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Second Year Osteopathy > Clinical Skills 4 > Flashcards

Clinical Skills 4 Flashcards

1
Q

Nociceptive pain

A

most common
potentially harmful stimuli detected by nociceptors
usually acute

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2
Q

Neuropathic pain

A

injured neural structures
acute or chronic
increased risk of chronicity

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3
Q

Nociplastic pain

A

arises from altered nociception despite no actual or threatened tissue damage

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4
Q

What is acute pain?

A
  • presence and duration relate directly to tissue damage
  • predominately nociceptive
  • generally less than 3-6 months
  • normal physiological response to noxious stimulus
  • activation of tissue nociceptors
  • modified by fear, anxiety and previous experience
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5
Q

Symptoms of acute pain

A

localised pain, often sharp, proportionate to injury

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6
Q

What is chronic pain?

A
  • lasts beyond the normal healing time after injury or illness
  • predominately nociplastic
  • results from neuroplastic changes to pain pathways (peripheral & central sensitisation, descending facilitation & disinhibition)
  • influenced by social cognitive & affective factors
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7
Q

Symptoms of chronic pain

A

widespread or diffuse pain, hyperalgesia/allodynia, temperature sensitivity

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8
Q

Neuropathic pain

A
  • consequence of a lesion or disease affecting the somatosensory system
  • central or peripheral, such as radicular pain from an injured nerve
  • chronic neuropathic pain may involve central sensitisation
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9
Q

Symptoms of Neuropathic pain

A

burning, shooting, pricking pain
sensory &/motor deficits

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10
Q

What is referred somatic pain?

A
  • produced by a noxious stimulation of nerve endings within spinal structures
  • proposed mechanism of referral is convergence of nociceptive afferents on second-oder neurons in the spinal cord
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11
Q

What is radicular pain?

A
  • evoked by ectopic discharges emanating from a dorsal root or its ganglion
  • disc herniation is the most common cause
  • Inflammation of the affected nerve
  • pain is lancinating, shocking, electric in a narrow band-like distribution down the leg
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12
Q

Common lumbar spine conditions

A

Nonspecific low back pain
degenerative joint disease
intervertebral disc disease
spondylolysis & spondylolisthesis
congenital anomalies
inflammatory arthritides
visceral referral

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13
Q

Uncommon lumbar spine conditions

A

Malignancy
Infection
Pagets disease
Diffuse idiopathic skeletal hyperostosis

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14
Q

Non-specific low back pain (NSLBP)

A
  • pathoanatomical cause of pain cannot be determined
  • most cases (90%) of uncomplicated LBP
  • can be acute or chronic
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15
Q

Degenerative joint disease

A
  • synonymous with Osteoarthritis
  • chronic degenerative condition of lumbar spine that affects vertebral bodies & intervertebral discs, facet joints and contents of spinal canal
  • part of aging (>90% of those >50 y/o)
  • severity has little relationship to degree of LBP
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16
Q

Typical presentation of Degenerative joint disease

A

older age group
gradual onset/chronic condition
aching pain
spinal tenderness
stiffness
aggravated by overuse
stiffness after periods of inactivity
pain reduced by paracetamol

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17
Q

Risk factors for Degenerative joint disease

A

heavy, physical work
excess weight
previous low back injury
early onset can be familial

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18
Q

Diagnosis for Degenerative joint disease

A

History
Physical examination
X-ray

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19
Q

What is lateral canal stenosis?

A

narrowing of the intervertebral foramen

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20
Q

Causes of Lateral canal stenosis

A

DJD
disc protrusion or prolapse

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21
Q

Conditions of lateral canal stenosis

A
  • can be asymptomatic
  • usually unilateral
  • nerve root &/ spinal nerve impact (radicular pain/radiculopathy)
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22
Q

What is central canal stenosis?

A

Narrowing of the spinal canal

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23
Q

Causes of Central canal stenosis

A

DJD
Disc protrusion or prolapse
congenital
spondylolisthesis

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24
Q

Conditions of central canal stenosis

A

can be asymptomatic
may impact spinal cord/cauda equina (neurogenic claudication, cauda equina syndrome)

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25
Q

What is Neurogenic claudication?

