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DPT 730/1: MSK > E2- TOS- Stenosis > Flashcards

E2- TOS- Stenosis Flashcards

1
Q

what is the general management of HA

A

HA with other suspicious S&S require urgent or emergency referral
all other HA complaints can be investigated with MSK scan

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2
Q

what are the types of HA

A

primary and secondary

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3
Q

what are primary HA

A

tension, migraine, cluster

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4
Q

what are secondary HA

A

cervicogenic

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5
Q

what is a tension HA

A

Bilateral band - like tightness
Anxiety/stress cause
No migraine S&S - milder
Dull pressure

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6
Q

what can cause a tension HA

A

anxiety/stress

commonly confused with cervicogenic HA because of muscle tension

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7
Q

what is the PT Rx for tension HA

A

address stress/anxiety
MET
oscillations or manipulations

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8
Q

what is a migraine

A

Pulsating
Out of commission
Unilateral
N & V
Drome’s
Sensational auras with visual and auditory sensitivity

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9
Q

what causes migraines

A

temporal artery vasodilation
trigeminal n nociplastic pain with CV dysfunction

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10
Q

what is the PT Rx for migraines

A

address CV dysfunction
vasoconstriction of temporal arteries - ice and caffeine
increase water intake 1.5 L
2-3 mg of melatonin
nociplastic pain MET

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11
Q

what is a cluster HA

A

Comes and goes
Retro-orbital and temporal region
Unilateral
Sudden and severe pain
Horners syndrome
INtense
Grumpy

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12
Q

what causes cluster HA

A

abnormal hypothalamus
genetic
sleep dysfunction
medication side effects

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13
Q

what is the prevalence for primary HA

A
  1. Tension
  2. migraine
  3. cluster
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14
Q

what are S&S cervicogenic HA

A

unilateral
starting in neck/occipital region
PROVOKED by neck motion
mild to moderate pain
non throbbing/pulsating

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15
Q

what can cause cervicogenic HA

A

C2/3 jt dysfunction

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16
Q

what can find in a scan for cervicogenic HA

A

limited and painful A/PROM
possible + with combined motion
neuro- possible + hypersensitivity
hypomobility and/or hypermobility with + linear stress test
+ cervical Flx/RT test
+ TTP in O-C3 region

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17
Q

what is the Rx for cervicogenic HA

A

address cervical dysfunction

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18
Q

what does the research say about dry needling with HA

A

no better than other modalities
should be paired with more MT and MET

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19
Q

what is TOS

A

compression of subclavian a and possibly brachial plexus

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20
Q

what can cause TOS

A

FHP
scalenes compress
trauma
differential diagnosis

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21
Q

what is the mechanism of FHP in TOS

A

upper thoracic jt hypomobility into extension
increase tension of subclavian fascia on axillary a
the floor or roof compresses the nerve

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22
Q

why would scalene compression cause TOS

A

chest breather with respiratory dysfunction and excessive use of accessory respiratory muscles

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23
Q

why can trauma cause TOS

A

WAD
protective muscle guarding
adhesions and scarring if torn

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24
Q

what are some differential diagnosis that can cause TOS

A

cervical rib
pancoast tumor compressing medial cord of brachial plexus
carpal tunnel
spinal n impingement
neurovascular disease

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25
Q

what are symptoms of TOS

A

UE glove/sleeve-like paresthesia
coldness and swelling with vascular compromise

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26
Q

what are the symptoms of peripheral n damage

A

nonsegmental paresthesia - short/intermittent duration, fast progression to well defined area of numbness
coldness and swelling with vascular compromise

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27
Q

what can increase symptoms of TOS

A

raising arms, prolong period
sleeping
poor sitting posture

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28
Q

what can we find in the scan for TOS

A

ob- FHP, possible UE discoloration
A/PROM- possible upper thoracic restriction
Resisted/MMT- decreased strength/endurance in post sh/scap muscles due to FHP
Neuro - only dural mobility +

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29
Q

what is dural tension restriction

A

paresthesia increased from both end
due to decreased elasticity or inflammation

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30
Q

how would you treat acute dural tension

A

paresthesia at rest
POLICED
motion without resistance or symptoms
STM over segmental

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31
Q

how would you treat persistent dural tension

A

paresthesia with resistance
motion with resistance
neural mobilizations with resistance at END range once acuity settles

