Cervicothoracic Spine pt. 3: Test 2 Flashcards

Question

describe the annulus

Answer 1

outer = type I collagen type II increases going inward (blends/forms gradient with nucleus) fibrocartilage connective tissue hyper to hypo neural out to in (nociceptive, proprioceptive) stabilizes like a ligament and leads to multifidi contraction avascular (slow healing)

Answer 2

both pulling and pushing creates tension (like a water balloon)

Answer 3

resist compression (primarily type II collagen; high GAGS) dense connective tissue avasculr, depends on diffusion for nutrients, aneural

Answer 4

move as a unit normally deformation but not migration of nucleus with motion

Answer 5

highly innervated/vascularized assists with nutrient diffusion covers nucleus and MOST of annulus with specialized connective tissue (articular cartilage toward vertebral body, fibrocartilage toward disc) weak link of intervertebral joint (especially at annular connection) can calcify and limit diffusion

Answer 6

type I collagen 6 times stiffer and 3 times thicker than a disc

Answer 7

persistent > acute rare in thoracic region (also greater consequences in this area due to narrowest canal; less than 1% of all cases) rare in C2-6 region due to additional stability from UV joints

Answer 8

posterolateral portion of the disc is most common area it is weaker, thinner, with more vertical and less oblique annular fibers transition of the annulus into the endplates is a weak spot (highly connected area)

Answer 9

more commonly annular tear and end plate evulsion less commonly the nucleus pulposus herniation disc structures are immunoreactive once damaged (body sees as a non self; large inflammatory phase) large autoimmune inflammatory response occurs

Answer 10

excessive osmotic pressure creates disc and spinal nerve swelling spinal nerve sensitized to pressure/tension radiculopathy/radicular S&S poor drainage due to lack of lymphatic vessels extended inflammatory phase

Answer 11

dull/achy spinal pain (annulus is highly innervated = lots of pain; less swelling than lumbar disc due to lower number of GAGs) radiculopathy (possible segmental paresthesias w/I 24 hours to distal extremity; worse if cold indicating circulatory compromise) referred pain

Answer 12

decreased pain when unloaded/supine increased pain/paraesthesias when looking down any movement down and away from the issue will cause pain increased pain in mornings and influenced as above while worsening throughout the day lots of early symptoms due to pressure from swelling

Answer 13

all may increase pain flex and contralateral SB and RT from injured area likely limited and increase extremity/spinal pain die to pressure from pushing swelling towards SC and tension on annulus/endplate tear ext and RT/SB towards affected area may be less limited (may increase spinal pain due to increased hydrostatic pressure on disc)

Answer 14

inconsistent for discogenic pain but it may be present abolition of distal and or spinal pain in a distal to proximal direction in response to repetitive motion or sustained positions

Answer 15

resistance and MMT = variable possible + stress tests with compressions, distractions, and PA pressures (b/c endplate is like cartilage and annulus is like a ligament so all movements have potential) neuro possibly + depending on timing/severity (myotomal fatigue, hypo reflexive DTR, diminished derm, and + dural mobility) + stability tests

Answer 16

unique S&S = cord PT implications = immobilization and emergency referral

Answer 17

developed by Robert McKenzie based on belief that most pain comes from injuries to the disc which is not supported in research classification of symptoms based on location and positions that decrease symptoms

Answer 18

position, motion, and or factor that alleviates symptoms irrespective of location cervical = may be associated with centralization with the addition of decreasing severity and improving function

Answer 19

weak evidence for effectiveness no more beneficial vs general exercise and a control group out to 12 months

Answer 20

with cervical radiculopathy and IDD aggressive nonsurgical treatment is successful 24/26 parts of treatment include: -intermittent traction -specific therapeutic exercise -oral anti-inflammatory meds -pt edu

Answer 21

POLICED intermittent traction neural mobilizations (mvmd without symptom reproduction) MET ultimately for tissue proliferation and stabilization of muscles

Answer 22

improving stabilization offsets the laxity from the tear add resistance and the right loads/reps to change/heal the tissue

Answer 23

degenerative disc disease age related sic changes (not always due to age alone)

Answer 24

lumbar > cervical when you do have cervical... -most common at C5,6 and C6,7 -C6 spinal nerve is most involved nerve and largest diameter in lower cervical spine die to numerous innervations from lateral and posterior cord from brachial plexus

Answer 25

lumbar > cervical when you do have cervical... -most common at C5,6 and C6,7 -C6 spinal nerve is most involved nerve and largest diameter in lower cervical spine die to numerous innervations from lateral and posterior cord from brachial plexus

Answer 26

acute IDD can lead to persistent sedentary lifestyle genetics

Answer 27

annular/end plate changes lead to earlier disc changes in growth of nociceptive pain fivers from acute IDD healing can lead to persistent inflammation/nociplastic pain persistent inflammation brings excessive and destructive proteins and a low grade infection is likely to enter disc (which can drive inflammation that causes pain)

Answer 28

less GAGs so more fibrotic and dehydrated nucleus more acidic disc that kills disc cells and limited proliferation (loss of water = no dilution = more acidic) annular disorganization thinning/loss of cartilage at end plates increased inflammation and fatty deposits in vertebra then persistent herniations gradually develop per the miller classifications once changes occur with the discs

