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MSK II > Class 1: Spine/Thoracolumbar > Flashcards

Class 1: Spine/Thoracolumbar Flashcards

(49 cards)

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1
Q

describe what you may see with stiff areas

A

may not be painful

could cause other hypermobile areas

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2
Q

why are hypermobile areas generally more painful and how should you treat

A

because the axis of motion is less controlled

treat by stabilizing with smaller/deeper muscles

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3
Q

describe the orientation of the thoracic facets

A

more vertical

generally set up for frontal plane

however ribs limit the amount of side bend even with the frontal plane orientation

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4
Q

describe the orientation of the lumbar facets

A

slightly curved

more in sagittal plane (i.e. like praying hands that move anterior/posterior

favor flexion/ext

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5
Q

with trunk rotation how much is occuring at the lumbar spine

A

not much; maybe 2 degrees per segment

most is from lower thoracic where there are not true ribs

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6
Q

4 variables for stabilization

A
  1. joint integrity
    2.passive stiffness
  2. neural input
  3. muscle function
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7
Q

characteristics of local muscles

A

postural
aerobic
type 1
deeper
stabilization > rotary forces
aerobic > anaerobic
closer to axis

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8
Q

global muscle characteristics

A

further from axis
superficial
rotary more than stabilization
spurt mm
anaerobic
type II

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9
Q

action of psoas

A

frontal plane stabilizer

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10
Q

pelvic floor/transversus abdominus important function

A

increase contraction of multifidus

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11
Q

smaller transversospinalis is associated with what (i.e. multifidus/rotatores)

A

smaller = higher injury rate and LBP

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12
Q

pain swelling laxity and disuse can cause what

A

atrophy of local muscles
inhibition (preferable to type I)
decreased performance of local muscles
increased stress on non-contractile structures

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13
Q

if there is a decrease in local muscle activation what happens to global muscles

A

inefficient and increased activity to compensate

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14
Q

muscle fiber transformation with pain, swelling, and joint laxity

A

type I changes to type II

muscles have less endurance than original

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15
Q

does normal muscle activity return when pain is gone

A

no

muscle activation of 30% is enough tto keep stability and improve endurance

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16
Q

what is pain phenotyping

A

set of observable pain characteristics of an individual resulting from the interaction between the body and the environment

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17
Q

3 types of pain phenotyping

A

nociceptive
nociplastic
neuropathic

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18
Q

what is nociceptive pain

A

non nervous tissue

MSK - including spondylogenic

viscerogenic

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19
Q

what is neuropathic pain

A

nervous tissue compromise

radicular. radiculopathy, and peripheral

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20
Q

what is nociplastic pain

Study These Flashcards
A

altered pain perception

w/o complete evidence of actual tissue compromise

21
Q

what is spondylogenic pain

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A

from the spine

common

local/refferred from spinal structures

cannot cause visceral dysfunction

22
Q

explain somatic convergence

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A

senseory afferents converge on and share the same innervation

greater referral from proximal/deep structures than distal/superficial

23
Q

symptoms of spondylogenic pain

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A

rarely paraesthesias
non segmental pain
vague/deep/achy/boring

reffered to vague area due to somatic convergence that settles to consistent location

24
Q

signs of spondylogenic pain

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A

neuro = WNL

cant reproduce entire symptom pattern with motion

25
how might spondylogenic pain present in the thoracic region
along the respective vertebral levels with overlap in the trunk
26
what is the common presentation of spondylogenic pain in the lumbar spine
most often in gluteal region and proximal thigh may go as far as the foot inconsistent pattern between individuals
27
what is viscerogenic pain
from an organ due to viscerosomatic convergence i.e. kidneys can refer into T10-L1 dermatomes
28
S&S of viscerogenic pain
usually cant be mechanically reproduced neuro = WNL
29
what is viscerosomatic convergence
viscera and somatic sensory afferents converge on and share the same innervation
30
what is radicular pain
ectopic or abnormal discharge fron highly inflammed spinal nerve (dorsal root)
31
symptoms of radicular pain
lancing, electrical shock like pain along an extremity in a narrow band
32
signs of radicular pain
dermatomes, DTRs, and myotomes likely WNL possibly difficult to localize segment if acute/mild (takes time for hypoactivity to show) + dural mobility tests b/c high inflammation not common imaging is helpful for involved level
33
what is radiculopathy
blocked conduction of a spinal nerve due to compression and or inflammation
34
symptoms of radiculopathy
segmental paraesthesias: constant/long duration; slow progression to vague area due to derm overlap possible weakness (80% conduction loss required)
35
signs of radiculopathy
neuro + for spinal n hypoactivity imaging is helpful for involved n
36
symptoms of a peripheral n issue
non-segmental paraesthesias intermittent/short duration fast progression to well defined area of numbness; minimal overlap possible weakness
37
signs of peripheral n issue
derms, DTRs, and myotomes WNL non segmental peripheral n hypoactivity (decreased sensation/possible weakness) + dural mobility
38
what is nociplastic pain
sensitization to pain (original term) sensatization = underlying mechnaism altered pain perception without complete evidence of actual or threatened tissue compromise
39
pathogenesis of nociplastic pain x5
thinning of myelin sheath increased sensitivity and misinterpretation by PERIPHERAL nociceptors Increased sensitivoty and misinterpretation by central structures (sensations occur easier and are harder to block) somatic convergence (c-fibers split and travel 2 segments sup and inf) persistent excitation of A-delta and C fibers (this inhibits larger myselinated A-beta fibers presynaptically which makes it harder to override pain)
40
functional questionaires for nociplastic pain
central sensitization inventory neurophysiology of pain test (fear avoidance, catastrophizing, and understanding) regional specific ones
41
prevalence of nociplastic pain/associated conditions
growing prevalence migraines neck pain shoulder pain lateral elbow pain LBP ARJC persistent fatigue syndrome fibromyalgia
42
S&S/criteria for "possible" nociplastic pain
more than 3 months of pain regional or spreading symptoms pain that can't be explained hypersensitivity to non-painful stimuli
43
S&S/criteria for probable nociplastic pain
addition of any of the following to "possible" criteria: sensitivity to light, sound, or odor sleep disturbances fatigue cognitive problems
44
S&S that indicate the autonomic nervous system x7
pitting edema with lymph compromise decreased sebaceous gland activity (fragile skin, decreased mobility of skin, excessive reddening with scratch test) sweaty hands/feet cold/clammy from artery shunting loss of laterality increased erector pili activity + graphesthesia
45
possible JM Rx for nociplastic pain (theoretical benefits) x5
has theoretical benefits : stimulates inhibitory pain mechanisms (more endorphins) induces presynaptic inhibition (limits pain transmission and overrides pain better) reduced dorsal horn excitability decreases inflammatory mediators
46
MET for nociplastic pain
low to moderate global aerobic and resistive activities 2-3x/wk 30-90 min sessions at least 7 wk duration
47
benefits of met for nociplastic pain
endogenous/opiate analgesia interpret pain and motion as non-threatening reorganizes homunculus
48
benefits of neuroscience edu/behavioral therapy for nociplastic pain
not just mind over matter explain the sensitivity and miinterpretation to reduce stress/anxiety challenges fears and ensures exercise safety transitions pt to adaptive coping
49
prognosis for nociplastic pain
vary levels of improvement longer recovery likely not a full resolution of symptoms

MSK II (18 decks)

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