Common MSK Conditions Of The Spine Flashcards
Describe the bio psycho social model
- evidence based
- patient centered
- psychological factors = yellow flags (predictor of poor outcomes, correlation of symptoms persistance)
- social factors (influence outcome, influence disability)
Briefly describe the ICF model
Health conditions are influenced by body functions and structure, activity and participation, all of these being influenced by the environment factors and personal factors
What is the difference between recent and persistent stages ?
Recent : <3 months
Persistent: >3 months
What are the different outcome durations ?
- immediate : closest to immediately following intervention
-short term : 1-3 months - intermediate terme : shortest to 6 months
- long term : closest to 12 months
What are the 3 pain mechanisms ?
- nociceptive
- neuroplastic
- neuropathic
Define the nociceptive pain mechanism
Pain that arises from actual or threatened damage to non neural tissues and is due to the activation of nociceptors. Pain is associated with acute actual tissue damage and inflammatory conditions.
Define the neuropathic pain mechanism
Pain caused by a lesion or a disease of the somatosensory nervous system
Define the neuroplastic pain mechanism
Central sensitization
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.
Define neck pain
Pain in the location Outlined by the superior nuchal line, the spines of the scapulas, the superior border of the clavicles and the suprasternal notch. This pain is with out without radiation to the head trunk and upper limb.
List the risk factors for neck pain
- gender : female
- prior history of neck pain
- old age
- high job demand
- smoking
- low social/work support
- prior history of MSK condition in the spine
What are the patho anatomical characteristics of neck pain and their relation to imaging
- specific features or pain generator are rarely identifiable by imaging
- imaging is important to exclude red flags
- imaging allows to recognize specific conditions
- if radiating pain with serious neurological signs is present : RMI
In neck pain, Which factors can affect the prognosis ?
- high pain intensity : on scale from 0 to 10 (if superior or equal to 6)
- high self-reported disability : use neck disability index (higher Thant 30%)
- high pain catastrophizing : use pain catastrophizing scale (score of 20 or greater)
- high acute posttraumatic stress symptoms : use impact of event scale revised (score of 33 or greater)
- cold hyperalgesia : use the TSA-II neuro sensory analyzer
In neck pain, which variables can affect the prognosis ?
- lower social support
- preference for passive coping strategies
In neck pain, how to measure the outcome ?
- neck disability index
- patient specific functional scale
In neck pain, how to measure the physical impairement ?
- active ROM
- passive ROM
- cervical flexion rotation test
- spurring test
- neck distraction test
- neurodynamics
- cranial cervical flexion and neck flexors endurance test
- pressure pain threshold
What are the grade of neck pain
Grade 4: signs of major structural pathology
Grade 3: no signs of major structural pathology but presence of neurological signs
Grade 2: no signs of major structural pathology but major interference with activities of the daily living
Grade 1: no signs of major structural pathology and no/minor interference with daily living
How to conduct a proper clinical evaluation of patient with neck pain ?
1) exclude serious neck problems => or refer to a physician
2) recognize specific neck problems => specific pathway
3) if the neck pain is non specific => prognosis profile by evaluating the impairments (ICF)
4) recommend treatments
What is the classification of neck pain without signs of serious medical/psychological condition ?
ICF impairement based category :
-NP with mobility deficit
-NP with headache
-NP with movement coordination impairements (whiplash)
-NP with radiating pain (radiculopathy)
Define special tests
Special tests are used during a physical examination by clinicians in physical therapy and orthopedics. The tests can be used to rule in or rule out whether a patient has a certain musculoskeletal problem. They are helpful in diagnosing orthopedic conditions and injuries. These physical examinations may be useful to classify a patient in the ICF impairement-based category.
What are the risks factors of cervical spine anatomical instability ?
TRAUMATIC EVENT
- fall
- trauma
- MVA
NON TRAUMATIC EVENT
- rheumatoid arthritis
- Down syndrome
- ankylosing spondylitis
- prolonged oral contraceptive
- prolonged corticosteroid use
What are the risk factors of spinal fracture
Usually caused by trauma or injury
- age
- prolonged use of corticosteroids
- trauma : compressive axial force, fall > 3m, motor vehicle collision > 100km/h
- osteoporosis
How to test cervical spine instability ?
Clinical tests lack validity
They will consist in provocating ligamentous structures to reproduce symptoms :
- tectorial membrane
- transverse ligament
- alar ligament
What are the self reported symptoms in cervical spine instability ?
- recent onset of headaches described as unusual
- impaired ROM with sharp sharp pain at permitted end range or sudden movement
- transient neurological symptoms = upper motor neuron signs; cranial nerve palsy; partial Horner’s syndrome
What are the risk factors for cervical artherial pathology ?
Rare (vascular dissection)
-Mild to moderate recent trauma
-vascular anomaly
- current or past smoker
- migraine
- high cholesterol
- recent infection
- hypertension
- oral contraception
- family history of stroke
What are the signs of cervical artherial pathology ?
PREISCHEMIC SYMPTOMS (may be present for weeks)
- Ipsilateral posterior neck pain
- occipital headache
ISCHEMIC SYMPTOMS (depending and the brain area and tissue damages)
- unsteadiness
- ataxia
- imbalance
- weakness UL/LL
- dysphasia
- dysarthria
- aphasia
- facial palsy
- ptosis
- nausea/vomiting
- dysphagia
- drowsiness
- confusion
- loss of consciousness
Define myelopathy
Space occupying lesion within the cervical spine with the potential to compress the spinal cord (CNS involved).
What is the subjective examination of myelopathy ?
Symptoms may appear in the LL first with gait related changes :
- upper motor neuron changes
- dysfunctional cortico spinal and spinocerebellar tracts
Later on, lower motor neuron findings in UL:
- loss of strength
- atrophy
- fine finger movements difficulties
What are the special tests for myelopathy ?
- Peripheral neurological examination
- dermatoses
- myotomes
- deep tendon reflexes - Upper motor neuron
- Lhermitte sign
- Hoffman’s test
- Babinski’s sign
- clonus
- Romberg
What is the subjective examination of cervical radiculopathy ?
Presence of neck pain with radiating pain
Signs of nerve root involvement may be present
Neck pain with radiating pain in the involved extremity (lancinating, burning, electric pain or paresthesia)
What are the specific tests for cervical radiculopathy ?
- wainner’s cluster
ULNT1
Painful ipsilateral cervical rotation < 60°
Distraction test
Spurling test - peripheral neurological examination
Dermatomes
Myotomes
Deep tendon reflexes
What is the subjective examination of neck pain with mobility deficit?
- central and/or unilateral pain
- limitation in ROM (with reproduction of symptoms at end range of passive and active motions)
- associated/referred shoulder girdle pain
What are the special tests for neck pain with mobility deficit ?
-limited/painful end range in active/passive ROM
-spring test
-trigger points
How to manage recent neck pain with mobility deficit ?
-education (stay active)+home training
- manual therapy (cervical + thoracic)
- stretching
- ROM
- general fitness training
How to manage subacute neck pain with mobility deficit ?
- manual therapy
- cervicoscapulothoracic endurance exercise
How to manage persistent neck pain with mobility deficit ?
Education
Manual therapy
Cervicoscapulothoracic neuromuscular exercises
Dry needling
…etc
Define whiplash
Categorized as neck pain with movement coordination impairement.
Bony or soft tissue injury resulting from rear-end or side impact, predominantly in motor vehicles accident, and from other mishaps as a result of an acceleration-deceleration mechanism of energy transfer to the neck. Up to 50% of patients will report an ongoing pain after 12 months.