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32
Q

what is gliding dural restriction

A

paresthesia increased from one end but relieved from other
due to adhesion

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33
Q

how do we treat acute gliding dural restriction

A

same as neural tension

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34
Q

how do we treat persistent gliding dural restriction

A

same as neural tension but neural mobilizations at MID range

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35
Q

what rep range do we do with neural mobilization

A

10-20 reps a day

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36
Q

what would we find in biomechanical exam for TOS

A

more often a upper thoracic hypomobility
less often - limited 1st rib inferior glide (guarded scalenes, sublaxation due to WAD)
use gilliard’s cluster

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37
Q

how do we treat TOS

A

posture/ergonomic
diaphragmatic breathing
MT/MET- improve mobility, strength and endurance of sh/scapular muscles

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38
Q

what MSK changes happen due to FHP

A

diaphragm actively insufficient/overworked
thoracic extensors and accessory muscles overworked with respiration

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39
Q

what is Dowager’s hump

A

fat pad over upper C/T junction develops with atrophy and shearing

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40
Q

what are most common thoracic restrictions with FHP

A

bilateral upper thoracic extension leads to lower cervical instability

can contribute to TOS and shoulder conditions

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41
Q

how can we treat FHP

A

MT/MET- more upright posture
postural education
ergonomic improvements
breathing training

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42
Q

what are the statistics for gillards cluster for TOS

A

5/5 LR+ =5.3
<5/5 LR- =.19

meaning if a pt has all 5 they have TOS bc it is so good at picking up - if + they got it and vice versa

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43
Q

describe tinels test

A

tap supraclavicular fossa - tenderness

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44
Q

describe adson’s test

A

15 degrees abd, inhale and hold breath for 10-20 sec with neck ext and ipsi RT - parethesia or descreased radial pulse

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45
Q

describe hyperabd test

A

90 degrees sh abd/er up to 1 min - paresthesia or decreased radial pulse

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46
Q

describe roo’s test

A

90 degrees sh abd/er while rapidly opening and closing fist for 1 min - symptoms

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47
Q

describe wright test

A

90 degrees sh abd/er with contra RT up to 1-2 min - paresthesia or decreased radial pulse

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48
Q

What is acute IDD

A

Annulus and end plate tear
Acute herniation (least common)

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49
Q

What is persistent IDD

A

Disc changes due to numerous variable allow herniation to happen gradually
Most prevalent

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50
Q

Describe the outer annulus

A

Type 1 collagen- resist tension- trigger multifidus to contract
Like a ligament- proprioceptive

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51
Q

Describe the inner annulus

A

Type 2 collagen - resist compression

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52
Q

Describe the anatomy of the annulus

A

Avascular
Concentric rings 15-25 fibers
Both compression and distraction can cause pain
Embedded into end plate

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53
Q

Describe the nucleus pulposa

A

Resist compression- type 2 collagen
High number of GAG
Dense connective tissue
Avascular, depends on motion

54
Q

How does the annulus and nucleus move

A

Move as a unit

55
Q

Describe the end plate

A

High innervate and vascularized
Nutrient diffusion for disc
Articular cartilage towards bone
Fibrocartilage towards disc
Weak link
May calcify and limit diffusion

56
Q

What is the prevalence of IDD

A

Persistent over acute
Rare in thoracic- greater risk if so

57
Q

Where on the disc is IDD most likely to occur and why

A

Posterolateral portion of disc

Weak,thinner,more vertical
Transition of annulus into endplate

58
Q

What response can happen once a disc structure gets damaged

A

Immunoreactive
Large auto immune inflammatory- excessive osmotic pressure, n gets sensitized due to chemicals, no drainage, extends inflammatory phase

59
Q

What would a pt report with postlat acute IDD

A

Dull achy spinal pain - referred pain
Radiculopathy

60
Q

What is the worse situation with acute postlat IDD

A

Presence of radiculopathy
Presence of coldness indicating circulatory compromise

61
Q

What are influencing behaviors with acute postlat IDD

A

Decrease pain with unloading
Increase pain and paresthesia with looking down
Increased pain in AM and worsening through day

62
Q

How is ROM in a scan affected from acute postlat IDD

A

All may increase pain
FLX and contra SB/RT - limited and increase spinal pain (pressure on spinal n and tension on annulus)
EXT and ipsi SB/RT - decrease spinal pain (centralization) but could increase spinal pain due to hydrostatic pressure

63
Q

What do symptoms do as they centralize

A

Decrease distal and/or spinal pain in a distal to proximal direction because of motion or position

64
Q

What can be found in a scan for acute postlat IDD

A

Resisted/MMT- varies
Stress- possible +
Neuro- possible + (dural mobility always positive)
Stability test - +

65
Q

Why can stress test be positive with all stress tests

A

Annulus irritated with distraction
Nucleus irritated with compression
Finding the segment irritated with PA pressure

