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Cervicothoracic Spine Flashcards

1
Q

t/f
stiff areas may not be painful, and if not addressed, will cause painful hypermobile compensations elsewhere in the body

A

true

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2
Q

why are hypermobile areas usually painful

A

the axis of motion is less controlled

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3
Q

where is hypermobility most likely in the cervical spine

A

C5-C7

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4
Q

what determines direction and amount of motion in the spine

A

orientation of facets

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5
Q

where in the cervical spine do facets favor motion rather equally

A

C2-7
because of 45 degrees angle

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6
Q

the upper thoracic facets favor motion in which plane

A

frontal plane
favors SB but ribs limit motion

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7
Q

what section of the cervical spine has the most motion

A

AA joint

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8
Q

what are the 4 variables for stabilization

A

joint integrity
passive stiffness
neural input
muscle function

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9
Q

describe local muscles

A

closer to axis of motion
deeper
stabilization > rotary forces
postural
aerobic

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10
Q

describe global muscles

A

further from the axis of motion
superficial
rotatory >stabilization
spurt muscles
anaerobic

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11
Q

what is an example of cervical local muscles

A

longus colli, suboccipital, splenius

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12
Q

what is an example of thoracic local muscles

A

rotators, multifidus, pelvic floor, transverses abdominus

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13
Q

pain, swelling, joint laxity, disuse causes

A

decreased motor activation and coordination of local muscles, increased activity of global muscles

supply lowered can lead to easily overworked muscles

local muscle atrophy

increase stress on noncontractile structures

fiber transformation - type 1 to type 2

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14
Q

t/f
normal muscle activity returns spontaneously even when pain is gone

A

false
normal muscle activity does not return spontaneously even when pain is gone

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15
Q

what is nociceptive pain

A

non-nervous tissue compromise
MSK including spindylogenic
viscerogenic

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16
Q

what is neuropathic pain

A

nervous tissue compromise
radicular
radiculopathy
periperal

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17
Q

what is nociplastic pain

A

altered pain perception without complete evidence of actual or threatened tissue compromise

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18
Q

what is spondylogenic pain

A

pain from the spine
local/referred spinal pain from noxious stimulation of spinal structure

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19
Q

can spondylogenic pain cause visceral dysfunction

A

no

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20
Q

what are the symptoms of spindylogenic pain

A

non-segmental pain
rare parthesia’s
vague, deep, achy, boring pain
referred to ill-defined area that settles into consistent location

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21
Q

what does non-segmental pain mean

A

not spinal nerve
everything else that is innervated by the nerve will also have symptoms

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22
Q

what are the signs of spondylogenic pain

A

neuro -WNL
symptoms are not reproduced by motion

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23
Q

what is somatic convergence or referred pain

A

type of spondylogenic pain

sensory afferents converge on and share same innervation

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24
Q

describe somatic convergence or referred pain

A

greater referral of proximal and deep structure that distal and superficial structures

