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MSK 1 - Cervicothoracic > Cervicothoracic Spine V > Flashcards

Cervicothoracic Spine V Flashcards

1
Q

What is acute internal disc derangement due to?

A

Trauma

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2
Q

What is acute internal disc derangement?

A

Annular end plate tear
Acute herniations (LEAST COMMON)

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3
Q

Disc changes due to numerous variables allow herniations to ____________ develop over time

A

Gradually

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4
Q

Most common internal disc derangement type is?

A

Chronic or persistent

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5
Q

What are the components of the intervertebral disc?

A

Annulus (inner and outer)
Nucleus pulposus
End plate
Body

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6
Q

What is the most innervated part of the annulus?

A

The outer annuluus

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7
Q

What collagen type is greater in the outer annulus? Why?

A

Type I to resist tension

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8
Q

What type of collagen increases into the nucleus of the annulus? Why?

A

Type II to resist compression

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9
Q

What does the annulus stabilize like?

A

A ligament

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10
Q

Are the annulus and nucleus very distinct in a healthy disc?

A

No

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11
Q

The annulus has concentric rings with ______ fibers?

A

Layered/overlapping

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12
Q

The annulus is avascular so it depends on what?

A

Diffusion

Depends on movement compression and decompression

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13
Q

Can compression produce tension and vice versa?

A

YES

think of a water balloon sides get tense with force
tension can create compression (ex- rotating towel and hands get closer)

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14
Q

The majority of fibers in the annulus are where?

A

deeply embedded into end plate

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15
Q

What does the nucleus do?

A

Resists compression

high # of GAGs for hydrostatic pressure

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16
Q

What is the nucleus made up of?

A

Dense connective tissue

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17
Q

Does the nucleus have innervation?

A

No avascular and aneural

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18
Q

Do the annulus and nucleus move as a unit?

A

Yes normally

Movement can cause deformation but not migration of nucleus

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19
Q

Is the vertebral end place innervated? Vascular?

A

Highly innervated and vascularized

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20
Q

What does the vertebral end plate do?

A

assists with nutrient diffusion for disc

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21
Q

What does the vertebral end plate cover?

A

Covers nucleus and MOST of annulus

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22
Q

What types of cartilage is the vertebral end plate made up of?

A

Articular cartilage (Type II) towards vertebral body

Fibrocartilage (Type I) towards disc

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23
Q

What type of collagen is the vertebral body?

A

Bone - type I collagen

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24
Q

Is persistent or acute IDD more common?

A

Persistent

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25
Q

Where is IDD rare?

A

Thoracic spine (<1% all disc herniations)
C2-6 region due to stability from U joints

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26
Q

Where is the most common area for IDD on the disc? Why?

A

Posterolateral portion of disc

Weaker thinner and more vertical with less oblique annular fibers

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27
Q

What are the most common structures involved with acute IDD? less common?

A

Outer annular tearing and end plate avulsion

Less commonly inner annular tearing and nucleus pulposus herniation

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28
Q

Disc structures are _________ once damaged

A

Immunoreactive

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29
Q

What kind of immune response do we expect with IDD?

A

Large auto immune inflammatory response

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30
Q

What happens with the inflammatory response with IDD?

A

Excessive osmotic pressure or static fluid pressure in and around disc and spinal nerve

Radiculopathy/radicular s&s

extended inflammatory phase

(static fluid consists of increased inflammatory chemicals that sensitizes spinal nerve and structures to pressure/tension )

31
Q

What are some typical postlateral IDD symptoms?

A

Dull achy spinal pain
radiculopathy
referred pain

32
Q

Why is the pain with postlat IDD dull and achy

A

Highly innervated outer annulus so very painful

33
Q

What are the characteristics of radiculopathy with postlat IDD?

A

Possible segmental paresthesias within 24 hours into distal extremity

34
Q

What does the presence of coldness with postlat IDD indicate?

A

Circulatory compromise

35
Q

What are some typical postlat IDD symptoms?

A

Decreased pain upon unloading (lying down)
Increased neck pain and paresthesias looking down
Increased pain in AM due to pooling of swelling while sleeping

36
Q

What would we find in our scan for postlat IDD?

A

all ROM may increase pain

FLX and possibly contralateral SB/Rot likely limited and increases extremity and spinal pain

Ext and possibly ipsilateral sb/rot less limited

37
Q

Why would flexion and contralateral SB/Rot increase pain with postlat IDD?

A

Pressure pushing swelling toward sensitized spinal nerve
tension on annulus and endplate tear and dura

38
Q

Why would ext and ipislateral sb/rot be less limited with postlat IDD?