66
Q

What are the central IDD symptoms and what would we do

A

Cord S&S
Immobilize and emergency referral

67
Q

what does research say about Mckenzie method with cervical IDD

A

weak evidence
no more beneficial vs general exercise

68
Q

what is the aggressive nonsurgical Rx for acute IDD

A

intermittent traction
specific therapeutic exercise
oral anti-inflammatory meds
patient education

69
Q

what is the Rx for acute IDD

A

POLICED
intermittent traction - may help if no centralization
neural mobilizations
MET

70
Q

what is the ultimate Rx goal with MET for acute IDD

why

A

tissue proliferation and stabilization

if non-contractile tissue is the issue for instability, motion and strengthening of local muscles can help stabilize the jt

71
Q

what is persistent IDD

A

degenerative disc disease
age related disc changes

72
Q

what region is the most common persistent IDD

A

lumbar

if cervical, C6 spinal n is most effected bc it is largest in diameter

73
Q

what can cause persistent IDD

A

acute IDD
sedentary lifestyle
genetics

74
Q

if pt has persistent IDD with persistent inflammation, what can happen

A

the persistent inflammation brings excessive and destructive proteins and a low-grade infection likely enters disc

75
Q

what is the snowball affect of persistent IDD

A

less GAGs so more fibrotic and dehydrated nucleus
more acidic disc
annular disorganization
thinning/loss of cartilage at end plates
increase inflammation and fatty deposits (Modic)

76
Q

what are the categories of disc herniation

A

protrusion (bulge)
extrusion
free sequestration

77
Q

what can happen due to persistent IDD

A

narrowing of:
disc - instability develops
increased load on facet - age related jt changes can develop
foramen - stenosis may develop

78
Q

how are symptoms affected with persistent IDD

A

slow change allows tissue to adapt

79
Q

how do we treat persistent IDD

A

what structure is the symptom driver??
disc?
jt hyper?
jt hypo?
nerve?
combo???

80
Q

what is the prognosis of acute and persistent IDD

A

mostly good

81
Q

what are the predictors of negative prognosis in acute IDD

A

peripheralization
pt attitude is negative
tumor

82
Q

what are the possible MD Rx for acute/persistent IDD

A

antibiotics
laminectomy - paired with fusion because you are making the jt unstable
partial discectomy
total disc replacement

83
Q

what is the axis of the jt maintained by

A

passive structures
active structures
neural control

84
Q

what is the result of abnormal motion in a spinal segment under a load

A

in P! and instability that changes instantaneous axis of motion

85
Q

what is functional instability

A

instability that can be stabilized with m activation or positioning

86
Q

what is mechanical instability

A

instability that cannot be completely stabilized with muscle activity

87
Q

what segments have the most instability

A

C5-7

88
Q

what can cause of instability

A

trauma
age related disc changes - narrowing
repetitive activities
creep
adjacent hypomobility
connective tissue disorder

89
Q

you can have BJHS if….

A

2 major criteria
1 major and 2 minor criteria
4 minor criteria

90
Q

what are functional instability symptoms

A

predictable pain
decrease pain with position changes or support
increase pain with prolong position
catching
easy self manip

91
Q

what can we find in a scan for functional instability

A

ROM- aberrant (acute), inconsistent WB and NWB findings, PROM > AROM
CM- inconsistent block
RST- most often strong/painless
neuro- (-)
ST- (+) PA pressure
Linear Stability test= (+)

92
Q

what are the symptoms of mechanical instability

A

unpredictable pattern
worsening symptoms and more often
increase pain with less stress
symptoms dont get better as quick

93
Q

what can be found in a scan for mechanical instability

A

same as functional BUT
ST- (+) wont stabilize fully

94
Q

what can you do in a linear stability test to further test for mechanical instability

A

neck FLX tightens posterior ligament (closed pack postion)
functional = jt tighten
mechanical = still lax

95
Q

what is the Rx for instability

A

POLICED
postural education
JM- increase adjacant hypo jts (C2 or thoracic)
bracing/taping
MET= stabilization, local muscles

96
Q

why is EXT limited/painful with acute functional instability

A

increased ant vertebral shearing

97
Q

why is FLX better than EXT with acute functional instability

A

large posterior lig/fascia tighten to help stabilize

98
Q

what can be the MD Rx in severe/rare cases of mechanical instability

A

prolotherapy (injection) for stabilize along with PT
fusion surgery

99
Q

what is the culprit tissue of age related jt changes

A

articular cartilage

100
Q

what are the common diagnosis of age related jt changes

A

Degenerative joint disease
OA
spondylosis at multiple levels

101
Q

what are the most common regions for age related jt changes

A

C5-7
L4-S1

102
Q

why does age related jt changes progress along with age related disc changes

A

facets could bear more load due to disc narrowing causing facets to have more wear

