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MSK Spine > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

rare but serious health conditions

A

Neoplasm
Infection
Ankylosing Spondylitis
Rheumatoid Arthritis (RA)
Klippel Feil Syndrome
Cervical Arterial Dysfunction (CAD)

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2
Q

Lead Kettle (PB KTL)

A

prostate, breast, kidney, thyroid, lung

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3
Q

Rheumatoid arthritis

A

synovial hypertension, destruction of articular cartilage and bone, synovial cysts and ligamentous laxity
likely develops prior to 6th decade
women> men

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4
Q

ankylosing spondylitis

A

Ossification ligaments of spine, IV discs/ end-plates, facet structures
men>women
observed in 3rd decade
improves with activity, worse at night

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5
Q

klippel feil syndrome

A

congenital; failed C spine segmentation
fusion of C2-C3 is most common

<50% have short neck, low posterior hairline, and limited ROM
>50% have scoliosis

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6
Q

cervical arterial dysfunction

A

intimal (inner) tear with penetration of circulating blood into the vessel wall and formation of intramural hematoma

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7
Q

consequences of cervical arterial dysfunction

A

Retinal or brain ischemia
Compression or stretching causes local symptoms
Subarachnoid or intra-cerebral hemorrhage

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8
Q

underlying abnormality of the vessel wall for CAD

A

vertebral arteries
internal carotid arteries

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9
Q

symptomology of cervical arterial dysfunction

A

neck pain
face pain
headache
pain is severe
extremity dysesthesia, motor dysfunction, pain
pulsatile tinnitus

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10
Q

Ds and Ns of CAD

A

dizziness
dysarthria
dysphagia
diplopia
drop attack
nystagmus
nausea
numbness

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11
Q

horners syndrome

A

Ptosis (dropping of upper eyelid)
Miosis (constriction of pupil)
Enophthalmos (sinking of the orbit)
Anhydrosis (dry eyes)

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12
Q

symptomology of cervical myelopathy

A

Neck pain/ stiffness
Shoulder pain
Imbalance/ fall Hx
(UE) Dysesthesia
May involve LEs first (gait, weakness)

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13
Q

clinical prediction rule for cervical myelopathy

A

Gait Deviation
Hoffmann’s Sign
Inverted Supinator Sign
Babinski Sign
Patient age >45 years old

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14
Q

upper cervical instability has an increased risk associated with

A

history of trauma
throat infection
congential collagenous compromise
inflammatory arthritides
recent neck.head/dental surgery

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15
Q

common special tests for upper cervical instability

A

Modified / Sharp-Purser Test
Alar Ligament Stability Test
Lateral Shear Test
Tectorial Membrane Test
Posterior A-O Membrane Test

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16
Q

jefferson fracture of C1

A

atlas fracture
4 part burst fracture of atlas
2 fractures at each arch

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17
Q

spondylolysis

A

defect of pars interarticularis

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18
Q

spondylolysthesis

A

anterior displacement of vertebral body
degenerative process that is most common at C3/4 and C4/5

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19
Q

3 factors of canadian C spine rule

A
  1. Any high risk factor that mandates radiography?
  2. Any low risk factor that allows safe assessment of range of motion?
  3. Able to rotate neck actively?
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20
Q

NEXUS low risk rule

5 criteria in order to be classified as having a LOW probability of injury

A

no midline cervical tenderness
no focal neurologic deficit
normal alertness
no intoxication
no painful, distracting injury

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21
Q

spondylosis

A

affects vertebral bodies and discs
degenerative process where osteophyte complexes form around margin of bodies

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22
Q

osteoarthrosis

A

zygapophysial joint and AA joints
osteophytes can cause joint narrowing

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23
Q

stenosis

A

narrowing of a vertebral canal

locations:
- central
- lateral

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24
Q

lateral canal stenosis can cause

A

radicular pain or radiculopathy

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25
Q

central canal stenosis can cause

A

myelopathy

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26
Q

somatic referred pain

A

pain from an anatomic structure

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27
Q

radicular pain

A

pain in a spinal nerve (dermatome) distribution due to irritation

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28
Q

radiculopathy

A

conduction block, motor and sensory affected

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29
Q

pancoast tumor

A

Tumor at the apex of the lung
May involve C8 and first thoracic nerve structures

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30
Q

symptomology of pancoast tumor

A

Chronic cough
Bloody sputum
Unexplained weight loss
Malaise
Dyspnea

will examine fever and wheezing

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31
Q

classification of TLICS

A

Morphology

Integrity of PLC
- Supraspinous ligament
- Interspinous ligament
- Ligamentum flavum
-Z-joint capsules

