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DPT 730: MSK > Cervicothoracic Spine pt. 2: Test 2 > Flashcards

Cervicothoracic Spine pt. 2: Test 2 Flashcards

1
Q

when are intra-muscular injections considered helpful for neck pain

A

lidocaine for persistent MND and myofascial trigger points

IV injection of methylpredisolone for acute WAD

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2
Q

what are possible oral Rxs for neck pain and their effectiveness

A

pscychotropic agents = mixed results

NSAIDS = little evidence/support

muscle relaxants, analgesics, and NSAIDS = limited evidence

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3
Q

how useful is botox for neck pain

A

moderate evidence that intramuscular injections of botox were no better than saline

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4
Q

describe the effectiveness of radiculopathy surgery for neck pain with PT compared to just PT alone

A

surgery + PT had more rapid/greater improvement in the first year compared to just PT, but in 2 years there were moo significant differences between groups

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5
Q

describe the varying prognosis of neck pain in the acute category

A

about 45% had mild problems with rapid recovery

about 40% had moderate problems with incomplete recovery

about 15% has severe problems and no recovery

most recovery occurs in the first 12 weeks with very little after 12 months

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6
Q

when is there more likely a worse prognosis with neck pain

A

when pain is greater than 6/10
neck disability questionnaire more than 30%
pain catastrophic > 20
post traumatic stress > 33
cold hypersensitivity

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7
Q

describe the etiology of whiplash associated disorder

A

acceleration-deceleration event
often strains/sprains
possible head injuries (don’t have to hit head)

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8
Q

tests/measures for WAD

A

craniovertebral scan initially with all neck trauma

eventually cervicothoracic scan and biomechanical exam

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9
Q

most often involved structures with WAD

A

z joint sprains (especially C1-3, particularly C2 because of the transitional joint surface)

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10
Q

what should be included in the scan findings for a L side Z joint sprain

A

flex, R SB, and R RT would be painful because these are the movements that cause a L SAL

compression would relieve, distraction would cause pain, and positive PA pressures

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11
Q

describe characteristics of a dens fracture

A

typically occurs before transverse ligament tears

splinted, particularly with SB because of alar ligament pulling on dens

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12
Q

what are S&S for MOST fractures anywhere

A

hx of trauma
splinting
Pain with palpation, vibration, compression
limited ROM/empty and painful end feels
weak/painful in almost all directions
crepitus
possible + neuro in spine
+ special tests (i.e. percussion with stethescope, CDRs abd CPRs for fx)

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13
Q

describe bone

A

highly vascular throughout and highly neural particularly in periosteum (covering)

supports/protects/attachment

produces blood cells and houses minerals/fats

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14
Q

what are the elements of bone

A

organic = osteocytes
mineral = crystalline calcium phosphate hydroxyapatite (uniqueness as a specialized connective tissue)
type I collagen = resist tension

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15
Q

what are the 2 types of bones

A

cortical = 80% of skeletal tissue/outer layer
cancellous (trabecular)=20% of skeletal tissue/inner layer

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16
Q

describe the repair phase of bone

A

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

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17
Q

describe the modeling phase of bone healing

A

typically occurs between 4-8 weeks but may be up to 12 weeks

osteoclastic activity replaces cartilage and osteoblastic bony or hard callus is formed

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18
Q

what is it called when the fracture line is no longer visible

A

clinical union

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19
Q

describe the remodeling phase of bone healing

A

can take months to years

cancellous bone (light/more porous) bone transitions to more abundant compact or cortical (denser/less porous) bone

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20
Q

what are the complicating factors of bone healing

A

deficient bone health and hormone levels (i.e. osteoporosis)

not meeting energy expenditure (inadequate diet, low sleep, high stress)

impaired circulation

infection

poor load management

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21
Q

complicating factors of bone healing may lead to what 3 things

A

delayed union = slow uniting

non-union = never unites

malunion = misalignment

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22
Q

complicating factors of bone healing may lead to what 3 things

A

describe delayed union = slow uniting

non-union = never unites

malunion = misalignment

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23
Q

describe the rx for fractures

A

possible reduction and maintenance of alignment (closed or ORIF)

typically start PT at 4-8 weeks after clinical union

with PT any pain is usually not form bone; focus more on consequences of prolonged immobilization and tissues that are negatively influenced