103
Q

what can protect against age related jt changes

A

physical activity

104
Q

what is the leading cause of disability

A

age related jt changes

105
Q

describe articular cartilage

A

covers ends of long bone, 2-4 mm thick
chondrocytes
frictionless
aneural/alymphatic/avascular

106
Q

If articular cartilage is aneural/alymphatic/avascular, what causes the inflammatory response

A

arthritis - everything in the jt but articular cartilage can become inflammed

mostly the bone takes on more compression causing the pain and initiating the inflammatory response of the repair phase — more fibrotic tissue

107
Q

what pressures does articular cartilage like

A

compression and decompression

108
Q

why is full ROM beneficial for our jts in the healing process

A

synovial fluid fully diffuses into cartilage
inflammatory agents fully exit cartilage

109
Q

how does viscoelasticity work in articular cartilage

A

rigid with more load
flexible with less load

110
Q

what can cause age related jt changes

A

gradual onset
trauma
sedentary lifestyle - underloading
genetics
other disease- RA
age

111
Q

what is the patho of age related jt changes

A

progressive
articular cartilage - fray, blisters, tearing
subchondral bone penetrated and overloaded
spurs
degenerative
acute tears

112
Q

why can the articular cartilage become degenerative in age related jt changes

A
  1. thins and the jt space narrows - synovial fluid does not fully fill
  2. fibrous capsule slackens then becomes more fibrotic - inflammatory response on overdrive (repair phase never stops)
  3. synovial membrane produces less synovial fluid - nutrients not there and increase friction
113
Q

what symptoms can be found with cervical ARJC

A

gradual onset
pain with prolong positions
morning stiffness < 30 minutes
pain and limitation with RT (looking in blind spot)
some movement helps, too much hurts

114
Q

why would a pt have pain and limitation with RT with cervical ARJC

A

IMP or compression on facets

115
Q

why might someone have paresthesias with cervical ARJC

A

compressed spinal n - narrowing or spurs

116
Q

based on the cervical symptoms, what can be found in a scan for ARJC

A

ROM- painful and limited (EXT, RT, SB) capsular pattern of restriction
CM- consistent block or opposing quadrant block
RST- depends on acuity
ST- (+) compression, EXT, RT, SB, PA pressure
neuro- (-) unless spurs can cause stenosis on spinal n

117
Q

what can show in a BE of cervical ARJC

A

accessory- hypomobility due to fixated hypermobile jts or hypomobile adjacent jts (C2-3 or thoracic)
special tests - spurlings may be (+) due to stressing the tissue in multiple positions (EXT, RT, SB)

118
Q

why would compression be (+)for cervical ARJC

A

more stress directly on the jt

119
Q

why would neuro tests be (+) with cervical ARJC

A

spurs can develop near the intervertebral foramina and compress the spinal n

120
Q

what are the 2 patho of stenosis

A

narrowing and fibrotic

121
Q

what can cause narrowing stenosis

A

compressed from outside in
IDD
ARDC
instability
enfolding of lig flavum (older people)

122
Q

describe fibrotic spinal n patho

A

due to persistent inflammation associated with instability
nerve wont expand, compression from inside out
circulation compromise

123
Q

what are the symptoms of lateral stenosis

A

unilateral UE P!, segmental paresthesias and gripping type pain
decrease pain with looking down, standind/walking, AM
increase pain with sitting, looking up, turning one side

124
Q

what would we find in a scan for lateral stenosis

A

ob- increase lordosis
ROM- FLX, contra SB/RT decreases pain, EXT ipsi SB/RT increases pain
ST- (+) compression, (+) PA pressure due to translation of vb
neuro- possible (+) = radiculopathy

125
Q

what can we do in BE for lateral stenosis

A

AM- jt hypomobility
MMT- local muscle inhibited
Spec. test- (+) spurlings, wainers CPR, stability= possible shear

126
Q

what is our Rx for stenosis

A

pt education for posture
MT with MET- improve thoracic ext, neural mobilizations
mechanical traction

127
Q

what is our Rx directed towards with stenosis

A

foraminal opening

128
Q

what is the MET for stenosis

A

aerobic- increase circulation
local muscle stabilization

129
Q

what is the MD Rx for stenosis

A

Sx- constant or worsening symptoms
laminectomy with or without fusion

130
Q

how does radiculopathy surgery compare to PT

A

surgery has a more rapid and greater improvement in P!, but the two groups were no different with symptoms after 2 years

DPT 730/1: MSK (11 decks)

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