acute/persistent Internal Disc Derangement - exam 1

Question 1

Acute IDD due to __________
_________ and _________tear
___________ LEAST common

Answer 1

trauma
annulus and end plate
acute herniations (nuclear migration)

Question 2

Chronic or persistent IDD due to:

Answer 2

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

Question 3

What is the most prevalent IDD?

Answer 3

chronic/persistent > acute

Question 4

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

Answer 4

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

Question 5

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?

Answer 5

20-45º
45º
60º

Question 6

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

Answer 6

thoracic

Question 7

________ portion of the disc is the MOST common

Answer 7

posterolateral

Question 8

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

Answer 8

weaker, thinner with MORE vertical and LESS oblique annular fibers

Question 9

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

Answer 9

forward bending (FB) w/o twisting/lifting

-FB at the waist

Question 10

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

Answer 10

anterior pelvic tilt

Question 11

Explain the process of acute IDD:

Answer 11

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

Question 12

What are the MORE common structures involved with acute IDD

LEAST common:

Answer 12

outer annular tearing and end plate avulsion (resists tension)

inner annular tearing and NP herniation (resist compression)

Question 13

Acute IDD: disk structures are _____________ when damaged

Answer 13

immunoreactive

Question 14

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

Answer 14

1. osmotic pressure
2. inflammatory
3. radiculopathy/radicular
4. lymphatic vv. ; inflammatory phase

Question 15

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

Answer 15

avulsion; jelly not out of donut tear of attaching structures

Question 16

Typical postlat IDD:
-symptoms
-annulus
-more

Answer 16

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

Question 17

Typical postlat IDD symptoms: worse situation

Answer 17

radiculopathy: segmental parathesis within 24hrs. into distal extremities

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

Question 18

Typical postlat IDD can cause referred P! ________

Answer 18

glutes and groin

Question 19

What are the functional inhibiting symptoms of typical postlat IDD:

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

Answer 19

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

Question 20

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

*view pptx. slide 109

Answer 20

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

Question 21

typical postlat acute IDD scan findings:
ROM

Answer 21

-all may movements maybe P!ful

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

EXT and SB; (jelly back into donut)

Question 25

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?

Answer 25

distal to proximal ext or hyperext.

Question 26

Typical postlat IDD sign; Scan 1. resistant & MMT: 2. stress test: 3. neuro test: 4. stability test:

Answer 26

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 4. (+)

Question 27

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

Answer 27

False

Question 28

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:

Answer 28

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

Question 29

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

Answer 29

Mckenzie Method

Question 30

What is the classification system of the McKenzie Method?

Answer 30

location of symptoms positions and motions that decrease symptoms

Question 31

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

Answer 31

directional preference centralization

Question 32

____________is the MOST common directional preference (>70%)

Answer 32

Extension

Question 33

Mckenzie Method 3 classification syndromes for Acute IDD:

Answer 33

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

Question 34

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

Answer 34

McKenzie LE Centralization

Question 35

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

Answer 35

nucleus

Question 36

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?

Answer 36

high osmotic; auto-immune increasing hydrostatic pressure; extension increases away centralize P!; decrease LE symptoms

Question 37

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

Answer 37

-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

Question 38

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

Answer 38

limited to no sitting limited to no driving/FB HEP

Question 39

What are the ultimate MET goals for Acute IDD: --examples:

Answer 39

tissue proliferation and stabilization, particularly of local mm. unweighted walking unloader aquatic anti-gravity systems (ALTERED-G)

Question 40

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

Answer 40

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

Question 41

Persistent IDD aka:

Answer 41

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

Question 42

Etiology of Persistent IDD: (7)

Answer 42

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

Question 43

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

Answer 43

diet and lifestyle

Question 44

Persistent IDD is NOT from routine ____________ and _____________

Answer 44

loading/physical activities and prolonged driving

Question 45

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

Answer 45

1. gradual; persistent inflammation 2. nociceptive fibers; nociplastic P! 3. proteins; infection

Question 46

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

Answer 46

fibrotic; muscles disc; proliferation disorganization cartilage herniations; migration

Question 47

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

Answer 47

Protrusion (buldge)

Question 48

The nucleus migrates through the outer annulus

Answer 48

extrusion

Question 49

The nucleus migrates and breaks away from the annulus

Answer 49

free sequestration

Question 50

Schmorls Nodes likely develop when

Answer 50

the nucleus migrates into the vertebral body

Question 51

Persistent IDD does not show bright white on imagining because

Answer 51

it is low grade inflammation not acute

Question 52

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

Answer 52

disc height and integrity instability transverse plane

Question 53

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

Answer 53

facets; stenosis

Question 54

Persistent IDD S&S:

Answer 54

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

Question 55

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

Answer 55

False; more effective with acute IDD

Question 56

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:

Answer 56

primary driver instability stenosis age-related joint changes combinations of above

Question 57

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

Answer 57

6 wks; 12 wks.

Question 58

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

Answer 58

False; most will NOT require Sx

Question 59

What is a negative outcome predictor of acute and persistent IDD? Persistent IDD has a significant association with (4)

Answer 59

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

Question 60

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

Answer 60

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

Question 61

Is lumbar fusion better than PT for persistent IDD?

Answer 61

no - may lead to adjacent joint hypermobility