Cervicothoracic Spine VI Flashcards
What are the four variables of stabilization?
Joint integrity
passive stiffness
neural input
muscle function
What does the abnormal movement of spinal segment under loaded conditions result in?
Pain / disability that changes instantaneous axis of motion
What is functional instability?
Instability that CAN be stabilized with muscle activity and/or positioning
What is mechanical instability?
Instability that CANNOT be completely stabilized with muscle activity and/or positioning
What gender is a risk factor for hypermobility?
Females more than males
What is the etiology of hypermobility?
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
Where is hypermobility most common? (what level)
At C5-7
What are some symptoms of functional instability?
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
What are some signs of functional instability?
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
What would you possibly find with accessory motion testing with functional instability?
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
What will segmental stability tests show with functional instability?
All positive
most often excessive anterior shearing
Will local muscles be inhibited with instability?
Yes
What are some symptoms of mechanical instability?
Unpredictable pattern of provoking activities
worsening symptoms with more frequent episodes
increased pain with even trivial and lesser ADLs
What are the signs of mechanical instability?
Positive stress tests that wont stabilize fully with repositioning and/or muscle activation
What are some tests and measures for mechanical instability?
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
What can be prescribed from the PT for hypermobility?
Postural ed
JM to increase adjacent joint hypomobilty
possible postural taping
MET with emphasis on stabilization of local muscles
What are some examples of age related joint changes?
Degenerative Joint Disease (DJD)
Osteoarthritis (OA)
Spondylosis if multiple spinal levels
Where are age related joint changes most common? (what level)
C5-7
Age related joint changes are the _______ common cause of disability in the US, existing in __ in __ adults.
MOST common
1 in 5 adults
What percentage of people over the age of 55 have age related joint changes?
80%
What joints are age related joint changes most common at?
Hip and knee followed by spine
What is protective for age related joint changes?
Physical activity
Where is articular cartilage located?
Covers ends of long bones and facets
2-4 mm thick
What makes up articular cartilage?
Chondrocytes
Is articular cartilage resistant to wear?
Yes
frictionless
What type of collagen is articular cartilage?
Type II - resists compression
Is articular cartilage innervated? have blood supply?
Aneural/ alymphatic/ Avascular
What does articular cartilage depend on?
Diffusion with intermittent compression and decompression with gliding
Does articular cartilage adapt to force?
Yes adapts to initial and rapid compressive force
Is articular cartilage highly permeable or does it have low permeability?
Low permeability
This is why we get an immediate increase in synovial fluid pressure
Does fluid leave quickly out of articular cartilage?
NO
Describe what happens to articular cartilage with full motion and decompression?
Hydrodynamic refilling with synovial fluid
Inflammatory agents exit
synovial nutrients diffuse into cartilage
What is the most common etiology of age related joint changes?
more commonly degenerative due to…
prior trauma
aging
genetics
other disease such as RA
sedentary lifestyle with underloading
What is typically the cause of age related joint changes in YOUNGER individuals?
acute tears
-involving high shear forces
What is the diagnosis category and classification of age related joint changes?
Neck pain with mobility deficits
What happens to articular cartilage with age related joint changes?
Frays, blisters, tears and thins so joint space narrows
What happens to subchondral bone with age related joint changes?
Overloaded and injured including marrow with greater loads
Why can spurs form with age related joint changes?
Excessive bony stress
What happens to the fibrous capsule with age related joint changes?
Slackens then thickens and stiffens
What happens to the synovial membrane with age related joint changes?
Produces less synovial fluid and nutrients
What happens with periarticular tissue with age related joint changes? (ligaments, capsule, muscle, etc)
Inflammation
What causes the persistent pain and inflammatory response with age related joint changes?
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
What are the cervical symptoms of age related joint changes?
-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
What would we find when we scan and observe the cervical area with age related joint changes?
*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
What would we find with accessory motion with age related joint changes in the cervical region?
Hypomobility
What special tests can we do for radiculopathy?
Spurlings
Use clinical prediction rate
What would an intermediate case of age related joint changes have as an end feel?
Firm end feel
hypomobile due to fibrosis
What would we prescribe for age related joint changes?
Joint mobs
MET
to involved AND adjacent joints for motion
Why do deeper defects heal better than superficial lesions?
Deeper defects stimulate bleeding by penetrating bone
Why is filling in with type I cartilage rather than the original type II less than ideal?
Resists tension over compression
leads to limited healing capacity with poor outcomes
Why do joint mobilizations help with age related joint changes?
Help with pain, cartilage integrity and mobility
Why do we prescribe MET for degenerative changes?
Improving motion, cartilage integrity and neuromuscular benefits
