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MSK 1 - Cervicothoracic > Cervicothoracic Spine III > Flashcards

Cervicothoracic Spine III Flashcards

1
Q

What is the etiology of whiplash associated disorder?

A

Counter Coo Mechanism

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2
Q

What kind of injury can lead to whiplash associated disorder?

A

Head injuries including concussions

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3
Q

What should we do with ALL neck trauma?

A

Craniovertebral scan initially

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4
Q

What are common symptoms of whiplash associated disorder?

A

Trauma
acute neck pain
referred over radiculating pain
Concussion or trigeminocervical nucleus symptoms

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5
Q

What are some common scan signs for whiplash associated disorder?

A

Concussion or TCN signs

likely splinting

ROM is limited with empty and painful end feels in most if not all directions

Resisted/MMT weak and painful in most if not all directions

Neuro- possible positive UMN or LMN findings

Stress tests positive for involved tissues

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6
Q

What are some common biomechanical exam signs of whiplash associated disorder?

A

Joint dysfunction
- accessory motion testing = joint hypo-mobility due to scar tissue/fibrosis esp with prolonged immobilization
- Stability testing = joint hypermobility/instability will likey be present more commonly due to laxity from sprains
Muscle inhibition
TTP

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7
Q

What are some concussion or TCN signs or symptoms?

A

Cervicothoracic MSK impairments
Vestibulo-oculormotor impairments
Autonomic dysfunction/exertion tolerance impairments
motor function impairments

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8
Q

Where is TCN usually located?

A

C2,3 segment that is often involved

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9
Q

Why can concussion/TCN cause head, face, and neck symptoms?

A

Inflammation and/or sensitization

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10
Q

What does the mandibular nerve produce with concussion?

A

ear - pain/tinnitus/hypersensitivity to sound
tongue - altered/hypersensitive taste

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11
Q

What symptoms can the opthalmic nerve produce with concussion /TCN?

A

Eye pain/hypersensitivity
dry eye
hypersensitive upper face and scalp sensation

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12
Q

What symptoms can the maxillary nerve produce with concussion/TCN?

A

Tooth pain
hypersensitive peri-oral, cheek, nostril, and lower eye lid sensation

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13
Q

What are Concussion or TCN signs and symptoms?

A

C1-3 spinal nerve involved
- CV region = upper cervical pain
- Headache
- dizziness
- paresthesias
-Face -> Pain/paresthesias
- Jaw -> TMJ pain

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14
Q

Why can the vagus nerve play a role in concussion / TCN symptoms?

A

C3,4 roots and can become hypersensitive

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15
Q

What can happen with a hypersensitive vagus nerve?

A

Irregular HR, lack of sweating, dyspnea, nausea, indigestion, and other GI s&s

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16
Q

Why can coordination be influenced with concussion / TCN?

A

Retrograde branch of trigeminal nerve goes to cerebellum

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17
Q

What are the MOST OFTEN involved structures in whiplash associated disorder?

A

Z jt sprains
- C1-3 due to transitional joint surface anatomy
muscle strain

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18
Q

What are the less often involved structures for whiplash associated disorder?

A

Dens fx
- splinted with SB due to alar ligament pulling on dens
- possible cord S&S if dens displaced

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19
Q

What are signs and symptoms for fractures?

A

*Trauma HX
*Splinting
*Pain with palpation, compression, and possible distraction
*Limited ROM with empty and painful end feels in most directions
*weak and painful in most if not all directions of resisted testing
*crepitus
*possible positive neuro tests in spine
*positive special tests= percussion with stethoscope, CDR and CPRs for FXs

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20
Q

What is the role of bone?

A

Support, protection, and attachment
Produces blood cells
houses minerals and fat

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21
Q

Bone is highly ______ & highly __________

A

Vascular and neural (particularly in peristeum)

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22
Q

What are the elements of bone?

A

Osteocytes
crystalline calcium phosphate hydroxyapatite

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23
Q

What does type I collagen do?

A

Resist tension

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24
Q

What are the two types of bone?

A

Cortical - outer layer, 80% of skeletal tissue
Cancellous (trabecular) - 20% of skeletal tissue, inner layer

25
Q

What is an avulsion?

A

Injury to bone where a tendon or ligament pulls off a piece of the bone

26
Q

What is a complex fx?

A

Damages soft tissue surrounding

27
Q

What is an epiphyseal fracture?

A

Growth plate fx

28
Q

What is a hairline fracture?

A

Minimal trauma to bone; incomplete rx with no displacement
ONLY in outer layer of bone

29
Q

What is an oblique fracture?

A

A fx that goes at an angle to the axis of the bone

30
Q

What is a spiral fracture?

A

Bone broken due to twisting motion
highly unstable

31
Q

What is a stress fracture?

A

Extend through all or only part of bone

32
Q

What is an impaction fracture?

A

When one fragment is driven into another

33
Q

What is a comminuted fracture?

A

A fx with more than two fragments of bone which have broken off

34
Q

What are some phases that impact bone healing?

A

Inflammatory phase
Repair phase
modeling phase
remodeling phase

35
Q

What is the repair phase of bone healing?

A

1-3 weeks
a soft callous or fibrous cartilage patch forms from fibro- and chondroblasts

36
Q

What is the modeling phase of bone healing?

A

between 4-8 weeks but up to 12
Osteoclastic activity replaces cartilage and osteoblastic bony or hard callus formed

37
Q

What is it called when fracture line is no longer visible on x-ray?

A

Clinical union

38
Q

What is the remodeling phase of bone healing?

A

Can take months to years
Cancellous bone transitions to more abundant compact or cortical bone (more porous to less porous bone)

39
Q

What are complicating factors for bone healing?

A

Deficient bone health and hormone levels
not meeting energy expenditure
- inadequate diet
-limited sleep
- high stress
impaired circulation
infection
poor load management

40
Q

What can complicating factors of bone healing lead to?

A

Delayed union
non union
malunion (misalignment)

41
Q

What is PT for bone focused on?

A

Consequences of prolonged immobilization where every tissue is negatively influenced

42
Q

When do we start PT for fractures?

A

when clinical union occurs between 4-8 weeks

43
Q

Is pain from fractures from the bone?

A

not typically

44
Q

What happens when muscle is immobilized?

A

Atrophy, decreased strength, contracture, etc.

45
Q

What happens when bone is immobilized?

A

Generalized osteopenia of cancellous and cortical bone

46
Q

What are the signs and symptoms of alar ligamentous tears?

A

Splinting, particularly with side bending due to immediate tension on ligament

Possible cord signs and symptoms due to loss of dens stability

47
Q

What are signs and symptoms of transverse ligament tears?

A

splinting
likely cord signs and symptoms with forward nodding

48
Q

Where is the dens more likely to move with a transverse ligament tear?

A

relatively posteriorly into cord under atlas gliding excessively anteriorly

49
Q

What tests can decrease transverse ligament tear symptoms?

A

Sharp-Pursor test
- manual retraction while stabilizing axis SP
- glides atlas posteriorly and cord away from dens

50
Q

What are some less involved structures with whiplash associated disorder?

A

Rim lesions - horizontal tear of anterior annulus close to end plate

51
Q

How do rim lesions occur?

A

Excessive hyperextension

52
Q

What are some unique signs and symptoms of rim lesions?

A

Splinting with extension due to tension on torn anterior annulus

Pain with compression AND distraction

53
Q

What are MTs and MET for with whiplash associated disorder?

A

ROM and stabilization

54
Q

What do we do for nociplastic pain with WAD?

A

90 minute submaximal sessions
2x a week
10-16 weeks

55
Q

WAD is ~50% pain free at 6 months and 8/10 fully recovered if…

A

less than 35 years of age
low level of disability on NDI

56
Q

What causes persistent and residual pain / disability with WAD?

A

More than 35 years of age
high level of disability on NDI
irritable
easily startled

57
Q

What is the prognosis of WAD at 6 months?

A

NDI less than 10% fully recovered
NDI 11-29% mild to moderate ongoing symptoms
NDI more than 30% moderate to severe ongoing symptoms

58
Q

What percentage report symptoms up to 2 years following MVA?

A

50%

MSK 1 - Cervicothoracic (7 decks)

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