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

Cervicothoracic Spine: Test 2 Flashcards

1
Q

What might happen if the there is hypo mobility in an area of the cervicothoracic spine that is left untreated? Give and example

A

stiff area may not be painful, and if it is not addressed it will typically cause painful hyper mobile compensations elsewhere

Example: stiff facet leads to hyper mobile adjacent facets or stiff upper thoracic regions lead to hyper mobile lower cervical spine

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2
Q

how can you obtain more uniform/distributed motion in the presence of hypo mobility

A

mobilize stiff areas

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3
Q

what determines the direction and amount of motion at the facet joints

A

orientation

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4
Q

describe the motion/location of the facet joints between C2-C7

A

they lie between the frontal and transverse planes

these facets favor all motion equally; this is not true for other spinal segments

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5
Q

describe the location/motion of the upper thoracic facet joints

A

mostly lie/move in the frontal plane

favors SB more (because the facets are more vertically oriented) BUT ribs limit the ROM of the SB

Thoracic vertebrae actually have more rotation than they do SB because of this even though their orientation would imply otherwise

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6
Q

describe the rotary motion of the upper cervical region

A

over 50% of neck rotation happens at the upper cervical area

mostly at the AA joint

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7
Q

how would you define stabilization

A

controlled mobility

more than just strength of superficial and big muscles

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8
Q

what are the 4 variables for stabilization

A

Joint integrity (i.e. cartilage)

Passive stiffness (i.e. ligaments)

Neural input (least often cause; usually not a conduction issue)

muscle function

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9
Q

describe local muscles

A

closer to axis of motion
often deeper
used more for stabilization than rotary forces
shunt muscles
tonic/postural
more aerobic than anaerobic (longer endurance)

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10
Q

describe global muscles

A

further away from the axis of motion
often superficial
used more for rotary forces than stabilization
spurt forces
phasic muscles (not always contracting)
more anaerobic than aerobic (less endurance capacity)

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11
Q

why are global muscle better overall joint movers

A

they have a longer lever arm that allows them to generate better/more propulsive forces

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12
Q

describe how local and global muscles interact with roles

A

both muscle types can contribute to both stabilization and movement

Local muscles tend to ensure stabilization first, and global muscles are primarily movers

if stabilizing muscles are inefficient then global muscles tend to act as stabilizers; since their makeup is not as conducive to that there can be pain, stiffness, etc in those global muscles

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13
Q

what are common local muscles in the cervical region

A

longus Colli and other deep neck flexors

sub occipitals and splenius mm

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14
Q

what are the main local muscles of the thoracic region

A

rotatores and multifidus (the smaller these muscles are the higher injury rate)

pelvic floor and transversus abdominus (activation of these can increase the contraction of the multifidus)

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15
Q

describe the inhibitory effects of pain, swelling, joint laxity, and disuse

A

decreased/delayed motor activation/coordination (aka inhibition of local muscles)

inhibition is preferential to type I muscles (endurance/stabilizing)

this inhibition limits the amount of activating muscles which means that the ones that still are activating can tire much quicker

the more inhibition, the more atrophy present with those local muscles (door hinge examples; more damage close to the axis, the more continual damage will occur there)

ultimately more stress put on non-contractile structures

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16
Q

what are some of the changes that take place in the muscles as a result of swelling, joint laxity, and disuse causes

A

increased/inefficient motor activity of global muscles (too much global muscle movement)

decreased cervical proprioception (motion sense; more likely to get hurt again; less feedback = less injury prevention)

atrophy leads to fatty infiltration (harder to gain back strength later on)

fiber types shift towards type II (less able to do what the muscle was originally designed to do)

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17
Q

describe how muscle activity/activation is the crucial treatment for stabilization

A

muscle activation of 30% is sufficient tot keep stability and is suitable to improve muscular endurance so it doesn’t take a lot

normal muscle activity does not just return after pain is gone from instability; must retrain

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18
Q

what is pain phenotyping

A

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

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19
Q

what are the 3 types of pain phenotyping

A

nociceptive
neuropathic
nociplastic

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20
Q

describe nociceptive pain and the subtypes

A

non-nervous tissue compromise

MSK pain (including spondylogenic)
viscerogenic (getting pain from organ dysfunction)

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21
Q

describe neuropathic pain and the subtypes

A

nervous system compromise

radicular, radiculopathy, and peripheral

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22
Q

describe nociplastic pain

A

qaltered pain perception without complete evidence of actual or treated tissue compromise

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23
Q

what is spondylogenic pain and some key characteristics

A

pain from the spine

common
can be local and/or referred spinal pain from noxious stimulation of spine structures
cannot cause visceral dysfunction as some providers claim (unless it is a spinal nerve itself; facet/bone/joint itself cannot)

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24
Q

symptoms of spondylogenic pain

A

non-segmental pain: means its not from a spinal nerve itself
rarely if any paraesthesias
vague, deep, achey, boring pain
referred into ill defined area that settles into a consistent location

