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MSK 1 - Cervicothoracic > Cervicothoracic Spine I > Flashcards

Cervicothoracic Spine I Flashcards

1
Q

Hypomobile stiff areas may not be painful, but if not addressed, can cause what?

A

Painful hypermobile compensations elsewhere

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2
Q

Where are hypermobile compensations normally found?

A

The path of least resistance

Ex- stiff upper thoracic region contributes to hypermobile lower cervical spine

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3
Q

What can we do for stiff areas for more uniform/distributed motion?

A

Mobilize them

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4
Q

Why are hyper-mobile areas usually painful?

A

The axis of motion is less controlled

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5
Q

What do we want to do with hypermobile areas?

A

STABILIZE THEM

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6
Q

What muscle groupings are we focussing on with stabilization of hyper-mobile areas?

A

Smaller and deeper muscles, that are almost always inhibited to better control motion

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7
Q

What does the orientation of the facet joints determine?

A

Direction and amount of motion

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8
Q

What is considered the upper cervical spine?

A

O-C2

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9
Q

What plane are upper cervical facets normally in?

A

Transverse plane

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10
Q

What motion does the upper cervical spine favor?

A

Rotation, particularly at C1,2

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11
Q

What plane are the lower cervical facet joints normally in?

A

Between frontal and transverse planes - at around 45 degrees

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12
Q

What motion does the lower cervical spine favor?

A

All motions rather equally

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13
Q

What makes up the lower cervical spine?

A

C2-C7

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14
Q

What plane are the upper thoracic facet joints in?

A

Mostly frontal plane

Ribs limit greater side bending

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15
Q

What motion is the greatest in the upper thoracic spine?

A

Greatest with rotation

Followed by side bend, flexion

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16
Q

What motion is the least favored in the upper thoracic spine?

A

extension

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17
Q

Where is the most rotation in the thoracic spine?

A

T5 and T10

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18
Q

Where is the least movement in the thoracic spine?

A

T11 and T12

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19
Q

What are the four variables for stabilization?

A
  1. joint integrity (i.e. cartilage)
  2. Passive stiffness (i.e. ligaments)
  3. Neural Input
  4. Muscle function
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20
Q

What is controlled motion more than?

A

Just strength of superficial and “mirror” muscles

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21
Q

What are local muscles?

A

-Closer to axis of motion
- often deeper
- favor stabilization over rotary forces
- postural
- aerobic over anaerobic

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22
Q

What type of fibers are local muscles most often composed of?

A

Type I fibers

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23
Q

What are global muscles?

A
  • further from axis of motion
  • often superficial
  • favor rotary over stabilization forces
  • spurt muscles
  • are anaerobic over aerobic
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24
Q

What type of fibers are global muscles most often composed of?

A

Type II fibers

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25
Q

What are some cervical local muscles?

A
  • longus colli and other deep neck flexors
  • suboccipitals and splenius muscle
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26
Q

What are some thoracic local muscles?

A
  • rotatores and multifidus
  • pelvic floor and transverse abdominus (increase contraction of multifidus)
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27
Q

If the Multifidi is smaller, what happens in regards to injury rates?

A

Higher injury rates

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28
Q

What does pain, swelling, joint laxity, and disuse cause?

A

Inhibited muscles

  • particularly local muscles
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29
Q

What is inhibition in regards to a muscle?

A

Decreased and delayed motor activation and coordination

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30
Q

What type of muscle is inhibition preferential to?

A

Type I muscles

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31
Q

What does the multifidi do when inhibited?

A

atrophy and declined strength

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32
Q

What does inhibition do to non-contractile structures?

A

Increases the stress put on them

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33
Q

When supply is lowered, what can it lead to?

A

More easily overworked muscles even without doing more

Think Jan 1st starting a new exercise program… doing more and maintaining an exercise routine = overuse

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34
Q

Why would inhibited muscles increase the stress on the non-contractile tissues?

A

Muscles are not controlling the mobility well

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35
Q

Pain, swelling and disuse cause increased and inefficient motor activity of what group of muscles?

A

Global muscles

i.e. UT, SCM, Scalenes, etc
-> tightness front being “overworked”

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36
Q

What can pain swelling joint laxity and disuse cause for cervical proprioception?

A

Decreases it

sense of where you are in space is disrupted

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37
Q

What does atrophy lead to aside from muscle loss?

A

Fatty infiltration

38
Q

What percentage of muscle cross sectional area is fat in the local/global muscles of those over the age of 60?

A

50%

39
Q

What happens to the fibers of muscles when there is pain, swelling, joint laxity and disuse?

A

Fibers transform from type I to type II

this means they won’t function as needed anymore

40
Q

Does normal muscle function return when the pain is gone?

A

NO

Normal muscle function doesn’t return spontaneously even when the pain is gone

41
Q

What percentage of muscle activation is sufficient to keep stability and is suitable to improve muscle endurance?

A

30%

42
Q

What is pain phenotyping?

A

Set of observable pain characteristics of an individual resulting from body and environment interaction

43
Q

What are the three types of pain phenotyping?

A
  1. Nociceptive
  2. Neuropathic
  3. Nociplastic
44
Q

What is nociceptive pain?

A

NON- nervous tissue compromise

-MSK including spondylogenic
-viserogenic

45
Q

What is neuropathic pain?

A

Nervous tissue compromised
-radicular
-radiculopathy
-peripheral

46
Q

What is nociplastic pain?

A

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

47
Q

What is spondylogenic pain from?

A

The spine

48
Q

Is spondylogenic pain common?

A

Yes

49
Q

What can cause spondylogenic pain?

A

Local and/or referred spinal pain from noxious stimulation of spine structure

50
Q

Is spondylogenic pain local or global?

A

LOCAL pain - symptoms are at the loaction of the source

51
Q

What can spondylogenic pain NOT cause?

A

Visceral dysfunction

52
Q

What can spondylogenic pain cause in regards to shared innervations?

A

Somatic convergence or referred pain

53
Q

Sensory afferents ___________ on and __________ same innervation, so symptoms are felt away from the source

A

Converge, share

54
Q

What are symptoms of spondylogenic pain?

A
  • non segmental pain
  • vague, deep, achy, and boring pain
  • may settle into a consistent location
  • rarely paresthesias
55
Q

What structures refer more than others?

A

Proximal and deep structures have greater referral than distal and superficial structures

ex- spinal facet joints refer more than the elbow joint

56
Q

What are signs of spondylogenic pain?

A
  • neuro scan WNL
  • may not reproduce entire symptom patten with motion
57
Q

Thoracic spondylogenic pain presents where?

A

along respective vertebral levels with overlap in trunk

58
Q

What is viscerogenic pain?

A

referred pain from an organ

59
Q

What is viscerosomatic convergence?

A

Viscera and somatic sensory afferents converge on and share the same innervation

60
Q

What kind of pain does viserogenic pain present as?

A

Vague,, deep, achy and boring pain

61
Q

What are signs and symptoms of viscerogenic pain?

A

Not typically able to be mechanically reproduced
neuro scan WNL

62
Q

What is an example of viscerogenic pain?

A

Heart can refer to left shoulder UE, neck, jaw
- all are innervated by C4-T4 spinal nerves

63
Q

What is radicular pain?

A

Ectopic or abnormal discharge from HIGHLY INFLAMMED spinal nerve

64
Q

Is radicular pain common?

A

NO

65
Q

What are symptoms of radicular pain?

A

Lancing, electrical shock like pain along an extremity in an narrow 2-3” band

66
Q

What are signs of radicular pain?

A

-Positive dural mobility tests due to the high inflammation
-Other LMN neuro test likely WNL unless severe compression

67
Q

What can be helpful to help us determine the involved spinal nerve in radicular pain?

A

Imaging

68
Q

Is conduction of the spinal nerves lost quickly or slowly?

A

Takes time for conduction to be lost

69
Q

What is radiculopathy?

A

Decreased conduction of a spinal nerve due to compression and/or inflammation

70
Q

What are symptoms of radiculopathy?

A

-segmental paresthesias
-often constant and long duration
-slow progression to smaller ill-defined area
-dermatomal overlap
- possible weakness

71
Q

What are signs of radiculopathy?

A

Neuro scan positive for spinal nerve hypoactivity
imaging helpful for involved spinal nerve

72
Q

What are symptoms of a peripheral nerve issue?

