shown that 68-85% of persistent IDD can be inherited, it is modified by __________ and ____________

A

diet and lifestyle

44
Q

Persistent IDD is NOT from routine ____________ and _____________

A

loading/physical activities and prolonged driving

45
Q
  1. Pathogenesis of Persistent IDD?
  2. In the growth of ________________ from acute IDD healing can lead to ____________ P!
  3. Brings excessive and destructive _________(amyloidosis) and low-grade__________enters discs
A
  1. gradual; persistent inflammation
  2. nociceptive fibers; nociplastic P!
  3. proteins; infection
46
Q

Persistent IDD:

LESS GAGS so MORE _______ and dehydrated _________

MORE acidic ______ that kill disc cells and limits __________

Annular __________

Thinning and loss of _________ at end plates

Increased inflammation in deposits in a vertebra (modic).

NOW persistent ________ and nuclear ________ GRADUULY developed

A

fibrotic; muscles
disc; proliferation
disorganization
cartilage
herniations; migration

47
Q

The nucleus migrates but remains contained in the annulus, the MOST common herniation.

A

Protrusion (buldge)

48
Q

The nucleus migrates through the outer annulus

A

extrusion

49
Q

The nucleus migrates and breaks away from the annulus

A

free sequestration

50
Q

Schmorls Nodes likely develop when

A

the nucleus migrates into the vertebral body

51
Q

Persistent IDD does not show bright white on imagining because

A

it is low grade inflammation not acute

52
Q

Presentist IDD: Narrowing

initial changes are related to the loss of _________ and __________
_________may develop
joint hypermobility noted during sagittal and frontal plane motions BUT not in ____________ plane

A

disc height and integrity
instability
transverse plane

53
Q

Due to joint space narrowing of persistent IDD, it leads to great load bearing on ________ which ultimately may develop ________

A

facets; stenosis

54
Q

Persistent IDD S&S:

A

slow change allows tissue to adapt without symptoms
gradual onset may be like acute S&S if inflamed
“mixed bag”

55
Q

McKenzie Exercises are more effective with Persistent IDD than Acute. T or F

A

False; more effective with acute IDD

56
Q

Persistent IDD: PT Rx
Need to consisder the __________ _________of symptoms from the development of other conditions even if imaging shows disc changes

example of primary drivers:

A

primary driver

instability
stenosis
age-related joint changes
combinations of above

57
Q

Prognosis for acute and persistent IDD: 90% improve by _______ wks and resolve symptoms by _____ wks.

A

6 wks; 12 wks.

58
Q

MOST acute/persistent IDD pts. will require sx. T or F

A

False; most will NOT require Sx

59
Q

What is a negative outcome predictor of acute and persistent IDD?

Persistent IDD has a significant association with (4)

A

peripheralization

mental distress/depression
P! behaviors
Somoatation - conversion of anxiety into bodily symptoms
fear of work

60
Q

Acute and Persistent IDD:
-MD Rx: Meds
-purpose of sx and types of sx’s performed?
-indications of sx:

A

NSAIDs, muscle relaxants, acetaminophen
spinal decompression; laminectomy, partial discectomy
persistent and/or worsening radiculopathy

61
Q

Is lumbar fusion better than PT for persistent IDD?

A

no - may lead to adjacent joint hypermobility

DPT MSK Fall 22' - Spring 23' (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions