Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how useful is botox for neck pain

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tests/measures for WAD

A

craniovertebral scan initially with all neck trauma

eventually cervicothoracic scan and biomechanical exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

most often involved structures with WAD

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe the repair phase of bone

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

clinical union

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

complicating factors of bone healing may lead to what 3 things

A

delayed union = slow uniting

non-union = never unites

malunion = misalignment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
describe transverse ligament tears in relation to WAD
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
why might a transverse ligament tear likely cause cord S&S with fwd nod
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
what is a rim lesion (what is it, etiology, S&S, stress tests)
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
symptoms of WAD
trauma with acute neck and intrascapular P! potential trigeminocervical nucleus (TCN) symptoms
29
scan signs of WAD
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
persistent signs and symptoms in a biomechanical exam for WAD
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
what is TCN
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
what are the areas of symptoms for TCN
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
what are the areas of symptoms for TCN
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
how might sensitization of the vagus nerve with TCN present
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
how can TCN affect coordination
retrograde branch of trigeminal nerve goes to cerebellum so therefore coordination can be influenced
36
general PT prescription for WAD
POLICED (think of tissue; possible soft collar use) ultimately improve joint mechanics and stabilize
37
how might one improve joint mechanics/stability for a pt with WAD
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
what is the prognosis for WAD at baseline
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
for the half of patients that have persistent/residual pain and disability from WAD, what are some common characteristic
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
what is the prognosis for WAD at 6 months based on NDI
NDI /= 30% = moderate to severe ongoing symptoms
41
prognosis for WAD following MVA
50% report symptoms up to 2 years following MVA
42
prevalence of headache
over 90% lifetime prevalence rate common symptom with both serious and non-serious pathologies
43
general management of headaches
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
2 general types of headaches
primary = due to HA condition itself secondary = due to another source
45
3 types of primary headaches
cluster tension migraine
46
characteristics of tension HA
Bilateral band like tightness anxiety/stress etiology no migraine S&S (milder) Dull pressure
47
prevalence/etiology of tension HA
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
PT Rx for tension HA
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
migraine characteristics
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
prevalence/etiology of migraines
prevalence = 10-15% of HAs etiology = temporal artery vasodilation or trigeminal nociplastic P! with CV dysfunction
51
PT Rx for migraines
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
cluster HA characteristics
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
prevalence and etiology for cluster HA
less than 1% of HAs unknown etiology; possibly: -abnormal hypothalamus -genetic -sleep dysfunction -medication -may be precipitated by alcohol, smoking, foods
54
prevalence of cervicogenic HA
15-20%
55
pathophysiology of cervicogenic headache
C2 and C3 joint dysfunction due to trigeminal nerve influence
56
symptoms of cervicogenic HA
unilateral starts in neck/occipital region progresses to front-ocular region provoked by neck motion mild to moderate pain non-throbbing/pulsating
57
signs of cervicogenic HA
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
PT Rx for cervicogenic HA
address cervical dysfunction
59
validity of dry needling for headache Rx
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions