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DPT 730/1: MSK > E2-Joint Mobs/Manips, Neck P! - WAD > Flashcards

E2-Joint Mobs/Manips, Neck P! - WAD Flashcards

1
Q

What is a direct and parallel joint mobilization

A

Parallel to joint surface- indirection of glides
At or toward point of limitation with more chronic and painless limitations

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2
Q

What is an indirect mobilization

A

Away from point of limitation in a parallel direction or possibly a perpendicular direction (aka distraction) from the joint surface

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3
Q

What is an indication for an indirect mobilization

A

Acute/painful limitation like an intra articular inclusion like a loose body
Fixated hypermobility/instability- small drawer big hole

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4
Q

What is the tissue integrity/Rx for P! Constant or with all accessory motions

A

Acute and POLICED

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5
Q

What is the tissue integrity/Rx for some painless accessory motion/before point of limitation

A

Acute/ Grade1/2 JM in neutral

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6
Q

What is the tissue integrity/Rx with pain at same time as point of limitation

A

Subacute/ Grade 2/3 JM moving out of neutral

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7
Q

What is the tissue integrity/Rx with pain after point of limitation

A

Subacute to chronic/ Grade 3/4 JM

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8
Q

What is the tissue integrity/Rx with painless to point of limitation

A

Chronic/ Grade 3/4 holds and grade 5 JM

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9
Q

What are the outcomes for JM

A

Pain levels
Reassess glide
Measure ROM
Functional tests

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10
Q

How many sessions should JM be performed

A

2-4 sessions of MT if pt pain adaptive
Window of opportunity for exercises

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11
Q

Contraindication or Precaution and what’s the rationale:
Constant, severe, pain, includes headache, not influenced by motion

A

Contraindication
Not appropriate for PT

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12
Q

Contraindication or Precaution and what’s the rationale:
Severe inflammation and bleeding condition

A

Contraindication
More bleeding

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13
Q

Contraindication or Precaution and what’s the rationale:
Osteopenia or menopausal women

A

Precaution
Damage tissue

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14
Q

Contraindication or Precaution and what’s the rationale:
Advanced diabetes

A

Contraindication
Damage tissue due to lack of sensation and compromise

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15
Q

Contraindication or Precaution and what’s the rationale:
Cancer hx

A

Precaution
Damage tissue if metastasis there

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16
Q

Contraindication or Precaution and what’s the rationale:
Joint hypermobility

A

Precaution
Increased hypermobility of fixated joint that is hypermobile to begin with

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17
Q

Contraindication or Precaution and what’s the rationale:
Capsular fibrosis or bony fusion that prevent any distraction

A

Contraindication
Damage tissue

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18
Q

Contraindication or Precaution and what’s the rationale:
Recent fracture, dislocation, rupture

A

Contraindication
Damage tissue

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19
Q

Contraindication or Precaution and what’s the rationale:
Local or systemic infection or tumor

A

Contraindication
Spread or damage tissue

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20
Q

Contraindication or Precaution and what’s the rationale:
Corticosteroid or anticoagulant therapy off for > 3 months

A

Contraindication
Damage weakened tissue

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21
Q

What are the adverse events of Grade 5 JM

A

Often mild/transient soreness like exercise
Less than medications

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22
Q

What are the serious events of Grade 5 JM

A

Fractures
Neurological/vascular compromise
Disc herniation

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23
Q

What should we do before manipulation

A
  1. Compression test of each spinal segment
  2. Slump test
  3. Compress hand along chest for recoil
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24
Q

If RT is limited even with FLX to the same side, what is indicated, why, and Rx

A

Ipsilateral OA jt
Occiput is put posterior and then more posterior
Glide C1 anterior and upward while stabilizing Occiput

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25
Q

If RT is limited even in EXT to the same side, what is indicated, why, and RX

A

Contralateral OA jt
Occiput is put anterior of the opposite side and then more anterior
Scoop the bowl of contralateral side