A

pain, paraesthesia, cramping, heavy legs on walking

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26
Q

What symptoms are with cauda equina syndrome?

A

LBP, Lower limb pain/weakness, perineal parestesthesia, bowel/bladder disturbance

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27
Q

WHat are the causes of Cauda equina syndrome?

A
  • rare but serious neurological condition
  • caused by compression of the cauda equina
  • most often due to IVD prolapse
  • requires urgent medical/surgical referral
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28
Q

Symptoms of CES

A

back pain and/or unilateral/bilateral leg symptoms
reduced perineal sensation
altered bladder function
loss of anal tone
loss of sexual function

29
Q

What is an intervertebral disc disease?

A

Degenerative
prolapse & herniation
internal disc disruption

30
Q

What is degenerative disc disease?

A

similarities to DJD
normal part of aging
- discs become less hydrated and thinner with age, lose capacity for shock absoption and become susceptible to tears
often asymptomatic

31
Q

Diagnosis for Degenerative disc disease

A

MRI
but findings do not correlate well with symptoms
clinical presentation is more relevant

32
Q

Symptom presentation of Degenerative disc disease

A
  • disruption of innervated annulus causes diffuse mechanical LBP
  • bulging/prolapse can cause inflammation or compression resulting in lateral or central canal stenosis inflammation or compression
33
Q

Typical presentation for Degenerative disc disease

A
  • severe, acute LBP
    antalgic posture
    paraspinal muscle spasm/guarding
    radiating pain in a lower limb
    lower limb paraesthesia

agg: by flexion and bearing down (sneezing, toilet)
rel: rest (lying down)

34
Q

Internal disc disruption symptoms

A
  • constant deep aching pain, aggravated by any movement that stresses disc
  • cannot be diagnosed clinically
35
Q

What is Spondylolysis?

A
  • defect or stress fracture in pars interarticularis of vertebral arch
  • results from repetitive mechanical load/stress
  • typically presents in young athletic population
  • bilateral/unilateral
  • most often asymptomatic
  • if symptoms: focal LBP with buttock pain, agg by extension/rotation, hyperlordosis, relieved by rest
36
Q

What is Spondylolisthesis?

A
  • slippage of one vertebra on the next causing pain and/or radicular symptoms
  • congenital or acquired
  • often caused by spondylolysis
  • most commonly anterolisthesis
  • most frequently L5/S1
  • slippage graded 0-4
  • most grade 1-2 are stable and asymptomatic
  • if severe, can produce canal stenosis
37
Q

Presentation of Spondylolisthesis

A
  • intermittent, localised LBP
  • Agg by flexion/extension
  • pain on palpation
  • step-off sign
  • relieved lying supine
  • Hamstring tension/discomfort
  • less commonly: ssx of lateral canal stenosis
  • rarely: ssx of central canal stenosis
  • diagnosed via xray
38
Q

What are congenital anomalies?

A

Congenital anomalies comprise a wide range of abnormalities of body structure or function that are present at birth and are of prenatal origin

39
Q

What is Spina bifida occulta?

A
  • asymptomatic non-union of the posterior vertebral elements
  • may observe hairy patch, dimple in back, fatty deposits, port wine mark
40
Q

What is Facet tropism?

A

Asymmetry in the sagittal orientation of the facet joints
- may be associated with instability and degeneration

41
Q

What is a transitional vertebrae?

A

Lumbarisation - S1 is not fully fused with the sacrum

Sacralisation - L5 takes on characteristics of and is fully or partially fused with sacrum

42
Q

Where is Inflammatory arthritides more commonly present?

A

extremities

43
Q

What is Ankylosing spondylitis?

A

Inflammation of joints
inflammatory changes cause pain, stiffness and loss of ROM
2:1 male:female
symptom onset 20-40 y/o
can cause progressive fusion of spinal joints
can be associated with uveitis, inflammatory bowel disease, weight loss

44
Q

Typical presentation of Ankylosing spondylitis

A
  • low back/buttock/SI pain is often the first symptom
  • insidious onset
  • spinal stiffness
  • morning stiffness
  • chronic in nature
  • relieved by activity
  • aggravated by rest
45
Q

Diagnosis of Ankylosing spondylitis

A

Clinical presentation, Blood tests, Xray

46
Q

What is visceral referral pain?