A

Non segmental paresthesia
- often intermittent and short duration
- fast progression to larger well-defined area of numbness
bc of minimal overlap of peripheral nerve
Possible weakness

73
Q

What are signs of peripheral nerve issues?

A

*Dermatomes, DTRs, and myotomes WNL
*Non-segmental peripheral nerve hypoactivity
- decreased sensation along peripheral nerve
distribution
- possible weakness of muscles innervated by a
peripheral nerve
*Positive dural mobility tests

74
Q

What is nociplastic pain?

A

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

75
Q

How does nociplastic pain happen?

A

*Thinning of myelin sheath
*Increased sensitivity and misinterpretation by PERIPHERAL nociceptors
*persistant excitation of A-Delta and C fibers

76
Q

What does the persistent excitation of A-delta and C fibers do?

A

Inhibits larger myelinated A-Beta fibers pre-synaptically
Harder to override pain with motion

77
Q

How does nociplastic pain happen?

A

*Increased sensitivity and misinterpretation by CENTRAL structures
*Loss of descending anti-nociceptive mechanisms

78
Q

What is the increased sensitivity of central structures caused by with nociplastic pain?

A
  • Increased excitability of segmental dorsal horn neurons
  • Lower synaptic resistance so pain sensations occur easier
79
Q

What is the loss of descending anti-nococeptive mechanism caused by?

A

Less endogenous opiates released
Less pain control

80
Q

What is somatic convergence?

A

Shared areas of innervation share symptoms

**think of spondylogenic and referred pain

81
Q

How do C-fibers play a role in nociplastic pain?

A

They transmit pain, split and travel at least 2 spinal segments superiorly and inferiorly

domino effect

82
Q

With somatic convergence the brain precieves the pain as coming from _____ _____ areas with _________ symptoms

A

Even more

persistent

brain homunculus “smudged”

83
Q

What are some functional questionnaires for nociplastic pain?

A

Central sensitization inventory
Neurophysiology of Pain Test
- to assess fear avoidance, catastrophizing,
understanding
Regional specific

84
Q

What is the prevalence of nociplastic pain?

A

Growing number of conditions

85
Q

What are some examples of nociplastic pain conditions?

A
  • migraine
  • neck pain
  • shoulder pain
  • lateral elbow pain
  • low back pain
  • age-related Joint Changes
  • persistent fatigue syndrome
  • fibromyalgia
86
Q

What are signs and symptoms for possible nociplastic pain?

A

More than or equal to three months of pain
regional or spreading symptoms
pain that cannot be entirely explained
pain hypersensitivity or allodynia (non-painful stimuli causing pain)

87
Q

What are signs and symptoms for probable nociplastic pain?

A

Sensitivity to sound, light, and/or odor
sleep disturbances
fatigue
cognitive problems

88
Q

What are some autonomic nervous symptom indications for nociplastic pain?

A

Pitting edema with lymph compromise
decreased sebaceous oil gland and hair follicle activity
- skin appears scaly and fragile
- decreased skin mobility and increased sensitivity
- positive scratch test (excessive reddening)
sweaty hands/feet
Clamminess
Loss of laterality
increased erector pili muscle activity
Positive graphesthesia (cant differentiate drawn letters/#s on skin)`

89
Q

What is the manual therapy for nociplastic pain?

A

JM - manipulation
-> stimulated descending inhibitory pain mechanisms
induces presynaptic inhibition
-> limit pain by A-Delta and C-fibers
-> overriding of pain by A-beta stimulation
Reduces dorsal horn excitability
Decreases inflammatory mediators

90
Q

What are the METs for nociplastic pain?

A

Low to moderate intensity global aerobic and resistance activities
2-3 x a week
30-90 mins per session
at least 7 weeks duration
- endogenous analgesia
- helps pt interpret pain and motion as non-threatening
- reorganizes homunculus

91
Q

What else can we do for nociplastic pain aside from manual therapy and METs?

A

Neuroscience education/behavioral therapy

92
Q

What is the prognosis for nociplastic pain?

A

Varying degrees of improvement
longer recovery
likely not full resolution of symptoms

MSK 1 - Cervicothoracic (7 decks)

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