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26
Q

If RT is limited even in FLX and EXT, what is indicated, why, and RX

A

AA jt
RT is no worse
Ipsilateral- Stand opposite of affected side, SB ipsilateral side, stabilize Occiput/C1 and push C2 up the slide
Contralateral- stand opposite of affected side, SB contralateral side to stabilize Occiput, then glide C1 inferiorly and anteriorly with C2 stabilized

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27
Q

If SB is limited and worse in FLX, what is indicated, why, and Rx

A

Cervical contralateral Z jt.
SAL is put anterior and then more anterior
JM Z jt superiorly

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28
Q

If SB is limited and worse in EXT, what is indicated, why, and Rx

A

Cervical ipsilateral Z jt
IMP is put posteriorly and then more posterior
JM of Z jt more inferiorly

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29
Q

If SB is limited and remains restricted in FLX and EXT, what is indicated, why, Rx

A

Indicates U jt
Both FLX and EXT are restricted meaning not Z jt
Posterior and anterior JM on affected side U jt

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30
Q

If pt demonstrates during their scan neck RT but at the end SBs, what is restricted and what test is indicated

A

Upper thoracic region
Manubrial Test

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31
Q

What is general Rx for hypomobility

A

Mobilize area for motion

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32
Q

If the upper thoracic is hypomobile, what can it lead to

A

Hypermobile lower cervical region

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33
Q

Why address adjacent jts

A

The hypermobile region can make other jts hypermobile to compensate for the absence of movement

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34
Q

Why is hypermobility painful

A

The axis of motion is less controlled

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35
Q

What is the general Rx for hypermobile jts

A

Stabilize the jts by working the smaller deeper muscles closer to the joint

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36
Q

What facet jts favor all motions in the frontal and transverse planes and why

A

C2-7
The 45 degree angle allows the jts to move equally

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37
Q

What do the facet jts in the upper thoracic favor and why

A

Mostly frontal plane- SB
the facets are more vertical allowing for easy SB but the ribs limit that motion

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38
Q

What are the variables for stabilization

A

Jt integrity
Passive stiffness
Neural input
Muscle function

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39
Q

What is controlled mobility

A

More of the deeper smaller muscles controlling the mobility of the jt

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40
Q

Once a passive, non contractile tissue has healed, how do we make the jt more stable

A

By improving muscle function and creating more control of the smaller/deeper muscles

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41
Q

What are the characteristics of local muscles

A

Closer to axis
Often deeper
Stabilization
Tonic, postural
Aerobic

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42
Q

What are the characteristics for global muscles

A

Farther from axis
Superficial
Rotatory
Spurt muscles
Anaerobic

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43
Q

What muscles have a higher rate of injury

A

Rotators and multifidus

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44
Q

What muscles increase contraction of multifidus

A

Pelvic floor and transverse abdominus

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45
Q

What does pain, swelling, jt. Laxity, and disuse cause for local muscles

A

Decreased and delayed motor activation
Inhibition of type 1
Load supply is lowered leading to easily overworked muscles
Muscle atrophy
Increase stress on non contractile tissue

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46
Q

Why does pain, swelling, inflammation, and disuse cause increase stress on non contractile tissues

A

the force of the global muscles can end up damaging structures around the jt. because stabilization isn’t there to manage the force. therefore putting stress on noncontractile tissues

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47
Q

what does pain, laxity, inflammation, swelling, and disuse do to global muscles

A

increased and insufficient motor activity- overcompensate
decrease cervical proprioception
atrophy/fatty infiltration
fiber transformation

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48
Q

why is fiber transformation important when a jt has pain, swelling, laxity or disuse

A

the muscles loses their purpose
endurance is lost therefore integrity

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49
Q

what percentage of muscle activation is needed for sufficient stability and to improve endurance

A

30%

the patient doesnt need to go to the gym, they just need to do 30% of their muscle contraction to improve muscle function

