Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK II > Class 1: Spine/Thoracolumbar > Flashcards

Class 1: Spine/Thoracolumbar Flashcards

1
Q

describe what you may see with stiff areas

A

may not be painful

could cause other hypermobile areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

4 variables for stabilization

A
  1. joint integrity
    2.passive stiffness
  2. neural input
  3. muscle function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

characteristics of local muscles

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

global muscle characteristics

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

action of psoas

A

frontal plane stabilizer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pelvic floor/transversus abdominus important function

A

increase contraction of multifidus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

smaller = higher injury rate and LBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

inefficient and increased activity to compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

muscle fiber transformation with pain, swelling, and joint laxity

A

type I changes to type II

muscles have less endurance than original

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 types of pain phenotyping

A

nociceptive
nociplastic
neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is nociceptive pain

A

non nervous tissue

MSK - including spondylogenic

viscerogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is neuropathic pain

A

nervous tissue compromise

radicular. radiculopathy, and peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is nociplastic pain

A

altered pain perception

w/o complete evidence of actual tissue compromise

21
Q

what is spondylogenic pain

A

from the spine

common

local/refferred from spinal structures

cannot cause visceral dysfunction

22
Q

explain somatic convergence

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

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

A

neuro = WNL

cant reproduce entire symptom pattern with motion

25
Q

how might spondylogenic pain present in the thoracic region

A

along the respective vertebral levels with overlap in the trunk

26
Q

what is the common presentation of spondylogenic pain in the lumbar spine

A

most often in gluteal region and proximal thigh

may go as far as the foot

inconsistent pattern between individuals

27
Q

what is viscerogenic pain

A

from an organ

due to viscerosomatic convergence

i.e. kidneys can refer into T10-L1 dermatomes

28
Q

S&S of viscerogenic pain

A

usually cant be mechanically reproduced

neuro = WNL

29
Q

what is viscerosomatic convergence

A

viscera and somatic sensory afferents converge on and share the same innervation

30
Q

what is radicular pain

A

ectopic or abnormal discharge fron highly inflammed spinal nerve (dorsal root)

31
Q

symptoms of radicular pain

A

lancing, electrical shock like pain along an extremity in a narrow band

32
Q

signs of radicular pain

A

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
Q

what is radiculopathy

A

blocked conduction of a spinal nerve due to compression and or inflammation

34
Q

symptoms of radiculopathy

A

segmental paraesthesias: constant/long duration; slow progression to vague area due to derm overlap

possible weakness (80% conduction loss required)

35
Q

signs of radiculopathy

A

neuro + for spinal n hypoactivity

imaging is helpful for involved n

36
Q

symptoms of a peripheral n issue

A

non-segmental paraesthesias

intermittent/short duration

fast progression to well defined area of numbness; minimal overlap

possible weakness

37
Q

signs of peripheral n issue

A

derms, DTRs, and myotomes WNL

non segmental peripheral n hypoactivity (decreased sensation/possible weakness)

+ dural mobility

38
Q

what is nociplastic pain

A

sensitization to pain (original term)

sensatization = underlying mechnaism

altered pain perception without complete evidence of actual or threatened tissue compromise

39
Q

pathogenesis of nociplastic pain x5

A

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
Q

functional questionaires for nociplastic pain

A

central sensitization inventory

neurophysiology of pain test (fear avoidance, catastrophizing, and understanding)

regional specific ones

41
Q

prevalence of nociplastic pain/associated conditions

A

growing prevalence

migraines
neck pain
shoulder pain
lateral elbow pain
LBP
ARJC
persistent fatigue syndrome
fibromyalgia

42
Q

S&S/criteria for “possible” nociplastic pain

A

more than 3 months of pain

regional or spreading symptoms

pain that can’t be explained

hypersensitivity to non-painful stimuli

43
Q

S&S/criteria for probable nociplastic pain

A

addition of any of the following to “possible” criteria:

sensitivity to light, sound, or odor

sleep disturbances

fatigue

cognitive problems

44
Q

S&S that indicate the autonomic nervous system x7

A

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
Q

possible JM Rx for nociplastic pain (theoretical benefits) x5

A

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
Q

MET for nociplastic pain

A

low to moderate global aerobic and resistive activities

2-3x/wk

30-90 min sessions

at least 7 wk duration

47
Q

benefits of met for nociplastic pain

A

endogenous/opiate analgesia

interpret pain and motion as non-threatening

reorganizes homunculus

48
Q

benefits of neuroscience edu/behavioral therapy for nociplastic pain

A

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
Q

prognosis for nociplastic pain

A

vary levels of improvement

longer recovery

likely not a full resolution of symptoms

MSK II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions