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Cervicothoracic spine 2 Flashcards

1
Q

what is the etiology of TOS

A

forward head posture creates upper thoracic joint hypomobility into extension

scalenes compress

trauma (WAD)

differential diagnosis

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2
Q

how does FHP influence TOS

A

increased tension of subclavian fascia on axillary artery which doesn’t allow clavicle to roll anteriorly

issues specifically with overhead activities bc of the need for the clavicle to roll

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3
Q

how does chest breathing influence TOS

A

excessive use of accessory respiratory muscle

scalenes guard and press downward on inferior structures

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4
Q

what are spinal nerve symptoms

A

segmental, related to the segment that the nerve exits
slower onset of numbness

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5
Q

what are peripheral nerve symptoms

A

nonsegmental, several segments contribute
quicker onset of numbness

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6
Q

what are thoracic outlet syndrome symptoms

A

UE glove/sleeve-like paresthesia’s
coldness and swelling with vascular compromise

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7
Q

what activities increase TOS symptoms

A

raising arms for prolonged perior
sleeping
poor sitting posture

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8
Q

what would you expect to observe during the scan for TOS

A

FHP
possible UW discoloration d/t degree of artery involvement

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9
Q

what muscle groups are expected to be weak with TOS

A

posterior shoulder nad posterior throacic

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10
Q

what is expected during the scan for TOS

A

ROM: indications of upper thoracic restriction
RST: decreased strength/endurance in post. shoulder/scap
Neuro: non-segmental hypoactivity, ULTT +

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11
Q

what is the cause of dural tension restriction

A

decreased elasticity or inflammation

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12
Q

what is the PT rx with acute dural tension restriction

A

paresthesia’s at rest

POLICED - NO C
motion w/o resistance/symptoms
STM over segmental level

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13
Q

what is the PT rx with persistent dural tension restriction

A

paresthesia’s at resistance

motion with resistance
neural mobilization with resistance at end range once acuity settle

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14
Q

what are the S&S of dural tension restriction

A

paresthesia’s increased from both ends

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15
Q

what are the S&S of dural gliding restriction

A

paresthesia’s increased from one end but relieved from the other

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16
Q

what is the cause of dural gliding restriction

A

adhesion

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17
Q

what is the PT rx for acute dural gliding restriction

A

POLICED - no C
motion w/o resistance/symptoms
STM over segmental level

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18
Q

what is the PT rx for persistent dural gliding restriction

A

motion with resistance
neural mobilizations at mid range

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19
Q

what factors about the pt determine if the neural mobilizations will be successful