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25
what is segmental pain
pain distribution from spinal nerve in a dermatomal pattern
26
what are signs of spondylogenic pain
neuro scan WNL (because there is no spinal nerve involvement) can't reproduce entire symptoms pattern with motion
27
describe what somatic convergence means in reference to spondylogenic pain
aka referred pain; sensory afferents converge on and share the same innervation this means that some joints in the neck are also innervated by nerves from some neck muscles there is greater referral to proximal and deep structures rather than distal and superficial (i.e. the more midline/centered the joint is the more likely it will cause referred pain) i.e. spinal facet joints refer pain more often than the elbow joint
28
describe viscerosomatic convergence
viscera and somatic (body) sensory afferents CONVERGE on and SHARE the same innervation for example approximately C4-T4 there is a shared innervation of the heart and some neck muscles; thus heart issues can cause pain in the left shoulder, UE, neck, and jaw (all shared innervation)
29
signs and symptoms of viscerogenic pain
not typically able to be mechanically reproduced neuro scan WNL
30
what is radicular pain
ectopic or abnormal discharge from highly inflammed spinal nerve (dorsal root)
31
symptoms of radicular pain
lancing electrical shock like pain along an extremity in a narrow 2-3" band neural test would possibly be normal because its new/acute/inflamed and hasn't been around long enough to lose conduction
32
signs of radicular pain (nDTR/myotome/derm, dural mobility)
dermatomes, DTRs, and myotomes are likely WNL: may be difficult to localize segment if acute/time because ti takes time for hypoactivity to show positive dural mobility tests due to high inflammation NOT common imaging helpful for the involved spinal nerve
33
what is radiculopathy
more persistent blocked conduction of spinal nerve due to compression or inflammation
34
symptoms of radiculopathy
segmental paresthesias (dermatomal pattern w/ possible loss of DTR); constant or long duration; slow progression to ill defined area due to the dermatomal overlap possible weakness (80% conduction loss needed before there is perceivable fatiguing weakness); thus off there is a positive myotome test there is a significant conduction deficit
35
signs of radiculopathy
neuro scan positive for segmental hypoactivity imaging helpful for involved spinal nerve
36
describe peripheral nerve pain
decreased conduction of nerve branch (i.e. median nerve with carpal tunnel)
37
symptoms of peripheral nerve pain
non-segmental paresthesias: intermittent/short duration; fast progression to well-defined area of numbness because of minimal overlap of peripheral nerves (unlike spinal nerves) possible weakness
38
signs of a peripheral nerve issue
dermatomes, DTRs, and myotomes WNL non segmental hypoactivity; decreased sensation along peripheral n distribution; possible weakness of muscles innervated by peripheral nerve positive dural mobility tests
39
describe the relationship between the terms sensitization and nociplastic pain
sensitization was the initial term sensitization is an underlying mechanism of nociplastic pain; symptoms of sensitization are present within nociplastic pain patients with sensitization are labeled as having nociplastic pain sensitization falls under the umbrella of nociplastic pain
40
define nociplastic pain
altered pain perception without complete evidence of actual or threatened tissue compromise
41
pathogenesis of nociplastic pain
thinning of myelin sheath in spots and the thinning causes the peripheral nociceptors (a-delta and C fibers that carry pain) to be extra sensitive and misinterpret the pain signals as more painful than it actually is increased sensitivity and misinterpretation by central structures as well (doesn't take as much stimulus for to fire) loss of descending antinociceptive mechanisms (less hormone/opiate release in body to control the pain naturally)
42
describe the somatic convergence portion of the pathogenesis of nociplastic pain
C fibers (carry pain) travel and split to at least 2 spinal segments superiorly and inferiorly thus there are many areas of shared innervation and pain can begin to spread all throughout multiple segments of innervation domino effect
43
describe how somatic convergence can affect the homunculus
the brain perceives the pain as coming from even more areas with persistent symptoms
44
what are some conditions associated with nociplastic pain prevalence
prevalence = growing persistent fatigue syndrome fibromyalgia LBP age related joint pain lateral elbow pain shoulder pain migraines neck pain: both traumatic and not traumatic
45
S&S/criteria for "possible" nociplastic pain
more than 3 months of pain regional or spreading symptoms pain that can't be entirely explained by nociceptive or neuropathic pathways pain hypersensitivity or allogynia (non painful stimuli causing pain)
46
S&S for "probable" nociplastic pain
**addition of any of these comorbidities along with the "possible" criteria sensitive to light, sound, and or odor sleep disturbances fatigue cognitive problems
47
autonomic nervous system indicated S&S (x7)
pitting edema with lymph compromise decreased sebaceous gland and hair follicle activity sweaty hands/feet decreased peripheral artery shunting = cold/clammy loss of laterality (can't differentiate sides) decreased erector pili muscle (goose bumps) positive graphesthesia (can't differentiate drawn letters/numbers)
48