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50
Q

what is nociceptive pain

A

non nervous tissue compromise
spondylogenic
viscerogenic

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51
Q

what is neuropathic pain

A

nervous tissue compromise
radicular
radiculopathy
peripheral

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52
Q

what is nociplastic pain

A

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

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53
Q

what is the source of spondylogenic pain

A

local and or referred spinal pain

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54
Q

what are the S&S of spondylogenic pain

A

non segmental pain
vague, deep, achy, boring pain
referred pain- not specific
neuro scans normal
can’t reproduce pattern with motion

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55
Q

what is referred pain

A

somatic convergence
sensory afferents converge on and share same innervation

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56
Q

what is viscerogenic pain

A

referred pain from organ
viscerosomatic convergence

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57
Q

what is viscerogenic pain S&S

A

cannot produce mechanically
neuro scan normal

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58
Q

what is radicular pain

A

ectopic or abnormal discharge from highly inflammed spinal nerve

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59
Q

what are the S&S of radicular pain

A

electrical shock pain
derm/myotomes, DTRs=normal
dural mobility= ++++
imaging helpful

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60
Q

what is radiculopathy pain

A

more persistent blocked conduction of spinal n due to compression and inflammation

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61
Q

what are the S&S of radiculopathy pain

A

segmental paresthesia- constant/long duration, slow progression
possible weakness
neuro scan ++++
imaging helpful

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62
Q

what is peripheral pain

A

decreased conduction of n branch

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63
Q

what are the S&S of peripheral pain

A

non segmental paresthesia- short/intermittent, fast progression of numbness
possible weakness
derm/myotomes, DTRs,= normal
dural momility= ++++

64
Q

Name the pain:
referred pain
sensory, DTR, dural= normal
can’t reproduce pain with motion

what is the source/description

A

viscerogenic
referred pain from organ

65
Q

name the pain:
Sensory, DTR= normal
can’t reproduce pain with motion
dural mobility= ++++
quick pain

what is the source/description

A

radicular
highly inflammed spinal n

66
Q

name the pain:
Sensory, DTR, dural= ++++
possible weakness
slow progression

what is the source/description

A

radiculopathy
spinal n, blocked conduction

67
Q

name the pain:
Sensory, DTR, dural= normal
can’t reproduce entire pain with motion

what is the source/ description

A

spondylogenic
local/referred spinal pain

68
Q

name the pain:
Sensory, DTR= normal
dural= +++
possible weakness
short, intermittent pain

what is the source/description

A

peripheral
peripheral n, decreased conduction in extremity

69
Q

During a Manubrial test, Pt demonstrates:
L RT with R SB
R RT with R SB
FLX minimal to no movement
EXT with R SB

What is indicated and what do we do next

A

Unilateral restriction- L Z jt unable to extend
Seated or side lying assess each segment

70
Q

During a Manubrial test, Pt demonstrates:
L RT with R SB
R RT with R SB
FLX with R SB
EXT minimal to no movement

What is indicated and what do we do next

A

Unilateral restriction- R Z jt. Unable to flex
Sitting or side lying check each segment

71
Q

During a Manubrial test, Pt demonstrates:
L RT minimal to no movement
R RT minimal to no movement
FLX minimal to no movement
EXT minimal to no movement

What is indicated and what do we do next

A

Bilateral Z restriction
Sitting or side lying checking each segment

72
Q

What is a normal Manubrial test

A

Which ever way the neck rotates the ribs SB that way like a seesaw, in FLX or EXT there shouldn’t be much movement

73
Q

What is the summary of the prevalence of neck pain

A

70% will experience neck pain
2nd to people with LBP in workers comp
More in women
More in older