A

absence of neuropathy
older age
small ROM deficits with median nerve

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20
Q

what is expected in accessory motion tests with TOS

A

more often a unilateral upper thoracic hypomobility

less often limited 1st rib inferior glide

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21
Q

what is included with PT rx of TOS

A

postural/ergonomic changes

diaphragmatic breathing

MT/MET in cervicothoracic region to improve mobility

MET to increase strength/endurance in post shld/scp muscles

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22
Q

what is dowager’s hump

why does it develop

A

fat pad over upper C/t junction that develops with atrophy and shearing

wedging of vertebra d/t osteoporosis with persistent FHP

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23
Q

what are common thoracic restrictions

A

bilateral loss of thoracic extension that causes lower cervical instability

unilateral loss of upper thoracic extension contributes to unilateral TOS

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24
Q

what is the general rx for sitting FHP

A

MT/MET with local muscle focus to improve posture

posture education

ergonomic improvements

breathing training

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25
what is the cause of an acute internal disc derangement
trauma
26
what is the most prevalent IDD
chronic or persistent
27
what sections of the annulus are hyper-/hyponeural what type of cartilage is each section made of
hyperneural: outer portions, type 1 collagen hyponeural: inner portion, type 2 collagen
28
t/f the inner annulus is vascular
false Th outer portion of the annulus is vascular
29
what is the function of the nucleus
resists compression dense connective tissue avascular
30
t/f the annulus and nucleus move independently of each other
false the annulus and nucleus move as a unit deformation but not migration of the nucleus with motion
31
describe the vertebral end plate
highly innervated and vascularized assists with nutrient diffusion for disc covers nucleus and most of annulus with connective tissue weak link of intervertebral joint may calcify which limits diffusion
32
where is IDD rare in the spine
throacic - narrowest canal C2-6 - additional stability from UV joints
33
what area of the disc is IDD most prevalent
posterolateral portion of disc (transition of annulus in to endplate is weak spot)
34
what structures are involved with acute IDD
most common - annular tear and end plate avulsion least common - NP herniation
35
what happens once disc structures are damaged
large autoimmune inflammatory response -increase in water to the area = increases osmotic pressure -spinal nerve sensitized = paresthesias extended inflammatory phase
36
what are typical postlateral IDD symptoms
dull/achey spinal pain radiculopathy referred pain to respective areas decreased pain when unloaded increased neck pain and paresthesia's looking down increased pain in morning
37
what radiculopathy symptoms are common with postlateral IDD
possible segmental paresthesia
38
what ROM is expected with IDD postlateral IDD
all motions can increase pain FLX and possible contralateral SB and RT from injured area EXT and possibly SB and RT toward pain less limited
39
why is FLX and contralateral SB/RT away from injured area in IDD less painful
pressure from pushing swelling toward spinal nerve tension on annulus and endplate tear dura
40
what is centralization of symptoms
abolition of distal/spinal pain in distal to proximal direction in response to repetitive motions or sustained positions
41
what are typical postlateral IDD signs
MMT and RST: vairable ST: possible + with compression/distraction/PA pressures Neuro: +
42
what is the PT rx for acute IDD
aggressive nonsurgical treatment is successful POLICED intermittnet traction neural mobilizations MET
43
what is the focus of MET with acute IDD
tissue proliferation and stabilization of local muscles
44
what section of the spine most commonly has persistent IDD
lumbar
45
what part of the cervical spine is most involved with persistent IDD
C5,6 C6 spinal nerve
46
what is the etiology fo persistent IDD
acute IDD sedentary lifestyle genetics
47
what is the pathogenesis of persistent IDD
in-growth of nocicpetive fibers from acute IDD healing can lead to persistent inflammation and nociplastic pain persistent inflammation brings excessive and destructive proteins and low grade inflammation enters disc
48
what is the process of gradual onset of persistent IDD
less GAGs - more fibrotic an dehydrated nucleus more acidic disc which limited proliferation annular disorganization thinning/loss of cartilage at end plates increased inflammation of fatty deposits in vertebra
49
what are the categories of herniation per Miller
protrusion: nucleus migrates but remains contained in annulus extrusion: nucleus migrates thru outer annulus free sequestration: nucleus breaks away from annulus
50
what are changes that are likely to happen with disc, facets, and/or foramen with persistent IDD
disc: instability can develop facets: increased load bearing foramen: stenosis can develop all narrow, cards in deck with rubberband example
51
is it common for pt to not have symptoms with persistent IDD if not, why
no since the tissues have time to adapt/compensate for the structure changes
52
what is the PT rx for persistent IDD
possibly like acute IDD consider primary driver of symptoms
53
what is the negative outcome predictor for persistent IDD
peripheralization
54
what is the MD rx for acute and persistent IDD
antibiotic treatment laminectomy partial discectomy cervical fusion total disc replacement
55
what is functional instability
instability that can be stabilized with muscle activity or positioning
56
what is mechanical instability
instability that cannot be completely stabilized with muscle activity or positioning
57
what portion of the cervical spine has the highest prevalence of functional/mechanical instability
C5-C7
58
what is the etiology of functional/mechanical instability
traumatic or recurrent sprains age related disc changes repetitive extension activities creep d/t poor posture adjacent joint hypomobility connective tissue disorder
59
what structures are involved with mechanical/functional instability
passive restraints active stabilizers or local muscles inhibited neurological function
60
what are the symptoms of functional instability
predictable pain recurrent spine and referred pain decreased pain with position changes increased pain with prolonged positions, looking up, sudden, and strenuous ADLs catching easy self manipulation
61
what ROM is expective with functional instability
acute - aberrant motion limited and painful with ext better flexion
62
what scan findings are expected with scan for functional instability (CM, RST, neuro)
CM: inconsistent block RST: painful if acute neuro: _-
63
what is expected with accessory motion with functional instability
hypermobile accessory motion with possible adjacent ypomobility
64
what muscles are inhibited with functional instability
local muscles
65
what are the symptoms of mechanical instability
same as functional instability but worse with: -unpredictable pattern -worsening symptoms with more frequent episodes - increased pain with trivial and lesser ADLs
66
what is the PT rx with functional/mechanical instability
like ligamentous sprain POLICED postural education of sitting tall bracing/taping PRN
67
what is the focus of MET for functional/mechanical instability
stabilization of local muscles hyperextension of contraindicated
68
what cartilage is commonly affected with age related joint conditions
articular cartilage
69
what are the most common sections affected by age related joint changes
C5-7 L4-S1
70
what joints are most commonly affected by age related joint conditions
hip and knee
71
what is the general funciton of type 2 collagen
resists compression
72
what is the etiology of age related joint changes
prior trauma sedentary lifestyle with underloading genetics other disease
73
what happens with age related joint changes
articular cartilage thins and joint space narrows fibrous capsule slackens and becomes more fibrotic and with persistent inflammation and then stiffens synovial membrane produces less synovial fluid = increase friction
74
what is pain attributed with age related joint changes
subchondral bone and injury to marrow increased interosseous tissue synovial membrane inflammation periarticular tissue inflammation persistent inflammatory response foraminal narrowing on the spinal nerve
75
what are the cervical symptoms with age related joint conditions
gradual onset of neck pain pain with prolonged position (<30 mins) morning stiffness pain and limitation when looking in blind spot possible paresthesia's some movements help and others increase pain
76
what are the cervical scan components of age related joint conditions
ROM: P!/limitation with ext, ipsilateral SB/RT CM: consistent bock in ext quadrant or opposing quadrant RST: depends on acuity ST: P! compression, PA (+) Neuro: (-), could be (+) with radiculopathy
77
what special test can be used for age related joint conditions in cervical region
spurlings to test for radiculopathy
78
what is the PT for articular cartilage degeneration
improve integrity of cartilage and mobility POLICED JM for pain, tissue integrity, mobility
79
what is the focus of MET for articular cartilage degeneration
improve motion cartilage integrity neuromusclular benefits
80
where is RA most likely in the spine
c-spine
81
what is the pathogensis of stenosis
narrowing of spinal canal d/t IDD, DJD or age related disc changes fibrotic spinal nerve d/t persistent inflammation *narrowing form the outside in*
82
what population is most affected by stenosis
>65 years
83
does the CNS and PNS have lymphatic vv? What is the significance?
no, longer inflammatory phase when nerve tissue is involved slows healing process
84
what are lateral stenosis symptoms
unilateral UE spinal pain with segmental paresthesia's decreased pain when looking down, standing/walking increased pain when sitting, looking up, turning to 1 side
85
what would you expect to find in the scan for lateral stenosis
increased lordosis ROM: flx/contralaterl SB/RT lower spinal UE pain ext/ipsialteral SB/RT increase spinal/UE pain ST: + compression, spurlings, PA level neuro: possibly +
86
what special tests are used to confirm lateral stenosis
spurlings wainner's CPR stability test - excessive shearing
87
what is the PT rx for stenosis
pt education activity modification MT - improve thoracic ext and neural mobilizations, mechanical traction
88
what is the MET for stenosis
aerobic - improves circulation local muscle stabilization

MSK (7 decks)

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