A

May increase spinal pain due to increased hydrostatic pressure on disc with high osmotic pressure

May decrease pain esp with repetition by moving swelling away from spinal nerve

39
Q

What is the centralization of symptoms?

A

Abolition of distal and/or spinal pain in a distal to proximal direction in response to repetitive motions or sustained positions

40
Q

What would you find in your postlat IDD scan?

A

*resistance and MMT vary
*Possible positive stress tests with compression/distraction/PA pressures
*neuro tests possibly positive depending on severity
-myotomal fatigue
-DTR hyporeflexive
-diminished dermatomes
- positive dural mobility tests

41
Q

What would we find in our biomechanical exam with postlat IDD?

A

Possibly positive stability tests

42
Q

What can be done for acute IDD?

A

Mechanical diagnosis and therapy
-(mckenzie)

43
Q

What is directional preference?

A

A position, motion, and/or factor that alleviates symptoms irrespective of location

44
Q

What is cervical directional preference?

A

May be associated with centralization with the addition of decreasing severity and improving function

match up exercise and ADL positions

45
Q

What can be helpful for acute IDD?

A

Intermittent traction
MET for tissue proliferation and stabilization particularly of local muscles

46
Q

What is persistent IDD also known as?

A

Degenerative Disc Disease

47
Q

Are age related disc changes always only due to age?

A

NO

48
Q

What is the incidence of persistent internal disc derangement?

A

Lumbar more than cervical

49
Q

Why is cervical persistent IDD more common?

A

Largest diameter in lower cervical spine bc of numerous innervations for lateral and posterior cord in brachial plexus

50
Q

What is the most common site for persistent IDD?

A

C5,6 and the C6,7

C6 spinal nerve

51
Q

What is the etiology of persistent IDD?

A

Acute IDD
sedentary lifestyle
genetics

52
Q

Is persistent IDD quick or gradual?

A

Gradual

53
Q

What happens to cause persistent IDD?

A

Lost GAGs so more fibrotic
more acidic disc
annular disorganization
modic changed

54
Q

What are modic changes with persistent IDD? (changes seen on MRI)

A

Persistent bone marrow edema
- nociceptive fibers that lead to nociceptive pain
- excessive and destructive proteins and a low-grade infection likely enters disc

55
Q

What does bone marrow do with persistent IDD?

A

changes from circulatory to fatty type

56
Q

Now persistent herniations and nuclear migration ____________ develop per the miller classifications

A

Gradually

57
Q

What is a protrusion?

A

Nucleus migrates but remains contained in annulus

58
Q

What is the most common herniation?

A

Protrusion (buldge)

59
Q

What is an extrusion?

A

Nucleus migrates through the outer annulus

60
Q

What is free sequestration?

A

Nucleus migrates and breaks away from annulus

61
Q

What likely develops where the nucleus migrates into the vertebral body as well?

A

Schmorl’s Nodes

62
Q

What develops with persistent iDD?

A

Instability
disc space narrowing
joint space narrowing (greater load on facets)
foramen narrowing (stenosis may develop)

63
Q

What are some signs and symptoms of persistent IDD?

A

Slow change allow tissues to adapt w/o symptoms for some time

Gradual onset of symptoms
- inner annulus is hyponeural and nucleus is aneural so wont produce much pain

64
Q

What can be prescribed for persistent IDD?

A

Aggressive nonsurgical treatment
- intermittent traction
- specific therapeutic exercise
-oral anti-inflammatory medication
- pt education

65
Q

What percentage of people with radiculopathy have good or excellent outcomes at 2 years?

A

70%

66
Q

What percentage of people with radiculopathy have only mild symptoms at ~5 years?

A

90%

67
Q

What are some CPR for radiculopathy?

A

Over 54 years old
non dominant UE affected
looking down does not worsen
more than 30 degrees of flexion

68
Q

What can we do as PTs for radiculopathy?

A

Intermittent mechanical traction
multi-modal with MT and local muscle training
thoracic thrust manipulation

69
Q

When is traction most effective for Acute and persistent IDD?

A

Following CPRs
added to other interventions such as exercise and MT

70
Q

What is the negative outcome predictor for IDD?

A

Peripheralization

71
Q

What is peripheralization associated with?

A

Mental distress/depression
non-organic signs (tumor)
pain behaviors
somatisation (conversion of anxiety into bodily symptoms)
fear of work

72
Q

What can doctors do for IDD?

A

Antibiotics for infection
decompressive surgeries
- laminectomy
- partial disectomy

73
Q

What can a cervical fusion do?

A

Increase adjacent segment motion at the levels above and below

74
Q

What does a total disc replacement do?

A

unload facets superior to TDR and increased loading at level of TDR

MSK 1 - Cervicothoracic (7 decks)

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