74
Q

What are the strongest RF for neck pain

A

Female
Hx of neck pain

75
Q

What are other factors of neck pain

A

Over 40 years of age
Coexisting LBP
cycling
Comorbidities
Etc

76
Q

What is the etiology of neck pain

A

Unidentified

77
Q

What is neck pain normally classified as

A

Mechanical neck disorder
Nerve root compromise

78
Q

What is functional ROM for the neck

A

40-50 extension
60-70 rotation while driving

79
Q

What are S&S of neck pain

A

Varied in cervical spine and UE
Impaired scapular mechanics- muscle attachments to scapula and neck

80
Q

What findings can be found in MRIs even though Pt is asymptomatic

A

Bulging and herniated disc
Annular tears
Cord compression

81
Q

What are the structures involved with neck pain

A

variety and often unknown tissues
most do not have a known tissue producing symptoms

82
Q

how are clinical tests related to neck pain

A

poor screening tools and/or lack strong diagnostic accuracy measures

83
Q

what are the muscular benefits for JM in the neck

A

increase deep muscle recruitment
reduced superficial muscle recruitment

84
Q

what are predictors of success for cervical manipulation per CPR

A

neck disability index <11.5
bilateral involvement
sedentary work <5 hours per day
feels better with movement
extension does not increase symptoms
OA without radiculopathy
symptoms <38 days
+ expectation with manipulation
less than or equal to 10 difference rotation
pain with PA springs

85
Q

how does CPR work for cervical or thoracic manipulation

A

4 or more predicators of success= good outcome with JM

86
Q

what are the predictors for success for thoracic manipulation

A

symptoms < 30 days
no symptoms to distal shoulder
extension does not increase symptoms
diminished T3-5 kyphosis
cervical extension <30 degrees

87
Q

what regions should be included in MET for best outcomes with neck pain and what exercises should be done

A

cervical, thoracic, scapula, and shoulder
stabilization, strength and endurance parameters

88
Q

what is the MET for nociplastic pain in the neck

A

motor control and strengthening exercises for stabilization
30-60 minute sessions
2-3x/wk
7-12 wks

89
Q

what is the degree of research evidence for local and global muscles training related to neck pain

A

strong

90
Q

what is the MET for local and global muscle training in relation to neck pain

A

low load endurance for 6 wks (once acute phase is over)
isotonic/metric forward nodding
isometric cervical rotation
isotonic/metric scapular exercises

91
Q

how can you progress you forward head nodding for local m training

A

no gravity- low
gravity- high
forward nod with balance and external loads
functional exercise while maintaining forward nod

92
Q

what are other strong evidence based MET exercises for neck pain

A

proprioceptive training - eye fixation w/ or w/out head movement, sitting tall, head relocation with eyes open then closed with light

93
Q

what is the minimum number of weeks of exercise to obtain longer term benefits

A

6 weeks

94
Q

how is stretching for neck pain

A

not good in isolation
needs to be combined with MET
greater benefits from other MT and MET

95
Q

what is the evidence for traction with neck pain

A

mechanical tx= no support
intermittent tx= some support with short/intermediate traction with neck and related arm pain, especially with exercise and other CPRs

96
Q

what is the prognosis for radiculopathy

A

70% good or excellent outcomes at 2 years
90% had mild symptoms at 5 years

97
Q

what is CPR for radiculopathy

A

greater than or equal to 3 LR
less than 54 yr
non dominant UE
looking down does not worsen symptoms
more than 30 degrees of flexion

98
Q

what is the Rx for radiculopathy

A

mechanical traction
NO STM
MT and local muscle training
thoracic thrust manipulation

99
Q

how does evidence favor for modalities with neck pain

A

lacking, limited, or conflicting

100
Q

what is the evidence for education/counseling with neck pain

A

strong
early movement w/out provocation
reassurance of good prognosis and full recovery in most cases

101
Q

if pt has acute trauma to the neck, what is the best time period for recovery

A

1st 12 wks, little improvement after 12 months

102
Q

what is nociplastic pain

A

altered pain perception without complete evidence of actual or threatened tissue

103
Q

what is the peripheral patho of nociplastic pain

A

thinning myelin sheaths
a delta and c fibers get excited easily making it hard to override pain with motion