spinal facets joint refer more than elbow joint

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25
where is C2-3 referred pain most likely located
base of skull, headaches
26
where is C3-4 referred pain most likely located
neck pain
27
where is C4-5 referred pain most likely located
neck and shoulder pain
28
where is C5-6 referred pain most likely located
neck and shoulder pain
29
where is C6-7 referred pain most likely located
shoulder and back pain
30
what is viscerogenic pain
referred pain from an organ
31
what is viscerosomatic convergence
viscera and sensory afferents converge and share the same innervation
32
what are the S&S of viscerogenic pain
pain not mechanically reporiduced neuro - WNL
33
what is radicular pain
ectopic or abnormal discharge from highly inflammed spinal nerve
34
what are radicular pain symptoms
lancing, electrical shock-like pain along an extremity in a narrow 2-3'' band
35
what are the signs of radicular pain signs
dermatomes/DTR/myotomes - WNL + dural mobility bc of high inflammation
36
what is radiculopathy pain
more persistent blocked conduction of spinal nerve d/t compression or inflammation
37
what are radiculopathy pain symptoms
segmental paresthesias constant and long duration slow progression to ill defined area possible weakness
38
__% conduction loss needed before perceivable fatiguing weakness
80%
39
what are the signs of radiculopathy pain
+ neuro scan for segmental hypoactivity
40
what is peripheral nerve pain
decreased condition of nerve branch
41
what are the symptoms of peripheral nerve pain
non-segmental paresthesias intermittent and short duration fast progression to well-defined area of numbness
42
what are the signs of peripheral nerve pain
dermatomes, myotomes, DTRs - WNL nonsegmental hypoactivity decreased sensation along peripheral nerve distribution + dural mobility tests
43
what type of pain is defined as altered pain perception without complete evidence of actual or threatened tissue compromise
nociplastic pain
44
t/f patients with sensitization are labeled as having nociplasitc pain
true
45
what is the pathogenesis of nociplastic pain
thinning of myelin sheath in spots increased sensitivity and misinterpretation by peripheral nociceptors hard to override pain with motion d/t fiber malfunctions loss of descending anti-nociceptive mechanisms - less pain control with typical endogenous opiate release in the body somatic convergence
46
in regard to nociplastic pain, (increased/decreased) excitability of segmental dorsal horn neurons
increase
47
what is the pathogenesis of nociplastic pain in regard to somatic convergence
shared areas of innervation share symptoms C fibers split and travel at least 2 spinal segments superiorly and inferiorly
47
what is the pathogenesis of nociplastic pain in regard to somatic convergence
shared areas of innervation share symptoms C fibers split and travel at least 2 spinal segments superiorly and inferiorly brain perceives the pain as coming from even more areas with persistent symptoms
48
what are the S&S of nociplastic pain
>/= 3 months of pain regional or spreading symptoms pain that cannot be explained by nociceptive/neuropathic pathways pain hypersensitivity/allodynia
49
what are autonomic nervous system S&S of nociplastic pain
pitting edema with lymph compromise decreased sebaceous gland and hair follicle activity sweaty hands/feet loss of laterality decreased peripheral arterial shunting - coldness/clamminess increase erector pili muscles + grapesthesia
50
what is the PT rx of nociplastic pain
JM and manipulation patient education
51
what is the MET for nociplastic pain
low-moderate intensity global aerobic and resistance activities 2-3x/wk 30-90 minute sessions minimum 7 week duration
52
how does MET benefit nociplastic pain
helps pt interpret pain and motion as non-threating reorganizes homunculus
53
what is the prognosis of nociplastic pain
varying degrees of improvement long recovery likely not full resolution of symptoms
54
what is the functional ROM for full cervical extension
40-50 degrees to look up
55
what is the functional ROM for cervical rotation for driving
60-70 degrees
56
t/f with neck pain, few and specific tissues are involved in the cause of the pain
false variety and often unknown tissues are involved with neck pain
57
t/f MET is only effective with persistent neck pain
false MET is effective with acute and persistent neck pain
58
what MET is effective for neck pain with nociplastic pain
motor control and strengthening exercises for stabilization 30-60 minute session s 2-3x/wk 7-12 weeks
59
what is the focus of MET for neck pain
local and global muscle training low load endurance for 6 wks isometrics/isotonics
60
what is an example of local muscle training for neck pain
forward nod progress to more advanced exercises while maintaining forward nod
61
what are examples of proprioceptive training
eye fixation with/without head movement seated wobble board training head relocation with eyes open and focused light, eyes closed
62
what is the effect of modalities for neck pain
current evidence is lacking not recomended
63
other than MET, what is another PT intervention that is beneficial to improve neck pain
pt education
64
when does most recovery happen with neck pain
1st 12 weeks with little recovery after 12 months
65
what are the variables for worse prognosis of neck pain
pain > 6/10 neck diability index > 30% pain catastrophizing > 20 post traumatic stress > 33 cold hypersensitivity
66
what is the etilogy of WAD
acceleration-deceleration event strains and sprains includes concussions
67
what scan is necessary for all neck trauma patients
craniovertebral scan eventually cervicothoracic scan and BE
68
what are the sructures most often involved in WAD
z jnt sprains muscle strains
69
what is the most common section of the cervical spine that is affected by WAD, why
C2-3 vertebra move from horizontal to 45 degrees
70
what should be scan findings for left sided z jnt sprain
limited flx, ext, right SB
71
what are the less involved structures of WAD
dens fracture
72
what are the S&S of dens fracture
splinted, especially with SB
73
what structures are injured during a dens fracture
alar ligament
74
what is the function of the alar ligament
attaches from the dens to the base of the skull limited dens motion
75
what is the function of the alar ligament
attaches from the dens up and lateral to the foramen magnum resists transverse stress keeps dens from hitting spinal cord
76
what are the common S&S for fractures throughout he body
trauma hx splinting Pain with palpation, compresssion, vibration limited ROM with empty and painful end feels in most/all directions weak and painful in most/all directions of resisted testing + percussion with stethoscope
77
what part of the bone is most stress fractures located
periosteum
78
what is the function of type 1 collagen
resists tension
79
what is the repair phase for bone
1-3 wks soft callous/fibrous cartilage patch forms from fibro- and chondroblasts
80
what is the modeling phase for bone
4-8 wks, can be up to 12 wks osteoclastic activity replaces cartilage and osteoblastic bony/hard callus forms clinical union
81
what is the remodeling phase for bone
months to years cancellous none transitions to cortical bone
82
what are variables that could complicate bone healing
deficient bone health and hormone levels not meeting energy expidenture impaired circulation infection poor load management
83
complicating factors of bone healing can lead to __
delayed union, non-union, or malunion
84
what is the focus of PT for fracture
consequences of prolonged immobilization where every tissue is negatively influenced
85
what are the unique S&S of alar ligament tear
splinting, particularly with SB d/t immediate tension on ligament possible S&S
86
what are the S&S of transverse ligament tears
likely cord S&S with forward nodding splinting
87
what is the function of the transverse ligament
keeps dens from moving p\osterior and contacting cord
88
what is a rim lesion
horizontal tear of anterior annulus close to end plate caused by excessive hyperextension
89
what are the S&S of rim lesion
splinting, with extension d/t tension on torn anterior annulus pain with compression and distraction
90
what are the symptoms of WAD
trauma with acute neck and intracapsular referred pain potential trigeminocervical nucleus (TCN) symptoms
91
what are the scan signs of WAD
observation: splinting ROM: limited and empty, painful end feels RST: weak and painful neuro: + including cord or cranial stress: + for involved tissue
92
what are the biomechanical exam S&S for fx
joint hypomobility d/t immobilizaiton joint hypermobility d/t laxity if not immobilized
93
what are trigeminocervical nucleus symptoms
inflammation/sensitization produces head, face, and neck symptoms may develop nociplastic pain eight areas of symptoms
94
what is trigeminocervical nucleus
located at C2, 3 segment interaction of sensory nerve fibers of trigeminal nerve and upper cervical spinal nerves
95
what is the PT rx for WAD
POLICED improve joint mechanics and stabilization
96
what is the PT rx for WAD with nociplastic pain
body awareness and stabilization exercises 90 minute sessions 2x/week 10-16 weeks
97
what patients have the best prognosis with WAD
< 35 years of age low level of disability
98
what is the prognosis of WAD after MVA
50% report symptoms up to 2 years following MVA
99
what is a primary headache
due to headache condition itself tension, migraine, cluster
100
what is a secondary headache
due to another source cervicogenic
101
describe a tension headache
Bilateral band-like tightness Anxiety/stress etiology No migraine S&S Dull pressure
102
what is the PT Rx for tension headache
address stress/anxiety
103
describe migraine headaches
Pulsatign Out of commission Unilateral N&V Dromes Sensational auras with visual/auditory sensitivity
104
what is the PT rx for migraines
address CV dysfunction vasoconstriction of temporal arteries increase water intake melatonin nociplastic pain MET
105
describe cluster headache
Comes and goes Retro-orbital and temproal regions Unilateral Sudden and severe pain Horner's syndrome INtense Grumpy
106
what are the symptoms of cervicogenic headache
unilateral starts at neck/occipital region provoked by neck motion mild-moderate pain non-throbbing/pulsatign
107
what are the signs of cerviogenic headache
ROM: limited, painful CM: + Neuro: +

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