why might joint mobilizations be a good rx for nociplastic pain
theoretical benefits on symptoms most accepted = stimulates descending inhibitory pain mechanisms (i.e. more endorphins) induces presynaptic inhibition (limit pain transmission/better overriding of P! stimuli) reduced dorsal horn excitability decreased inflammatory mediators **basically flip all the signs and symptoms/work in the opposite direction
49
how might MET be a good rx for nociceptive pain
low to moderate intensity of global aerobicc and resistance exercises 2-3x/wk 30-90 min/session at least 7 week duration helps patient interpret pain/motion as non-threatening reorganizes homunculus endogenous/opiate analgesia
50
how might neuroscience education/behavioral therapy help nociplastic pain
not just mind over matter explain increase sensitivity/misinterpretation to reduce stress/anxiety of misperceived tissue injury challenges patients reasoning of fears and pain and helps ensure exercise safety transition to adaptive pain coping
51
prognosis of nociplastic pain
varying degrees of improvement longer recovers likely not a full resolution of symptoms
52
describe the prevalence of cervical neck pain
70% people will experience neck pain 1/3 will have it for more than 6 months almost 1/2 will be persistent (think nociplastic) 2nd only to LBP in workers comp costs more common in older and in women
53
how much of spine pathology is related to the thoracic region
15%
54
strongest risk factors for neck pain
history of neck pain and being a female
55
what is neck pain typically classified as
mechanical neck disorder (MND) or nerve root compromise
56
functional ROM for neck
full (40-50 degree) extension to look up 60-70 degrees needed to rotate while driving (don't need the full 80-90 functionally)
57
S&S of neck pain
varied in cervical spine and possible into the upper extremity impaired scapular mechanics
58
how well does imaging contribute for neck pain conditions dx
often fails to identify related structures often asymptomatic MRI findings in the neck (i.e. bulging/herniated discs, annular tears, or cord compression); don't necessarily mean they are the cause for the original pain
59
what structures are involved with neck pain
often varied and unknown most patients don't have a pathoanatomical cause or known tissue producing symptoms
60
how well do tests and measures help diagnose neck pain
nearly all clinical tests are poor screening tools and/or lack string diagnostic accuracy measures necessary for clinical decision making
61
how might a cervical JM help neck pain
modulate neck muscle function increase deep muscle recruitment and reduce recruitment of superficial muscles more effective and greater cost savings vs PCM or non manual Rx
62
what are the criteria that are indicators of cervical manipulation success
neck disability index <11.5 bilateral involvement sedentary work less than 5 hours a day feeling better with movement ext doesn't increase symptoms OA without radiculopathy
63
what are the MOST RECENT predictors of success for cervical manipulation
symptoms for more than 38 days expectation that manipulation will help greater than 10 degree difference in rotation pain with PA springs
64
criteria for success for thoracic manipulation
symptoms for more than 30 days no symptoms distal to shoulder ext doesn't increase symptoms fear avoidance beliefs questionnaire PA scale less than 12 diminished T3-5 kyphosis (flatter back between shoulder blades) cervical extension less than 30 degrees
65
when is met most effective for neck pain
with acute and persistent neck pain additive benefit to manual therapy
66
if neck pain is nociplastic, what criteria should MET follow
motor control and exercises for stabilization 30-60 minute sessions 2-3x/wk 7-12 wks
67
what other regions of the body should be included in MET when treating neck pain
cervical, thoracic, scapular, and shoulder regions work on stabilization and strength/endurance parameters
68
describe how you would prescribe MET for local and global muscle training with neck pain
low load endurance (6 weeks) include: isotonic and isometric forward nodding isometric cervical rotation isotonic and isometric scapular exercises
69
how might you incorporate local muscle training for neck muscles into functional activities
maintain forward head nod during balance training and with external loads integration with function
70
describe proprioceptive training for neck pain
eye fixation without head movement
71
describe how continual exercise/MET even after therapy can affect the outcome for neck pain patients
those who did it 3x/wk for a year were still good at 3 years 8-12 visits along led to benefits that lasted out to 12 months 2x/wk for 6 wks led to benefits that lessened by 6 months targeting the issue with exercise for at least 6 weeks for lasting effects, but even better results would occur from longer
72
how beneficial is stretching for neck pain
not beneficial in isolation needs to be combined with MET
73
describe the benefits of mechanical traction
no support for static Tx intermittent is not beneficial in isolation; some support for short term radiculopathy symptoms... more beneficial following CPRs or with other added interventions
74
describe the support for modalities in research
current evidence is lacking, limited ,or conflicting and NOT recommended
75
describe the benefits of education/counseling (for neck pain)
early movement without provocation reassures of good prognosis and full recovery in most cases

DPT 730: MSK (14 decks)

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