104
Q

what is the central patho for nociplastic pain

A

increased excitability of dorsal horn
loss of descending anti-nociceptive mechanism- less pain control - no endogenous opiate released

105
Q

how does the nociplastic pain work with somatic convergence in a region

A

c fibers split and travel 2 vertebrae superiorly and inferiorly

106
Q

what conditions are related to nociplastic pain

A

persistent fatigue syndrome
fibromyalgia
LBP
age related jt changes
lateral elbow pain
shoulder pain
migraine
neck pain

107
Q

what are the S&S for possible nociplastic pain

A

less than or equal to 3 months of pain
regional or spreading
Pain can not be explained
pain is hypersensitive or allodynia

108
Q

what criteria if present can be probable nociplastic pain

A

sensitivity to light, sound, or odor
sleep disturbance
fatigue
cognitive problems

109
Q

what are ANS S&S for nociplastic pain

A

pitting edma
decrease sebaceous gland
sweaty hands/feet
coldness/clamminess- decrease peripheral arterial shunting
loss of laterality
increased erector pili muscles

110
Q

what are test if + can indicate ANS S&S of nociplastic pain

A

distract jts for 1 min then retest- decrease skin mobility/rolling and increase sensitivity
scratch test- excessive reddening
graphesthesia- cant differentiate drawn letters on skin

111
Q

what is the general Rx for nociplastic pain

A

JM
MET
neuroscience education/behavioral therapy

112
Q

why is JM the best treatment in CNS

A

stimulates descending inhibitory pain mechanisms- release endorphins
induce presynaptic inhibition
reduce dorsal horn excitability
decrease inflammatory mediators

113
Q

what is the MET parameters for nociplastic pain

A

low to moderate intensity global aerobic and resistance
2-3x/wk
30-90 minute sessions
7 weeks duration

114
Q

what are the benefits of MET with nociplastic pain

A

endogenous analgesia
helps pt to interpret pain and motion as non threatening
reorganize homunculus

115
Q

why is neuroscience education/behavioral counseling beneficial for nociplastic pain pts

A

explain increased sensitivity and misinterpretation to reduce stress and anxiety
transition to adaptive pain coping

116
Q

what is the prognosis for nociplastic pain

A

varying degrees of improvement
longer recovery
not full resolution of symptoms

117
Q

how does WAD occur

A

acceleration-deceleration event
often strains and sprains
possible concussions

118
Q

what is the craniovertebral scan for

A

initial neck direct trauma

119
Q

what is the most involved structure injuries in WAD

A

Z jts sprains and muscle strains

120
Q

what is the most injury prone facet to be damaged by whiplash and why

A

C2-3
C2 is horizontal on top and transitions to 45 degree facets on the bottom for C3 facets

121
Q

what should be the scan findings for a pt with L sided Z jt sprain

A

limited ROM- R RT & SB, FLX (any motion that stretches the damaged tissue)
+ stress test - distraction and PA pressure
- neuro tests

122
Q

what are less involved structures in WAD

A

dens fractures

123
Q

what are S&S of dens fracture because of WAD

A

splinting, especially with SB because of alar lig pulling on dens

124
Q

what are the scan findings for a L muscle strain occurring because of WAD

A

P! with lengthened position for resisted testing
P! in opposite direction of action - R SB/RT and FLX

125
Q

what are S&S for fx anywhere in the body

A

trauma hx
splinting
pain with: palpation, compression, vibration/tuning fork, limited ROM with empty/painful end feels, weak and painful, crepitus

possible + neuro test in spine

126
Q

what are special tests for fx

A

percussion with stethoscope
CDRs and CPRs for fxs

127
Q

what is the bone made of

A

osteocytes
minerals
type 1 collagen

128
Q

what are the 2 layers of bone

A

cortical - outer layer
cancellous - inner layer

129
Q

what is the timing of bone healing

A

timing varies by innumerable factors

130
Q

what is the repair phase of healing for bone

A

1-3 weeks
soft callous or fibrocartilage forms from fibro/chondroblasts

131
Q

what is the modeling phase of bone healing

A

4-8 weeks sometimes up to 12
osteoclasts (destroy) cartilage and osteoblasts form bony and hard callous
fracture line no longer visible