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24
Q

describe alar ligament tears in relation to WAD

A

less involved

ligaments run from dens up and lateral to foramen magnum

weaker than transverse ligament

S&S = splinging (especially with SB) and possible cord S&S due to loss of dens stability

25
Q

describe transverse ligament tears in relation to WAD

A

A less involved structure
stronger than the dens
keeps dens from moving post and contacting cord

S&S = splinting, cord S&S with fwd nod,

26
Q

why might a transverse ligament tear likely cause cord S&S with fwd nod

A

dens is allowed to move relatively posterior into cord under atlas gliding excessively anteriorly

symptoms may be decreased with manual retraction while stabilizing axis SP to glide atlas posteriorly and cord away from dens

27
Q

what is a rim lesion (what is it, etiology, S&S, stress tests)

A

horizontal tear of anterior annulus close to endplate; like ligament rupture

often misdiagnosed as a rare anterior disc herniation

etiology = excessive hyperextension

S&S = splinting (especially with ext due to tension on anterior annulus) as well as P! with compression (endplate) and distraction (annulus)

28
Q

symptoms of WAD

A

trauma with acute neck and intrascapular P!

potential trigeminocervical nucleus (TCN) symptoms

29
Q

scan signs of WAD

A

observation = likely splinting
ROM = limited with empty and painful end feels in several if not all directions
Resisted/MMT= weak and painful in several if not all directions
Neuro=possible positive findings including cord or cranial nerve involvement (symptoms > signs)
stress tests= + for involved tissue

30
Q

persistent signs and symptoms in a biomechanical exam for WAD

A

joint hypo mobility with accessory motion due to immobilization/disuese and fibrotic scaring may occur to some joints

if no prolonged immobilization or fibrotic scaring then hyper mobility/instability will likely be present due to laxity

trigeminocervical nucleus nociplastic pain

31
Q

what is TCN

A

trigeminocervical nucleus nociplastic pain

located at C2-C3 segment

interaction of sensory nerve fibers of trigeminal nerve and upper cervical spinal nerves

inflammation and or sensitization produce head, face, and neck symptoms

may develop into nociplastic pain

32
Q

what are the areas of symptoms for TCN

A

branches of the trigeminal nerve:

-Mandibular (i.e. tongue or ear)
-opthalamic (eye)
-maxillary (tooth ache)

C1-C3 spinal nerves
-CV region
-Head (headache, dizziness, paresthesias)
-jaw (TMJ)

also receives sensory input from Vagus (nucleus at C3-C4) and that area can get sensitized as well

33
Q

what are the areas of symptoms for TCN

A

branches of the trigeminal nerve:

-Mandibular (i.e. tongue or ear)
-opthalamic (eye)
-maxillary (tooth ache)

C1-C3 spinal nerves
-CV region
-Head (headache, dizziness, paresthesias)
-jaw (TMJ)

also receives sensory input from Vagus (nucleus at C3-C4) and that area can get sensitized as well

34
Q

how might sensitization of the vagus nerve with TCN present

A

since it normally promotes calmness, relaxation, and digestion…

dysfunction lease to parasympathetic issues (i.e. irregular HR, lack of sweating, dyspnea, nausea, indigestion, and other GI S&S

35
Q

how can TCN affect coordination

A

retrograde branch of trigeminal nerve goes to cerebellum so therefore coordination can be influenced

36
Q

general PT prescription for WAD

A

POLICED (think of tissue; possible soft collar use)

ultimately improve joint mechanics and stabilize

37
Q

how might one improve joint mechanics/stability for a pt with WAD

A

cervical manipulation/JM
thoracic manipulation/JM
deep neck flexor and scapular stabilizer exercises

for nociplastic: body awareness/stabilization exercises, 90 min sessions, 2x/wk, 10-16 wks

