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MSK 1 - Cervicothoracic > Cervicothoracic Spine VII > Flashcards

Cervicothoracic Spine VII Flashcards

1
Q

What can happen to the AA joint with rheumatoid arthritis?

A

Subluxation/instability

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2
Q

What is the percentage of AA subluxation/instablility with rheumatoid arthritis?

A

40-85%

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3
Q

How much subluxation do we need for the patient to have neuro symptoms?

A

10mm

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4
Q

What can RA cause in the lower cervical region?

A

Dislocations

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5
Q

Would we do grade 3-5 mobilizations with RA?

A

NO could rupture joints

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6
Q

What population typically will have stenosis?

A

Over the age of 65

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7
Q

What percentage of people have asymptomatic canal narrowing?

A

30%

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8
Q

What are the two causes of stenosis

A
  1. compression from outside in
  2. compression from inside out
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9
Q

What is compression from outside in with stenosis due to?

A

Age related disc or joint changes most commonly
instability
enfolding or thickened ligamentum flavum

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10
Q

Is compression from outside in with stenosis usually bilateral or unilateral?

A

Unilateral over bilateral/ central

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11
Q

What happens with compression from inside out stenosis?

A

Sheath around nerve is fibrotic due to persistent inflammation

Increase blood supply to nerve with activity (causes nerve to enlarge)

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12
Q

What happens to a fibrotic nerve with compression from inside out?

A

Wont expand

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13
Q

What is the diagnosis category and classification for stenosis?

A

Neck pain with radiating pain

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14
Q

What are the structures involved with stenosis?

A

Ischemic compression and venous congestion (no good blood flow)

Spinal nerves

radicular arteries supply spinal nerves

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15
Q

What are symptoms with stenosis

A

Gradual onset

unilateral UE pain with segmental paresthesias and “gripping type pain due to ischemia”

Decreased pain looking down/ standing walking/ in the mornings

Increased pain sitting, looking up, turning to one side

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16
Q

What are signs of lateral stenosis we could find?

A

FHP

Flexion and contralateral side bend and rotation decreases spinal / UE pain

Extension and ipsilateral side bend and rotation increases spinal/ UE pain

positive neuro tests for radiculopathy

Stress tests: positive for compression (esp in ext, SB, & rot), distraction relieves, possible positive PA tests at involved level with prolonged hold

17
Q

What would we find with accessory motion with lateral stensosis?

A

Joint hypomobility contributing to foraminal size

18
Q

What muscles would be possibly inhibited with MMT on lateral stenosis?

A

Local muscles

19
Q

What special tests can we perform with lateral stenosis?

A

Spurlings (would be positive)
Wainner’s CPR
Stability tests - possible excessive shearing

20
Q

What are some unique central stenosis signs and symptoms?

A

Cord signs and symptoms
no change with SB or Rot

21
Q

What can we prescribe for lateral stenosis?

A

Pt education of foramen and good prognosis
intermittent mechanical traction
Directional preference into flexion

22
Q

What manual therapies would we do with lateral stenosis?

A

JM - improve thoracic ext (SALS)
Neural mobilizations if gliding restriction

23
Q

What MET should we prescribe for lateral stenosis?

A

Aerobic to increase circulation
local muscle stabilization

24
Q

What indicates radiculopathy surgery?

A

Presence of contant and or worsening symptoms

25
Q

Why is surgery a positive with stenosis?

A

Results in a more rapid and greater improvement in pain and during the first postop year than PT alone

BUT differences between the groups are not significant after two years

26
Q

What does autolytic mean?

A

Self-fuses due to stress on bone
usually happens to people who are very arthritic

27
Q

Can fusions be congenital?

A

Yes you can be born with smaller foramina

MSK 1 - Cervicothoracic (7 decks)

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