Cervicothoracic Spine VII Flashcards
What can happen to the AA joint with rheumatoid arthritis?
Subluxation/instability
What is the percentage of AA subluxation/instablility with rheumatoid arthritis?
40-85%
How much subluxation do we need for the patient to have neuro symptoms?
10mm
What can RA cause in the lower cervical region?
Dislocations
Would we do grade 3-5 mobilizations with RA?
NO could rupture joints
What population typically will have stenosis?
Over the age of 65
What percentage of people have asymptomatic canal narrowing?
30%
What are the two causes of stenosis
- compression from outside in
- compression from inside out
What is compression from outside in with stenosis due to?
Age related disc or joint changes most commonly
instability
enfolding or thickened ligamentum flavum
Is compression from outside in with stenosis usually bilateral or unilateral?
Unilateral over bilateral/ central
What happens with compression from inside out stenosis?
Sheath around nerve is fibrotic due to persistent inflammation
Increase blood supply to nerve with activity (causes nerve to enlarge)
What happens to a fibrotic nerve with compression from inside out?
Wont expand
What is the diagnosis category and classification for stenosis?
Neck pain with radiating pain
What are the structures involved with stenosis?
Ischemic compression and venous congestion (no good blood flow)
Spinal nerves
radicular arteries supply spinal nerves
What are symptoms with stenosis
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
What are signs of lateral stenosis we could find?
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
What would we find with accessory motion with lateral stensosis?
Joint hypomobility contributing to foraminal size
What muscles would be possibly inhibited with MMT on lateral stenosis?
Local muscles
What special tests can we perform with lateral stenosis?
Spurlings (would be positive)
Wainner’s CPR
Stability tests - possible excessive shearing
What are some unique central stenosis signs and symptoms?
Cord signs and symptoms
no change with SB or Rot
What can we prescribe for lateral stenosis?
Pt education of foramen and good prognosis
intermittent mechanical traction
Directional preference into flexion
What manual therapies would we do with lateral stenosis?
JM - improve thoracic ext (SALS)
Neural mobilizations if gliding restriction
What MET should we prescribe for lateral stenosis?
Aerobic to increase circulation
local muscle stabilization
What indicates radiculopathy surgery?
Presence of contant and or worsening symptoms
Why is surgery a positive with stenosis?
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
What does autolytic mean?
Self-fuses due to stress on bone
usually happens to people who are very arthritic
Can fusions be congenital?
Yes you can be born with smaller foramina