38
Q

what is the prognosis for WAD at baseline

A

about half of cases were pain free at 6 months and 8/10 fully recovered (if low level of diability and less that 35 years old)

the other half has persistent and residual disability

39
Q

for the half of patients that have persistent/residual pain and disability from WAD, what are some common characteristic

A

over 35 years old
high level of disability on NDI
difficulty concentrating and or sleeping
irritable
easily startled
PDS greater than or equal to 6 @ baseline

40
Q

what is the prognosis for WAD at 6 months based on NDI

A

NDI </= 10% = full recovery

NDI 11-29% = mild to moderate ongoing symptoms

NDI >/= 30% = moderate to severe ongoing symptoms

41
Q

prognosis for WAD following MVA

A

50% report symptoms up to 2 years following MVA

42
Q

prevalence of headache

A

over 90% lifetime prevalence rate

common symptom with both serious and non-serious pathologies

43
Q

general management of headaches

A

HA with other suspicious S&S = URGENT or EMERGENCY referral

all other HA complaints should be further investigated with MSK scan and BM exam

PT can help some types but some require MD intervention

44
Q

2 general types of headaches

A

primary = due to HA condition itself

secondary = due to another source

45
Q

3 types of primary headaches

A

cluster
tension
migraine

46
Q

characteristics of tension HA

A

Bilateral band like tightness
anxiety/stress etiology
no migraine S&S (milder)
Dull pressure

47
Q

prevalence/etiology of tension HA

A

40% of HAs (more rare than other types)

often caused by anxiety/stress

often confused with cervicogenic b/c of muscle tension associated with both BUT cervicogenic usually comes from the neck dysfunction itself

48
Q

PT Rx for tension HA

A

adress stress/anxiety

moderate quality evidence for MET with biofeedback

low evidence for sustained JM, so use of oscillations or manipulations are better (b/c muscle tension doesn’t like more tension)

49
Q

migraine characteristics

A

pulsating

out of commission (up to 3 days; mod/severe pain)

unilateral

N&V (due to extremity and gut vasoconstriction thus cold with poor intestinal absorption/diarrhea)

Drome’s: constitutional S&S; pre and postdrome

sensational auras with visual/auditory sensitivity

50
Q

prevalence/etiology of migraines

A

prevalence = 10-15% of HAs

etiology = temporal artery vasodilation or trigeminal nociplastic P! with CV dysfunction

51
Q

PT Rx for migraines

A

address CV dysfunction

vasoconstriction of temporal arteries (i.e. with cryotherapy and caffeine)

increase water intake to 1.5 L/day

Nociplastic pain MET

52
Q

cluster HA characteristics

A

comes and goes: recurrent or clusters/lasts up to a few hours at a time

may involve allergy symptoms

rtetroorbital and temporal regions
unilateral
sudden/severe
intense
grumpy
Horners syndrome (interruption of sympathetic supply to the eye)

53
Q

prevalence and etiology for cluster HA

A

less than 1% of HAs

unknown etiology; possibly:
-abnormal hypothalamus
-genetic
-sleep dysfunction
-medication
-may be precipitated by alcohol, smoking, foods

54
Q

prevalence of cervicogenic HA

A

15-20%

55
Q

pathophysiology of cervicogenic headache

A

C2 and C3 joint dysfunction due to trigeminal nerve influence

56
Q

symptoms of cervicogenic HA

A

unilateral
starts in neck/occipital region progresses to front-ocular region
provoked by neck motion
mild to moderate pain
non-throbbing/pulsating

57
Q

signs of cervicogenic HA

A

limited and painful AROM
possible + combined motion
neuro possibly + hypersensitivity

C2 and C3 dysfunction (hypo mobility and/or hyper mobility/instability + linear stress)

+ cervical flexion-rotation test

+ TTP in O-C3 region

58
Q

PT Rx for cervicogenic HA

A

address cervical dysfunction

59
Q

validity of dry needling for headache Rx

A

no better than transverse friction massage, ischemic compression, or BP meds in high quality studies

NOT reccomended as a stand alone treatment and should be used with manual therapy and exercise

DPT 730: MSK (14 decks)

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