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MSK II > Class 5/6: Persistent IDD-Hypermobility > Flashcards

Class 5/6: Persistent IDD-Hypermobility Flashcards

1
Q

etiology of persistent IDD

A

acute IDD

age = mixed findings

lower strength

sedentary life

heavier lifting

smoking

genetics (lumbar IDD associated with ARDC)

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2
Q

how much of persistent IDD can be inherited

A

65-85% but can be modified by diet and lifestyle

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3
Q

what are things that are NOT a cause of persistent IDD that some may think are

A

routine load/PA
prolonged driving

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4
Q

pathogenesis of persistent IDD

A

in growth of nociceptive fibers from acute IDD

excessive/destructive proteins cause low grade infection

less gags = dehydrated nucleus

annular disorganization

thinning of cartilage/end plates

fatty deposits in vertebrae

THEN persistent herniations develop once disc changes occur

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5
Q

what is protrusion

A

nucleus migrates but remains in annulus

most common

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6
Q

what is extrusion

A

nucleus migrates thru outer annulus

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7
Q

what is free sequestrian

A

nucleus migrates and breaks away from annulus

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8
Q

where do schmorls nodes develop

A

where the nucleus migrates into the vertebral body

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9
Q

why is a herniated disc not white on an MRI

A

because it lacks the same water content as a normal disc

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10
Q

how does narrowing play a role in the case of persistent IDD

A

changes in disc height/integrity lead to instability and hypermobility (sagittal and frontal plane only)

then the space in the joint narrows which leads to instability and greater loads on the facets

stenosis can develop from there

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11
Q

what are later changes that can occur with persistent IDD after the initial narrowing

A

greater ARJC

less of the prior instability due to stiffening of the joint

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12
Q

symptoms presentation for persistent IDD

A

slow change allows tissues to adapt without symptoms for some time

i.e. 2/3 of people who have disc issues on imaging have no symptoms q

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13
Q

PT Rx for persistent IDD

A

acute IDD Rx if inflamed

Mckenzie exercises less effective compared to acute IDD

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14
Q

effect of mckenzie exercises with persistent IDD

A

NOt better than stabilization

NOT better than manual therapy + non-stabilization exercises

short term benefit

no difference in pain/function vs no intervention at all

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15
Q

important thing to consider for PT in relation to Rx for persistent IDD

A

need to consider the primary driver of symptoms from the development of other conditions even if the imaging shows disc changes

i.e., ARJC, stenosis, instability, etc

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16
Q

prognosis for acute AND persistent IDD

A

like ligament/cartilage healing with longer timelines due to prolonged inflammatory phase

90% see improvements by 6 weeks

most dont need surgery

slower healing but the same overall outcomes without surgery after 2 years

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17
Q

Worse outcomes are present for IDD when symptoms are present for more than how long prior to treatment

A

more than 6 months prior to any treatment including sx

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18
Q

meds that may be used for IDD

A

NSAIDS, muscle relaxants and acetaminophen

conflicting benefits

possibly Rx for steroid pack for large inflammatory response

epidural = short term relief

antibiotic for benefits related to infection

19
Q

effectiveness of sx for IDD

A

waiting an average of 4.5 months on sx did not minimize benefits of sx

some studies how earlier and improved benefit of sx vs PT with severe acute IDD

20
Q

what are the indications for a spinal decompression sx such as a laminectomy or a partial discectomy

A

persistent/worsening radiculopathy

use when symptoms are unresponsive to non-surgical treatments

21
Q

effectiveness of lumbar fusion for IDD

A

no difference vs PT long term

not additive to a laminectomy or discectomy

can cause adj joint hypermobility/instability

22
Q

total disc replacement (TDR) effectiveness for IDD

A

better at load distribution across segments

safe/effective treatment more than 5 years post op

at 2 year follow up no differences compared to PT alone without radiculopathy for in return to work, life satisfaction, fear avoidance behavior, drug use, and back performance

23
Q

4 variables of stabilization

A

joint integrity
passive stiffness
neural input
muscle function

24
Q

what are the 2 types of instability

A

functional = CAN be stabilized with m activity/positioning

mechanical = CANNOT be completely stabilized with m activity/position

25
Q

etiology of instability

A

traumatic/recurrent sprain
ARDC
repetitive ext activities
creep
connective tissue disorder

26
Q

which segment is hypermobility most common

A

L4-S1

lower lumbar

27
Q

what can you get points for when testing for benign joint hypermobility syndrome

A

palms touch floor
each knee that hyperextends
each elbow that hyperextends
each thumb that touches forearm
each little finger that has 90 degree MCP hyperext

28
Q

minor criteria for hypermobility

A

> 4/9 beighton scale

arthralgia > 3 months > 4 jts

29
Q

what are the minor criteria for instability

A

beighton scale <3/9

arthralgia > 3 months in 1-3

soft tissue injury in > 3 locations

tall slim body

abnormal skin

varicose veins

30
Q

what are the requirements to be diagnosed with benign joint hypermobility syndrome

A

2 major criteria

1 major and 2 minor

4 minor

31
Q

symptoms of functional instability

A

predictable pain

spine and referred pain

possible paresthesias

decreased pain with posiiton/support

increased pain with prolonged position, repetitive bending, sudden motions, and strenuous ADLs

catching

self manipulation

32
Q

ROM signs for functional instability

A

acute = aberrant

P! with ext due to anterior shear

Flx = Gowers sign = use hands to get up

PROM > AROM

not acute = often WNL except ext crease

greater flexibility

inconsistent block

33
Q

signs that indicate aberrant AROM

A

painful arc

uncoordinated

Gower’s sign

LE/pelvis compensation

positive if one or more are present

34
Q

resisted/MMT for functional instability

A

if acute = painful

most often strong and painless bc global muscles arent affected

35
Q

neuro for functional instability

A
  • except possible hyperparesthesia with pinwheel
36
Q

stress tests for functional instability

A

+ PA stress tests

mixed findings with distraction; depends on severity

37
Q

acessory motion for functional instability

A

possibly hypomobility if hypermobility is stuck like a drawer

possible adj hypomobility (T10-12 RT, SI jt motion, and hip ext common)

38
Q

special tests that may be positive with functional instability

A

possible + prone LE ext test

likely + linear stability

possible + active SLR

inhibited local muscles

39
Q

describe what you may find in relation to linear stability tests with functional instability

A

most often anterior shear

LBP can lead to excessively recruited psoas (maintains lordosis when standing; excessive recruitment can cause hyper ext and anterior shearing with L/S hypermobility)

40
Q

what is ASLR and how is it scored

A

active SLR

score 1 pt for each:
-tremor
-pain
-ips pelvic RT to raised LE
-slow motion
-unable to raise LE

41
Q

symptoms of mechanical instability

A

same as functional but worse AND

pain is unpredictable

worse/more frequent symptoms

increased pain with lesser ADLs

+ stability tests dont fully stabilize

42
Q

what might radiographs show for instability

A

stress radiographs = compare vertebreal position in various positions for mechanical instability

may also be a spindylolisthesis

functional instability can exist without radiological evidence

43
Q

MD Rx for shearing/slipping with mechanical instability

A

prolotherapy for stabilization into iliolumbar ligaments + PT

spinal fusion if:
-mechanical instability
-similar long term results to multi discipline PT
-higher cost/greater risk

44
Q

PT Rx for instability

A

like ligament laxity
POLICED
postural edu to activate local muscles/chair support
JM to increase adj hypomobility
bracing/taping

MET emphasizing stabilization of local muscles, hip exercises, and contraindicated hyperext

MSK II (18 decks)

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