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MSK 1 - Cervicothoracic > Cervicothoracic Spine VI > Flashcards

Cervicothoracic Spine VI Flashcards

1
Q

What are the four variables of stabilization?

A

Joint integrity
passive stiffness
neural input
muscle function

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2
Q

What does the abnormal movement of spinal segment under loaded conditions result in?

A

Pain / disability that changes instantaneous axis of motion

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3
Q

What is functional instability?

A

Instability that CAN be stabilized with muscle activity and/or positioning

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4
Q

What is mechanical instability?

A

Instability that CANNOT be completely stabilized with muscle activity and/or positioning

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5
Q

What gender is a risk factor for hypermobility?

A

Females more than males

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6
Q

What is the etiology of hypermobility?

A

traumatic or recurrent sprains (IDD)
age related joint changes
repetitive ext activities (dance)
creep due to persistent poor posture
adjacent joint hypomobility
connective tissue disorder

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7
Q

Where is hypermobility most common? (what level)

A

At C5-7

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8
Q

What are some symptoms of functional instability?

A

Recurrent and predictable pain

spine and referred pain

possibly paresthesias from nociplastic pain from sensitization

decreased pain with positional changes / support

increased pain with prolonged positions, looking up, sudden and strenuous ADLs like lifting etc.

catching

easy self manipulation

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9
Q

What are some signs of functional instability?

A

if acute - limited ROM with aberrant motion

limited and painful with ext/hyperext due to shearing followed by side bend

flx will tend to be better

Prom larger than arom

inconsistent block with combined motion

resisted / MMT strong and painless unless acute because global muscles not affected

negative neuro tests

positive PA stress tests

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10
Q

What would you possibly find with accessory motion testing with functional instability?

A

Possible hypomobility if hypermobile joint is stuck

upper thoracic indicated by neck side bend at end range rotation, limited neck side bend in 2/3 positions and or manubrial drop with ext during exam

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11
Q

What will segmental stability tests show with functional instability?

A

All positive

most often excessive anterior shearing

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12
Q

Will local muscles be inhibited with instability?

A

Yes

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13
Q

What are some symptoms of mechanical instability?

A

Unpredictable pattern of provoking activities

worsening symptoms with more frequent episodes

increased pain with even trivial and lesser ADLs

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14
Q

What are the signs of mechanical instability?

A

Positive stress tests that wont stabilize fully with repositioning and/or muscle activation

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15
Q

What are some tests and measures for mechanical instability?

A

Radiographs
- lateral flx end range and ext view
- may be spondylolossthesis, fx and slippage of vertebra

Md Rx prolotherapy for stabilization along with PT, or fusion surgery

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16
Q

What can be prescribed from the PT for hypermobility?

A

Postural ed
JM to increase adjacent joint hypomobilty
possible postural taping
MET with emphasis on stabilization of local muscles

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17
Q

What are some examples of age related joint changes?

A

Degenerative Joint Disease (DJD)
Osteoarthritis (OA)
Spondylosis if multiple spinal levels

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18
Q

Where are age related joint changes most common? (what level)

A

C5-7

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19
Q

Age related joint changes are the _______ common cause of disability in the US, existing in __ in __ adults.

A

MOST common

1 in 5 adults

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20
Q

What percentage of people over the age of 55 have age related joint changes?

A

80%

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21
Q

What joints are age related joint changes most common at?

A

Hip and knee followed by spine

22
Q

What is protective for age related joint changes?

A

Physical activity

23
Q

Where is articular cartilage located?

A

Covers ends of long bones and facets

2-4 mm thick

24
Q

What makes up articular cartilage?

A

Chondrocytes

25
Q

Is articular cartilage resistant to wear?

A

Yes

frictionless

26
Q

What type of collagen is articular cartilage?

A

Type II - resists compression

27
Q

Is articular cartilage innervated? have blood supply?

A

Aneural/ alymphatic/ Avascular

28
Q

What does articular cartilage depend on?

A

Diffusion with intermittent compression and decompression with gliding

29
Q

Does articular cartilage adapt to force?

A

Yes adapts to initial and rapid compressive force

30
Q

Is articular cartilage highly permeable or does it have low permeability?

A

Low permeability

This is why we get an immediate increase in synovial fluid pressure

31
Q

Does fluid leave quickly out of articular cartilage?

A

NO

32
Q

Describe what happens to articular cartilage with full motion and decompression?

A

Hydrodynamic refilling with synovial fluid
Inflammatory agents exit
synovial nutrients diffuse into cartilage

33
Q

What is the most common etiology of age related joint changes?

A

more commonly degenerative due to…

prior trauma
aging
genetics
other disease such as RA
sedentary lifestyle with underloading

34
Q

What is typically the cause of age related joint changes in YOUNGER individuals?

A

acute tears
-involving high shear forces

35
Q

What is the diagnosis category and classification of age related joint changes?

A

Neck pain with mobility deficits

36
Q

What happens to articular cartilage with age related joint changes?

A

Frays, blisters, tears and thins so joint space narrows

37
Q

What happens to subchondral bone with age related joint changes?

A

Overloaded and injured including marrow with greater loads

38
Q

Why can spurs form with age related joint changes?

A

Excessive bony stress

39
Q

What happens to the fibrous capsule with age related joint changes?

A

Slackens then thickens and stiffens

40
Q

What happens to the synovial membrane with age related joint changes?

A

Produces less synovial fluid and nutrients

41
Q

What happens with periarticular tissue with age related joint changes? (ligaments, capsule, muscle, etc)

A

Inflammation

42
Q

What causes the persistent pain and inflammatory response with age related joint changes?

A

Persistent pain and inflammatory response due to
-stress on tissues
- increased nociceptor sensitivity
- local production of nitrous oxide leads to more interstitial inflammation and excess collagen (fibrosis)
- blood released from injured bone marrow

43
Q

What are the cervical symptoms of age related joint changes?

A

-Gradual onset of neck pain
-pain with prolonged positions (sitting w FHP, sleeping) over 30 minutes
-Morning stiffness
- pain and limitation looking in one blind spot while driving and with looking up
- possible paresthesias
- some movement helps some makes it worse

44
Q

What would we find when we scan and observe the cervical area with age related joint changes?

A

*FHP
*range of motion painful and limited
- pain with extension and ipsilateral side bend/ rotation
- typically one side worse than the other
- capsular pattern of restriction
*consistent block in ext or opposing quadrants with combined motions
* resisted/MMT depend on acuity
* stress tests likely painful with compression esp with ext, ipsilateral side bend and rotation
- PA’s painful
- distraction relieving if acute
* neuro tests - but could be + for radiculopathy with stenosis

45
Q

What would we find with accessory motion with age related joint changes in the cervical region?

A

Hypomobility

46
Q

What special tests can we do for radiculopathy?

A

Spurlings
Use clinical prediction rate

47
Q

What would an intermediate case of age related joint changes have as an end feel?

A

Firm end feel
hypomobile due to fibrosis

48
Q

What would we prescribe for age related joint changes?

A

Joint mobs
MET
to involved AND adjacent joints for motion

49
Q

Why do deeper defects heal better than superficial lesions?

A

Deeper defects stimulate bleeding by penetrating bone

50
Q

Why is filling in with type I cartilage rather than the original type II less than ideal?

A

Resists tension over compression
leads to limited healing capacity with poor outcomes

51
Q

Why do joint mobilizations help with age related joint changes?

A

Help with pain, cartilage integrity and mobility

52
Q

Why do we prescribe MET for degenerative changes?

A

Improving motion, cartilage integrity and neuromuscular benefits

MSK 1 - Cervicothoracic (7 decks)

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