Answer 29

protrusion (bulge) = nucleus migrates but remains in annulus; MOST common extrusion = nucleus migrates thru the outer annulus free sequestration = nucleus breaks away from the annulus **schmorls nodes likely develop where the nucleus migrates into the vertebral body as well

Answer 30

disc instability may develop increased load bearing on facets which means age related joint changes may develop narrowing of the foramen = stenosis may develop

Answer 31

slow change; tissues adapt gradual onset may be like acute S&S also need to consider other conditions that may develop and their respective S&S may even be a "mixed bag" fo symptoms

Answer 32

possibly acute IDD rx need to consider primary driver of symptoms from the development of other conditions -IDD -instabilty -age related joint changes -stenosis -combination of symptoms

Answer 33

refer to ligament and cartilage notes on healing and extend the timelines due to likely prolonged inflammatory phase of healing mostly good

Answer 34

negative outcome predictor opposite of centralization significant association with: -mental distress/depression -non-organic signs i.e. tumor -pain behaviors -somatisation = conversion of anxiety into bodily symptoms -fear of work

Answer 35

-infection benefits from antibiotic treatment -laminectomy (remove part of lamina to make space) -partial discectomy (shave off part of disc) -cervical fusion -total disc replacement

Answer 36

increased adj segment motion at the levels above and below after a 2-level compared with a 1-level anterior cervical disc fusion

Answer 37

unloads facets superior to TDR and increased loading at level of TDR are and effective treatmetn more than 5 years postoperatively restores height, pretenses structure, and allows movement reverses BM problems to some degree doesn't necessarily take all pain away bit greatly helps

Answer 38

inert structures like ligaments/capsules/discs contractile structures like local muscles patterning of CNS/PNS for motor control

Answer 39

abnormal movement if spinal segment under loaded conditions resulting in pain and disability that changes the instantaneous axis of motion

Answer 40

functional = instability that can be stabilized with muscle activity mechanical = can't be completely stabilized with mm activity or positioning

Answer 41

women more than men traumatic ir reccurent sprains age related disc changes repetitive ext activities creep adj joint hypo mobility (especially with fusion) connective tissue disorder most common at C5-7

Answer 42

1 point for each of the following: stand and palms touch floor each knee that hyperextends each elbow that hyperextends each thumb that touches forearm each little finger with 90 degrees MCP hyperextension

Answer 43

beighton scale greater than or equal to 4/9 = + test arthralgia > 3 months in > 4 joints

Answer 44

beighton scale of 3 or less out of 9 arthralgia > 3 months in 1-3 joints or LBP > 3 months (i.e. spongy condition) soft tissue injury in more than 3 locations tall/slim body abnormal skin droopy eyes varicose veins, hernias

Answer 45

2 major criteria present 1 major and 2 minor criteria present 4 minor criteria present

Answer 46

passive restraints (ligaments, capsules, and disc) active stabilizers or local muscles inhibited neurological function

Answer 47

predictable pain recurrent spine and referred pain (possibly paraesthestias) decreased P! with positional changes/support increased P! with prolonged positions, looking up, sudden/strenuous ADLs like lifting catching symptom easy self manipulation

Answer 48

if acute, limited with aberrant motion primarily limited and painful with ext b/c of lincreased anterior vertebral shearing followed by SB flx will tend to be better bc of large posterior ligamentous/fascia tightening to help with stabilization inconsistent WB/NWB findings often WNL except for ext with creasing combined motion = inconsistent block

Answer 49

resisted/MMT may be P! if acute; most often string/painless bc global muscles aren't affected - neuro tests except possible hyperesthesia with pinwheel during sensation testing + PA stress and linear stability tests that cam be stabilized bye muscle activation or positioning that should tighten the ligament s hypermobile accessory motion with possible adj hypo mobility inhibited local muscles

Answer 50

same as functional except worse and with unpredictable pattern, worsening symptoms, more frequent episodes, and increased pain with even trivial and lesser ADLs

Answer 51

same as functional except worse with positive stress tests that won't stabilize fully

Answer 52

Rx like ligament sprain POLICED posture edu of sitting tall/activating deep neck flexors JM- increased adj joint hypo mobility typically at C2 and t-spine bracing/taping pen MET with emphasis on stabilization particularly of local muscles; hyperextension is contraindicated

Answer 53

in rare cases of shearing/slipping prolotherapy for stabilization along with PT fusion surgery (only option for some pts)

Answer 54

age related joint changes at multiple levels

Answer 55

detected as early as 15 years old most common in C5-7 and L4-S1 progresses along with age related disc changes (bc they take on earlier/more stress if there is a present disc issue)

Answer 56

most common cause of disability in US 80% of people > 55 yrs most common at hip/knee followed by spine similar presence in athletic/non-athletic populations PA is protective so long as there is no trauma

Answer 57

covers ends of long bones and facets 2-4 mm thick near ligaments/tendons

Answer 58

chondrocytes

Answer 59

frictionless/resistent to wear aneural/alymphatic/avascular = not capable fo producing inflammatory response if P!/inflammation = more likely bone