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MSK > Cervicothoracic Spine > Flashcards

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
Q

where is C2-3 referred pain most likely located

A

base of skull, headaches

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26
Q

where is C3-4 referred pain most likely located

A

neck pain

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27
Q

where is C4-5 referred pain most likely located

A

neck and shoulder pain

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28
Q

where is C5-6 referred pain most likely located

A

neck and shoulder pain

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29
Q

where is C6-7 referred pain most likely located

A

shoulder and back pain

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30
Q

what is viscerogenic pain

A

referred pain from an organ

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31
Q

what is viscerosomatic convergence

A

viscera and sensory afferents converge and share the same innervation

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32
Q

what are the S&S of viscerogenic pain

A

pain not mechanically reporiduced
neuro - WNL

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33
Q

what is radicular pain

A

ectopic or abnormal discharge from highly inflammed spinal nerve

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34
Q

what are radicular pain symptoms

A

lancing, electrical shock-like pain along an extremity in a narrow 2-3’’ band

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35
Q

what are the signs of radicular pain signs

A

dermatomes/DTR/myotomes - WNL
+ dural mobility bc of high inflammation

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36
Q

what is radiculopathy pain

A

more persistent blocked conduction of spinal nerve d/t compression or inflammation

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37
Q

what are radiculopathy pain symptoms

A

segmental paresthesias
constant and long duration
slow progression to ill defined area
possible weakness

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38
Q

__% conduction loss needed before perceivable fatiguing weakness

A

80%

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39
Q

what are the signs of radiculopathy pain

A

+ neuro scan for segmental hypoactivity

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40
Q

what is peripheral nerve pain

A

decreased condition of nerve branch

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41
Q

what are the symptoms of peripheral nerve pain

A

non-segmental paresthesias
intermittent and short duration
fast progression to well-defined area of numbness

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42
Q

what are the signs of peripheral nerve pain

A

dermatomes, myotomes, DTRs - WNL
nonsegmental hypoactivity
decreased sensation along peripheral nerve distribution
+ dural mobility tests

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43
Q

what type of pain is defined as altered pain perception without complete evidence of actual or threatened tissue compromise

A

nociplastic pain

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44
Q

t/f
patients with sensitization are labeled as having nociplasitc pain

A

true

45
Q

what is the pathogenesis of nociplastic pain

A

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
Q

in regard to nociplastic pain, (increased/decreased) excitability of segmental dorsal horn neurons

A

increase

47
Q

what is the pathogenesis of nociplastic pain in regard to somatic convergence

A

shared areas of innervation share symptoms

C fibers split and travel at least 2 spinal segments superiorly and inferiorly

47
Q

what is the pathogenesis of nociplastic pain in regard to somatic convergence

A

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
Q

what are the S&S of nociplastic pain

A

> /= 3 months of pain
regional or spreading symptoms
pain that cannot be explained by nociceptive/neuropathic pathways
pain hypersensitivity/allodynia

49
Q

what are autonomic nervous system S&S of nociplastic pain

A

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
Q

what is the PT rx of nociplastic pain

A

JM and manipulation
patient education

51
Q

what is the MET for nociplastic pain

A

low-moderate intensity global aerobic and resistance activities
2-3x/wk
30-90 minute sessions
minimum 7 week duration

52
Q

how does MET benefit nociplastic pain

A

helps pt interpret pain and motion as non-threating
reorganizes homunculus

53
Q

what is the prognosis of nociplastic pain

A

varying degrees of improvement
long recovery
likely not full resolution of symptoms

54
Q

what is the functional ROM for full cervical extension

A

40-50 degrees to look up

55
Q

what is the functional ROM for cervical rotation for driving

A

60-70 degrees

56
Q

t/f
with neck pain, few and specific tissues are involved in the cause of the pain

A

false
variety and often unknown tissues are involved with neck pain

57
Q

t/f
MET is only effective with persistent neck pain

A

false
MET is effective with acute and persistent neck pain

58
Q

what MET is effective for neck pain with nociplastic pain

A

motor control and strengthening exercises for stabilization
30-60 minute session s
2-3x/wk
7-12 weeks

59
Q

what is the focus of MET for neck pain

A

local and global muscle training
low load endurance for 6 wks
isometrics/isotonics

60
Q

what is an example of local muscle training for neck pain

A

forward nod
progress to more advanced exercises while maintaining forward nod

61
Q

what are examples of proprioceptive training

A

eye fixation with/without head movement
seated wobble board training
head relocation with eyes open and focused light, eyes closed

62
Q

what is the effect of modalities for neck pain

A

current evidence is lacking
not recomended

63
Q

other than MET, what is another PT intervention that is beneficial to improve neck pain

A

pt education

64
Q

when does most recovery happen with neck pain

A

1st 12 weeks with little recovery after 12 months

65
Q

what are the variables for worse prognosis of neck pain

A

pain > 6/10
neck diability index > 30%
pain catastrophizing > 20
post traumatic stress > 33
cold hypersensitivity