132
Q

what is clinical union and what phase is it in

A

fracture line no longer visible
modeling phase

133
Q

when can a Pt start PT after a fx and what is the rehab focused on

A

4-8 weeks
fracture line no longer visible
more on consequences of prolonged immobilization or other injuries from the trauma (noncontractile)

134
Q

what is the remodeling phase of bone healing

A

months to years
conversion of cartilage for more abundant compact bone

135
Q

what can complicate bone healing

A

OP
amenorrhea
energy expenditure- stress, sleep, diet
impaired circulation
infection
poor load management

136
Q

what can complicating factors lead to in a fx

A

delayed union - slow uniting
non union - never unites
malunion - misalignment

137
Q

how can a fx be fixed

A

closed reduction
open reduction

138
Q

what are the S&S of alar ligamentous injury in WAD

A

splinting, particularly with SB
possible cord S&S loss of den stability

139
Q

if the pt has transverse ligament tear, what S&S could they present with and how could they be decreased

A

splinting
cord S&S - dens allowed to move posteriorly into cord

do manual retraction while stabilizing axis SP to glide atlas posteriorly and away from cord

140
Q

what does the rim resist

A

excessive hyperextension

141
Q

if pt has rim lesion, what can it present with in a scan

A

splinting with extension due to anterior annulus tears
P! with compression (end plate) and distraction (annulus)

142
Q

what are the symptoms of WAD

A

trauma with acute neck and intrascapular referred pain
potential TCN

143
Q

what are the scan findings for WAD

A

observation - splinting
ROM - limited with empty and painful end feels in all directions
resisted/MMT- weak and painful in several directions
neuro - possible + findings because of cord
stress - + for involved tissue

144
Q

why would someone have hypomobility with WAD

A

due to immobilization/disuse and fibrotic scarring

145
Q

why would someone have hypermobility with WAD

A

no prolonged immobilization or fibrotic scarring causing laxity

146
Q

what is TCN

A

located at C2-3 jt
interaction of sensory nerve fibers of Trigeminal n and C1-3
inflammation and/or sensitization symptoms of head, face, and neck
may develop to nociplastic pain

147
Q

in TCN what S&S could be present due to the trigeminal (mandibular) n

A

tongue- altered taste/tingling
ear- pain/tinnitus/hypersensitivity

148
Q

in TCN what S&S could be present due to trigeminal (ophthalmic) n

A

eye- pain, conjunctivitis without red eye, visual deficits

149
Q

in TCN what are S&S that could present due to trigeminal (maxillary) n

A

tooth ache/pain

150
Q

in TCN what are the S&S that could be present due to C1-3 spinal n

A

head- headache, dizziness, paresthesia
face- pain and paresthesia
jaw- TMJ pain

151
Q

what nerve can also be affected due to TCN and why

A

vagus n has nucleus in C3-4

152
Q

what are the S&S that can be given off due to vagus n involvement in TCN

A

irregular HR
lack of sweating
dyspnea
nausea
indigestion
other GI S&S

153
Q

why is balance affected with a concussion or WAD

A

restrograde branch of trigeminal n goes to cerebellum therefore coordination is affected

154
Q

what is the general Rx for WAD

A

POLICED
possibly a soft collar

155
Q

what are the parameters for nociplastic pain with WAD

A

body awareness and stabilization exercises
90 minute session
2x/wk
10-16 wks

156
Q

what are MT and MET that can be done for WAD once outside of acute phase

A

cervical and thoracic JM/manip
deep neck flexor and scapular stabilizer exercises

DPT 730/1: MSK (11 decks)

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