A
  • conditions of the visceral organs can present as low back pain
  • visceral conditions can cause LBP via inflammation, distension, ischaemia or neurological referral

Abdominal aortic aneurysm - rare but serious cause of LBP

47
Q

Which organs commonly refer pain to the low back?

A

reproductive organs, bladder, ureter, large & small bowel, appendix, kidney

48
Q

What is Osteomyelitis?

A

bone infection
insidious onset pain and stiffness
fever, chills, loss of appetite, night sweats
risk factors: previous infection, immunocompromise, pelvic surgery

49
Q

What is Malignancy?

A

> 50 y/o
history of malignancy
diffuse back pain, worse at night, unrelieved by rest or treatment
fatigue, weight loss
most commonly secondary metastasis

50
Q

What is Paget’s disease?

A

metabolic disease causing abnormal bone formation
affecting 2-4% of adults over 55 years of age
often asymptomatic
presents as constant, deep, aching, bone pain, worse at night
agg by rest and relieved by activity
often an incidental finding

51
Q

What is diffuse idiopathic skeletal hyperostosis?

A

calcification of soft tissue attaching to spine
often asymptomatic and discovered incidentally
more common in males and older adults >60
pain and progressive stiffness
impacts of hyperostosis on other organs

52
Q

What is a red flag?

A

signs and symptoms which indicate the possibility of serious pathology requiring urgent investigation

53
Q

Red flags for the investigation of acute low back pain

A
  • age of onset <20 or >55
  • recent history of violent trauma
  • constant progressive, non mechanical pain
  • thoracic pain
  • past medical history of malignant tumour
  • prolonged use of corticosteroids
  • drug abuse, immunosuppresion, HIV
  • systemically unwell
  • unexplained weight loss
  • widespread neurological symptoms
  • structural deformity
  • fever
54
Q

What are the red flags that must be screened for?

A

night pain, pain at rest
radiating pain, paraesthesia, weakness
alterations to bowel & bladder function

55
Q

Which ligaments are palpable in the posterior hip/lower back region?

A

Supraspinous ligament
Interspinous ligament
Ilio-lumbar ligament
sacroiliac ligament
sacrococcygeal ligament

56
Q

AROM of Lower back

A

Flexion - 55-70º
extension - 35-45º
LSB/RSB - 20-30º
Rotation L/R - 5-10º

57
Q

Diagnostic palpation with low back pain

A

bony - Lumbar SP’s & TP’s
Ligaments - Supraspinous, interspinous & iliolumbar ligament
muscles - erector spinae & multifidus, QL, Lats

58
Q

Diagnostic palpation with sacral pain

A

bony - PSIS, SIJ, sacral SP’s
Ligaments - posterior SI, long dorsal SI
Muscles - Gluteus medius, piriformis

59
Q

Joint play - Lumbar spine

A

PA springing

60
Q

Joint play - Pelvis & Sacrum

A

ASIS springing
Nutation
Counternutation

61
Q

Which neurodynamic tests are used for the lumbar spine and lower limb?

A

Straight Leg raise
Slump test
Prone Knee bend

62
Q

What is the Slump test testing for?

A

mechanosensitivity of lumbosacral nerves and/or neural connective tissues

63
Q

Orthopaedic tests for SIJ

A

Thigh thrust test
SIJ distraction test
SIJ compression test
Sacral thrust test
Active SLR

64
Q

Articulation - Sidelying

A

flexion, extension, sidebending, rotation

65
Q

Articulation - prone

A

extension, side bending, rotation, PA lumbar springing, sacral nutation and counternutation

66
Q

Lower Limb reflexes

A

Knee - L3/4
Ankle - S1
Babinski response
Clonus

67
Q

Motor strength testing lower limb

A

L 1/2 - hipflexion
L3/4 - knee extension
L4/5 - knee flexion/ankle dorsiflexion
L5 - big toe extension
S1/2 - ankle plantar flexion

68
Q
A

Second Year Osteopathy (9 decks)

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