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MSK II > Class 6/7: ARJC-Stenosis > Flashcards

Class 6/7: ARJC-Stenosis Flashcards

1
Q

prevalence of stenosis

A

most common dx for adults >60/65

if younger due to spondylolisthess=is

30% asymptomatic individuals had canal narrowing

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2
Q

2 methods of compression with stenosis

A

outside in
-unilateral more than bilateral
-due to ARJC/ARDC, instability, or enfolding of ligamentum flavum

inside out
-sheath around n = fibrotic
-increased blood supply causes enlarged n
-fibrotic wont expand

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3
Q

structures involved with stenosis

A

ischemic compression

venous congestion

no lymphatic vv in PNS/CNS

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4
Q

symptoms of lateral stenosis

A

unilateral LE > LBP

segmental paresthesias + gripping pain b/c of ischemia

pain decreased with FB, sitting, in morning (pain moves from LE to LBP)

pain increased in LE with standing/walking

greater symptoms with decline walking

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5
Q

observation for stenosis pt

A

slouched

possible scoliosis

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6
Q

ROM finding for stenosis pt

A

flx/cont. SB decrease pain (but may not be able to open foramen completely so possible limited ROM)

Ext/ips SB increase pain (possible limited ROM due to contact with n)

Rot = inconsistent

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7
Q

neuro and stress test findings for stenosis

A

+ neuro for radiculopathy

possibly + PA/torsion when SUSTAINED

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8
Q

Accessory motion findings for lateral stenosis

A

hypomobility in adj joints (lower thoraci and LE, especially hip)

hypomobily in flexion and contralateral SB

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9
Q

special test results for lateral stenosis

A

possible + stability tests for excessive shear

LE discrepancies

balance deficits with wide based gait

cooks CPR

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10
Q

factors for cooks CPR

A

bilateral symptoms

LE P! > LBP

P! with walking/standing

P! relief with sitting

> 48 yrs old

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11
Q

how to differentiate between neural and vascular causes

A

Ankle Brachial Test for peripheral artery disease
-ratio of tibial and brachial aa
-Normal = 0.9-3.1
-0.41-0.9 = mild
-less that 4 = severe

bicycle test
-upright cylce then bend to lean on handlebars for 3 min each
-if stenosis = pain decreases with bent position
-if not better = PAD

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12
Q

central stenosis S&S

A

cord or cauda equina syndrome

no change with SB/RT

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13
Q

PT Rx for stenosis (foraminal opening)

A

pt edu of foramen/good prognosis

flx directional preference

possibly helpful intermittent tx

neural mobs

manual therapy

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14
Q

what specific manual therapies are best for stenosis

A

manipulation most effective for sub group of stenosis with LBP
-lower thoracic
-lumbar manipulation most effective when combined with ex
-early evidence fo support for additional hip jt mobilizaiton

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15
Q

MET for stenosis

A

aerobic
-unweighted walking
-cycling as effective as unweighted walking
-primary influence = circulation improvements

balance training ONLY if able to be upright w/o symptoms

local muscle stabilization

corsets

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16
Q

sx indications for stenosis

A

presence of constant/worsening symptoms

failure to obtain relief with 3-6 months of non-surgical treatments

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17
Q

sx effectiveness for stenosis

A

inconclusive best sx with spinal decompression of laminextomy and/or partial discectomy w/ or w/o fusion

benefit with pain/disability

walking distance NOT better

if just stenosis = outcome can be just as good as PT

if stenosis + spondylolisthesis = substantially greater pain relief and improvement in fx vs PT at 4 yrs

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18
Q

what is spondylolysis

A

bony defect or fx of pars interarticularis unilaterally and bilaterally

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19
Q

etiology of spondylolysis

A

congenital

repetitive stress (especially ext/RT)

direct trauma

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20
Q

prevalence of spondylolysis

A

6-12%

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21
Q

most common level for spondylolysis

A

L5/S1

22
Q

S&S of spondylolysis

A

acute = fx S&S plus + B torsion test

persistent = asymptomatic often; like instability if symptoms are present

23
Q

what is spondylolisthesis

A

anterior vertebral segment slippage

24
Q

2 most common types of spondylolisthesis

A

isthmic or adolescent with spondylolysis
-most common
-age group with most rapid slippage
-due to repetitive trauma or ext

