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pt clin med > Cervical Spine pathology > Flashcards

Cervical Spine pathology Flashcards

1
Q

How can nerve stretching occur

A

Fall on arm, pull on arm, and seat belt during an accident

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2
Q

What is cervical stenosis

A

Narrowing of the intervertbral foramen or vertebral foramen

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3
Q

What is on symptom of down syndrome in the cervical spine

A

Laxity of transverse ligament

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4
Q

What should you not do with a person with down syndrome

A

Cervical spine manipulation

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5
Q

What is DDD

A

Degenerative disc disease

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6
Q

What is DJD

A

Degenerative joint disease

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7
Q

What is spondylosis

A

Wear and tear

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8
Q

What is tortocollis

A

Rye neck, side bending or distortion of neck

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9
Q

What is an ataxic gait

A

An unstable staggering gait

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10
Q

What causes acute tortocillis

A

Nerve impingment, muscle guarding, slept wrong, derangement of disc

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11
Q

What is the estimated % of incidence of neck pain

A

10-20%

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12
Q

What percent of people who experienced neck pain had neck pain in the last 6 months

A

54%

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13
Q

What is the estimated % of population that will experience neck pain

A

22-70%

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14
Q

When is the prevalence of neck pain most common

A

Women in the 5th decade of life

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15
Q

Where should the center of gravity be for the cervical spine

A

Anterior to the OA joint

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16
Q

What is postural syndrome

A

Only being in the specific posture causes pain

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17
Q

When is the problem considered to be musculoskeletal

A

If pain or symptoms change with movement

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18
Q

True or False:

Referred pain is more involved pain

A

True

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19
Q

True or False:

Stenosis can cause radicular pain

A

True

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20
Q

What are the 5 things to look for when clinically examining impaired posture

A
  1. A/PROM
  2. Strength and endurance
  3. Accessory motion test (joint play)
  4. Postural exam
  5. Ergonomics (work place)
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21
Q

What are some examples of MOI for acute injuries (5)

A
  1. Violent flexion
  2. Impaction (compression)
  3. Lateral stretch injuries
  4. Extension
  5. Whiplash
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22
Q

What is whiplash

A

Extension followed by flexion

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23
Q

What are some factors that result in poorer chance of recovery from whiplash (4)

A
  1. Older than 35
  2. Higher level of disability
  3. Trouble sleeping
  4. Irritable: overly alerts, easily startled
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24
Q

What is an insult

A

Injury

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25
Q

What is the order of soft tissue disruption with forward flexion injury (5)

A
  1. Supraspinous ligament
  2. Infraspinous ligament
  3. Capsule
  4. Disc (nucleus pulposus)
  5. Bone insult possible
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26
Q

True or False:

You should move in the direction that makes symptoms worse to promote healing

A

False

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27
Q

True or False:

Finding the preferred direction of movement is key in the healing process

A

True

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28
Q

What is a high state of contractility

A

Spasm

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29
Q

What is it called when all muscles contract to hold muscles still

A

Guarding

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30
Q

What are the tissues insulted due to trauma (6)

A
  1. Ligament
  2. Musculotendonous units
  3. Bone
  4. Disc
  5. Articular capsule
  6. Nerves/Spinal cord
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31
Q

What makes up the brachial plexus

A

Anterior rami of C5-T1

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32
Q

What nerves make up the brachial plexus (9)

A
  1. Subscapular
  2. Suprascapular
  3. Radial
  4. Musculocutaneous
  5. Median
  6. Thoracodorsal
  7. Long thoracic
  8. Dorsal scapular
  9. Median cutaneous nerve
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33
Q

What are the 3 classes of brachial plexus injuries

A
  1. Class 1: Neuropraxia
  2. Class 2: Axonotmesis
  3. Class 3: Neurotmesis
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34
Q

What causes neuropraxia

A

No actual damage to the nerve, only compression, it is the most common, stinger

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35
Q

How long does pain last during neuropraxia

A

5 minutes - 25 hours

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36
Q

What causes an axonotmesis

A

Some axon and nerve damage due to a crush mechanism

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37
Q

What are symptoms of axonotmesis

A

Wallerian degeneration and muscle weakness

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38
Q

What is wallerian degeneration

A

Injury to nerve where part distal to injury loses axon, myelin, and conduction ability

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39
Q

How long do symptoms last for axonotmesis

A

10 days - 2 weeks

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40
Q

What causes neurotmesis

A

Partial tear or complete severance of all neural and connective tissue elements

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41
Q

How long does it take a neurotmesis to repair

A

For a partial tear up to a year

For full tear there is little hope that function will recover

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42
Q

What are the 4 peripheral nerves that can have secondary trauma

A
  1. Spinal accessory nerve
  2. Suprascapular nerve
  3. Axillary nerve
  4. Long thoracic nerve
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43
Q

What causes injury of the spinal accessory nerve

A

Injury near clavicle

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44
Q

What causes injury of the suprascapular nerve

A

Blow to the base of the neck

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45
Q

What causes injury to the axillary nerve

A

GH dislocation or GH hyperextension

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46
Q

What does the spinal accessory nerve innervate

A

Trapezius and sternocleidomastoid

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47
Q

What does the suprascapular nerve innervate

A

Supraspinatus and infraspinatus

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48
Q

What does the axillary nerve innervate

A

Deltoid and teres minor

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49
Q

What does the long thoracic nerve innervate

A

Serratus anterior

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50
Q

What is stenosis

A

Narrowing

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51
Q

What is the diameter of the spinal canal

A

17-18 mm

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52
Q

What is the diameter of the spinal cord

A

About 10 mm

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53
Q

Where does a lateral stenosis occur

A

Intervertebral foramen

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54
Q

What type of problem does a lateral stenosis cause

A

LMN

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55
Q

What type of problem does a central stenosis cause

56
Q

What is a primary stenosis

A

Congenital

57
Q

What is a secondary stenosis

A

Degenerative condition

58
Q

How do you view the intervertebral foramen on an x-ray

A

Oblique x-rays

59
Q

How do you view the facets on an x-ray

A

Lateral x-rays

60
Q

What does a lateral stenosis cause

A

Radiculopathy

61
Q

What symptoms does a lateral stenosis come with (3)

A
  1. Parathesias/dysathesias in a dermatomal pattern
  2. Myotomal deficit
  3. Hyporeflexive
62
Q

What does a central stenosis cause

A

Myelopathy

63
Q

What symptoms does a central stenosis come with (4)

A
  1. Neck pain
  2. Unsteadiness in gait or clumsiness
  3. Extrasegmental distribution of parathesia
  4. Hyperreflexive
64
Q

What is the surgical repair for a lateral stenosis

A

Widening of the intervertebral foramen

65
Q

What is the surgical repair for a central stenosis

A

Laminectomy

66
Q

What are characteristics of DJD in older adults (4)

A
  1. Increase of calcific deposits in and around the periphery of the joint
  2. Wearing away of hyaline cartilage
  3. Thickening of the synovial lining and joint capsule
  4. Thickening of subchondral bone
67
Q

What are characteristics of DDD in older adults (4)

A
  1. Dehydration of nucleus pulposus
  2. Narrowing of intervertebral space
  3. Weakening and degeneration of the annular rings
  4. Approximation of the facet joints
68
Q

How do you treat DJD (3)

A

Laminectomy, PT, and NSAIDS

69
Q

How do you treat DDD (3)

A

PT, NSAIDS, and opening of intervertebral canal

70
Q

How do you image DJD (2)

A

X-ray or bone scan

71
Q

How do you image DDD (3)

A

X-ray, MRI, or CT

72
Q

True or False:

You should do manipulations of the neck for patients with RA

73
Q

What is RA

A

Systemic autoimmune inflammatory disease

74
Q

Most common group to get RA

A

Young-middle aged females

75
Q

True or False:

People with RA have joint laxity and deformity

76
Q

How do you care for RA

77
Q

True or False:

Cervical rotation can cause rupture of the transverse ligament of the atlas

78
Q

How many births result in a child with down syndrome

A

1 in 600 births

79
Q

What is another name for down syndrome

A

Trisomy 21

80
Q

What are characteristics of down syndrome (5)

A
  1. Sloping forehead
  2. Small ear canal
  3. Absent bridge to nose
  4. Low set ears
  5. Dwarfed physique
81
Q

True or False:

Down syndrome patients have agenesis or hypoplasia of the odontoid process

82
Q

What is torticollis or wry neck

A

Congenital muscular abnormality

83
Q

What causes torticollis

A

Unknown but 40% of patients had a difficult birth

84
Q

When is torticollis noticeable

A

The first few weeks of life

85
Q

How does idiopathic torticollis present

A

Head laterally flexed to ipsilateral side and rotated to the contralateral side

86
Q

What percent of people with torticollis have dsyplasia of 1 or both hips

87
Q

What is the most common treatment of wry neck

A

Stretching within the 1st month (90%)

88
Q

What is the surgical treatment for torticollis

A

Muscle division and release (10%)

89
Q

What are cervical headaches

A

Headaches which change as a result of movement and posture

90
Q

Does dysfunction cause intermittent or constant pain

A

Intermittent

91
Q

Does posture cause intermittent or constant pain

A

Intermittent

92
Q

Does derangement cause intermittent or constant pain

93
Q

What is another name for the mechanical diagnosis and therapy (MDT)

A

Mckenzie Approach

94
Q

How are patients classified using MDT

A

According to patient response to repeated movements

95
Q

What do MDT interventions rely heavily on

A

Patient generated forces

96
Q

True or False:
Manual therapy is incorporated in the Mckenzie Approach once the patient plateaus with self treatment or is incapable of self treatment

97
Q

What are the 3 types of classifications of Mechanical Diagnosis and Therapy

A
  1. Postural syndrome
  2. Dysfunction syndrome
  3. Derangement syndrome
98
Q

What is postural syndrome

A

Test movements do not reproduce complaint, symptoms brought on by sustained posture

99
Q

What is dysfunction syndrome

A

Shortened or impaired CT, typically produces end range pain

100
Q

What is derangement syndrome

A

Symptoms may dramatically change as a result of test movements

101
Q

How are cervical spine derangements determined classified

A

Determined by the movement examination and history

102
Q

How is cervical spine derangement pain characterized

A

Pain during movement or end range pain

103
Q

What are the locations of cervical spine derangement pain

A

Centralized or peripheralized

104
Q

What is centraliztaion

A

The progressive reduction and abolition of distal pain in response to therapeutic loading strategies

105
Q

What did Werneke et al determine by categorization of changes in pain location

A

Mechanical assessment and treatment allowed identification of patients with improved treatment outcomes

106
Q

What is direction of preference

A

An immediate, lasting improvement in pain from performing either repeated flexion, extension, or sideglide/rotation tests

107
Q

1/2 identifies what type of derangement

108
Q

3/5 identifies what type of derangement

A

Posterolateral (peripheral)

109
Q

4/6 identifies what type of derangement

A

Far lateral

110
Q

7 identifies what type of derangement

111
Q

Which number derangements have deformities

A

2, 4, and 6

112
Q

What type of derangement does 2 have

113
Q

What type of derangement does 4 have

A

Torticollis

114
Q

What type of derangement does 6 have

A

Torticollis

115
Q

Which number derangements do not have a derangement

A

1, 3, 5, and 7

116
Q

What number derangements get worse with flexion

117
Q

What number derangements effect the elbow and up

118
Q

What number derangements effect the elbow and down

119
Q

What number derangements cause central symmetrical

A

1, 2, and 7

120
Q

What number derangements cause unilateral asymmetrical symptoms to the elbow

A

3, 4, and 7

121
Q

What number derangements cause unilateral asymmetrical symptoms to below the elbow

122
Q

Who gets acute torticollis

A

Usually adults

123
Q

What does acute torticollis present with

A

Flexion and rotation to ipsilateral side

124
Q

What causes acute torticollis

A

Age and derangement

125
Q

What does a PT having an identification system provide patients

A

Better outcomes and more specific interventions

126
Q

True or False:

A 7 derangement can be anterior lateral as well as anterior medial

127
Q

Do PTs treat based on pathophysiology or based on classifications

A

Classifications

128
Q

True or False:

You should always rule out a derangement first for safety resonses

129
Q

True or False:

You should test passive range of motion before active range of motion

130
Q

Pain in center of spine

131
Q

Pain of to side of spine

132
Q

What responds better to retraction and extension

133
Q

What responds to side bending or retraction depending on location

134
Q

Pain below elbow worse with flexion

135
Q

What causes a 7 derangement

136
Q

What is a flexion responder

137
Q

What gets worse with extension

pt clin med (15 decks)

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