66
Q

what is the etilogy of WAD

A

acceleration-deceleration event
strains and sprains
includes concussions

67
Q

what scan is necessary for all neck trauma patients

A

craniovertebral scan
eventually cervicothoracic scan and BE

68
Q

what are the sructures most often involved in WAD

A

z jnt sprains
muscle strains

69
Q

what is the most common section of the cervical spine that is affected by WAD, why

A

C2-3

vertebra move from horizontal to 45 degrees

70
Q

what should be scan findings for left sided z jnt sprain

A

limited flx, ext, right SB

71
Q

what are the less involved structures of WAD

A

dens fracture

72
Q

what are the S&S of dens fracture

A

splinted, especially with SB

73
Q

what structures are injured during a dens fracture

A

alar ligament

74
Q

what is the function of the alar ligament

A

attaches from the dens to the base of the skull
limited dens motion

75
Q

what is the function of the alar ligament

A

attaches from the dens up and lateral to the foramen magnum
resists transverse stress
keeps dens from hitting spinal cord

76
Q

what are the common S&S for fractures throughout he body

A

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
Q

what part of the bone is most stress fractures located

A

periosteum

78
Q

what is the function of type 1 collagen

A

resists tension

79
Q

what is the repair phase for bone

A

1-3 wks
soft callous/fibrous cartilage patch forms from fibro- and chondroblasts

80
Q

what is the modeling phase for bone

A

4-8 wks, can be up to 12 wks
osteoclastic activity replaces cartilage and osteoblastic bony/hard callus forms
clinical union

81
Q

what is the remodeling phase for bone

A

months to years
cancellous none transitions to cortical bone

82
Q

what are variables that could complicate bone healing

A

deficient bone health and hormone levels
not meeting energy expidenture
impaired circulation
infection
poor load management

83
Q

complicating factors of bone healing can lead to __

A

delayed union, non-union, or malunion

84
Q

what is the focus of PT for fracture

A

consequences of prolonged immobilization where every tissue is negatively influenced

85
Q

what are the unique S&S of alar ligament tear

A

splinting, particularly with SB d/t immediate tension on ligament
possible S&S

86
Q

what are the S&S of transverse ligament tears

A

likely cord S&S with forward nodding
splinting

87
Q

what is the function of the transverse ligament

A

keeps dens from moving p\osterior and contacting cord

88
Q

what is a rim lesion

A

horizontal tear of anterior annulus close to end plate

caused by excessive hyperextension

89
Q

what are the S&S of rim lesion

A

splinting, with extension d/t tension on torn anterior annulus
pain with compression and distraction

90
Q

what are the symptoms of WAD

A

trauma with acute neck and intracapsular referred pain
potential trigeminocervical nucleus (TCN) symptoms

91
Q

what are the scan signs of WAD

A

observation: splinting
ROM: limited and empty, painful end feels
RST: weak and painful
neuro: + including cord or cranial
stress: + for involved tissue

92
Q

what are the biomechanical exam S&S for fx

A

joint hypomobility d/t immobilizaiton

joint hypermobility d/t laxity if not immobilized

93
Q

what are trigeminocervical nucleus symptoms

A

inflammation/sensitization produces head, face, and neck symptoms
may develop nociplastic pain
eight areas of symptoms

94
Q

what is trigeminocervical nucleus

A

located at C2, 3 segment
interaction of sensory nerve fibers of trigeminal nerve and upper cervical spinal nerves

95
Q

what is the PT rx for WAD

A

POLICED
improve joint mechanics and stabilization

96
Q

what is the PT rx for WAD with nociplastic pain

A

body awareness and stabilization exercises
90 minute sessions
2x/week
10-16 weeks

97
Q

what patients have the best prognosis with WAD

A

< 35 years of age
low level of disability

98
Q

what is the prognosis of WAD after MVA

A

50% report symptoms up to 2 years following MVA

99
Q

what is a primary headache

A

due to headache condition itself
tension, migraine, cluster

100
Q

what is a secondary headache

A

due to another source
cervicogenic

101
Q

describe a tension headache

A

Bilateral band-like tightness
Anxiety/stress etiology
No migraine S&S
Dull pressure

102
Q

what is the PT Rx for tension headache

A

address stress/anxiety

103
Q

describe migraine headaches

A

Pulsatign
Out of commission
Unilateral
N&V
Dromes
Sensational auras with visual/auditory sensitivity

104
Q

what is the PT rx for migraines

A

address CV dysfunction
vasoconstriction of temporal arteries
increase water intake
melatonin nociplastic pain MET

105
Q

describe cluster headache

A

Comes and goes
Retro-orbital and temproal regions
Unilateral
Sudden and severe pain
Horner’s syndrome
INtense
Grumpy

106
Q

what are the symptoms of cervicogenic headache

A

unilateral
starts at neck/occipital region
provoked by neck motion
mild-moderate pain
non-throbbing/pulsatign

107
Q

what are the signs of cerviogenic headache

A

ROM: limited, painful
CM: +
Neuro: +

MSK (7 decks)

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