degenerative
-b/c of ARDC
-50+ years old
-No fx

25
Q

what are the degrees of slippage with spondylolisthesis

A

Grade I = 0-25%
Grade II = 26-50%
Grade III = 51-75%
Grade IV = 76-100%

26
Q

S&S of spondylolisthesis

A

worse case of instability

possible lateral or central stenosis S&S with slippage

no correlation with slippage and degree of symptoms

27
Q

PT Rx and prognosis for spondylolysis and spondylolisthesis

A

like worse version of instability

MET = local muscles (better results than traditional therex alone

84% children/YA improved after 1 year with up to 25% slippage

better results with unilateral lesion/early intervention

28
Q

Sx indications/outcomes for spondylolisthesis

A

sx indicated if confirmed imaging w/o conservative benefits

sx outcomes = 83% excellent to good outcome with modified scott technique vs others (i.e. fusion)

29
Q

structures involved with facet joint impingement

A

meniscoid
-synovial fat/fibrous tissue
-compensate for in-congruency of articular surface
-facilitate spread of synovial fluid

facet joint

30
Q

pathomechanics of facet impingement

A

meniscoid becomes wedged due to a prolonged position/quick movement

associated with instability

31
Q

prevalance of ARJC

A

l4-S1 most common

progresses with ARDC

32
Q

what is spondylosis

A

ARJC at multiple levels

33
Q

what is spondylolysis

A

fracture

34
Q

what is spondylolisthesis

A

anterior slippage (could be due to fx or other causes)

35
Q

etiology of degenerative vs acute ARJC

A

degenerative = more common, older, chondrocytes cant keep up

acute = rare, younger, activem high shear forces

36
Q

etiology of ARJC (specific causes)

A

prior trauma
age
genetics
other diseases (i.e. RA)
sedentary life

37
Q

components of synovial joints and how they contribute to ARJC

A

articular cartilage = frays/blisters/tears and narrows joint space

subchondral bone overloaded/injured

osteophyte/spur formation b/c of stress

fibrous capsule slackens/thickens/stiffens

synovial membrane produces less fluid

periarticular tissue inflammation

38
Q

what causes the persistent pain and inflammation with ARJC

A

stress on tissues like bone

increased nociceptive response

local production of nitrous oxide = more interstitual inflammaiton and excess collagen

blood released from bone marrow

39
Q

lumbar symptoms for ARJC

A

gradual onset LBP

pain with prolonged positions (especially standing b/c synovial fluid is squeezed out w/o refill)

morning stiffness or after prolonged position that lasts more than 30 min

pain/limit with standing , walking, or lying on stomach

some movement helps, some makes worse

40
Q

observation for ARJC

A

forward bent in standing/walking

41
Q

ROM ARJC

A

painful/limited

pain with ext, ips SB, and cont RT

one sided more common

capsular pattern

42
Q

combined motion ARJC

A

consistent block often into ext quadrant

OR

opposing quadrants blocked

43
Q

resisted/MMT for ARJC

A

depends on acuity

44
Q

stress test findings with ARJC

A

pain with compression (especially in ext, ips SB, cont RT)

PA/torsion glides painful

distract can relieve if acute

45
Q

acessory motion and neuro for ARJC

A

hypomobility

possibly + neuro if stenosis

46
Q

which stages of ARJC have capsular pattern

A

early (if past trauma)

intermediate

NOT late stage b/c bony end feel due to osteophytes

47
Q

which stages of ARJC have hypermobility

A

just early stage due to narrowing if there is no past trauma

48
Q

Rx for each stage of ARJC

A

early = POLICED, JM for CPP, MET

intermediate = JM for CPP, MET for involved jt and adj jt

late = JM and MET with focus on adj jt

49
Q

PT Rx for ARJC

A

focus on improving integrity of cartilage and mobility

POLICED

wt management and avodi provocation

assistive device to unload cartilage

JM for pain, cartilage integrity, and mobility

50
Q

MET for ARJC

A

ultimate focus on improving motion, cartilage integrity, and neuromusclular benefits

no evidence for supplements

MSK II (18 decks)

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