Neurologic Status

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32
Q

traditional compression fractures

A

Stable injury

Anterior column affected

Spinal canal intact

Common mechanism: axial loading in flexed position

Traumatic
High Energy
Osteoporotic

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33
Q

burst fracture

A

Anterior and Middle columns

15-20% of all major vertebral body fractures

Most common at T/L junction (T12, L1)

Potential neural involvement; fragments may be found in canal

Vertebral segment subjected to high force axial (and/or flexion load)
- MVC
- Falls from heights
- High-speed sport injury

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34
Q

rotation/translation fracture

A

Associated with fall from a height or heavy object falling on body with bent trunk

Torsion & Shear forces

Horizontal displacement of one T/L vertebral body on another

Dislocation: facet joints intact, but dislocated

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35
Q

distraction fracture

A

Separation in the vertical axis

Anterior & posterior ligaments, anterior & posterior bony structures, both

Potential Frx to posterior elements

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36
Q

red flags for vertebral fracture

A

Older age
Significant trauma
Corticosteroid use
Contusion/ abrasion

37
Q

recommendation for clustered findings with a vertebral fracture
Henschke

A

Age > 70 years
Significant trauma
Prolonged corticosteroid use
Sensory alterations from the trunk down

38
Q

Roman CPR for identifying vertebral compression fracture

quadas score?

A

QUADAS = 8
A cluster of findings to aid in identifying the presence of an osteoporotic vertebral compression fracture includes the following:

Age > 52 years

No presence of leg pain

Body mass index </= 22

Does not exercise regularly

Female gender

39
Q

scheuermann’s disease

A

Defective growth of vertebral endplate
Poor diffusion of nutrients to un-vascularized disc

Proposed Etiology
- Genetics
- Excessive stress on pre-disposed (weak) endplate

40
Q

scheuermann’s disease risk is increased among

A

Manual workers who begin at early age
High intensity athletes?
High BMI?
“Short sternum”?

41
Q

criteria for Scheuermann’s disease diagnosis

A

Thoracic kyphosis > 45 deg

Wedging x 3 adjacent vertebrae > 5 deg

Thoracolumbar kyphosis > 30 deg

42
Q

symptomology/exam findings of Scheuermann’s disease

A

Thoracic pain, commonly apex of curvature (muscular tension, IV disc bulging/ spondylosis)

exam:
- Scoliosis (15% and 20%)
- Excessive thoracic kyphosis (Compensatory hyperlordosis, rounded shoulders/ forward head, pelvic rotation)
- Vertebral wedging, Schmorl’s nodes (16-48%), disc space narrowing
- Limited thoracic ROM
- Neurologic Complications (less common)

43
Q

disc disease of thoracic spine
symptomology

A

Back or chest pain
- Radicular: band-like pain in affected level’s dermatome, paresthesia/ anesthesia, leg pain
-Back pain at midline

Progressive/ insidious (months to years)

44
Q

thoracic spine myelopathy
sympotomology and exam findings

A

Symptomology:
Sexual dysfunction
Bowel and bladder dysfunction

Physical Examination:
Sensory/ motor impairments
UMN signs LEs

45
Q

etiologies of intercostal neuralgia

A

Traumatic Injury
Infection (e.g. herpes zoster)
Mechanical Compression (disc protrusion, osteophyte complex, neuroma, Frx)
Following thoracic Sx

46
Q

symptomolgy of intercostal neuralgia

A

Burning pain/ paresthesia/ anesthesia along intercostal nerve path

47
Q

exam findings with intercostal neuralgia

A

Focal tenderness of intercostal area
Herpes zoster: dermatomal distribution of rash with grouped vesicles and pustules

48
Q

T4 syndrome

A

Women > Men (4:1)
Etiology unknown
Theory: sympathetic reaction with hypomobile segment
Can affect T2-T7
Primary pain generators
Thoracic IV disks and
Thoracic zygapophyseal joints

49
Q

T4 syndrome
symptomology

A

Glove-like paresthesias unilateral/ bilateral UEs
Neck/ scapular/ bilateral upper extremity pain (constant or intermittent)
Worsens with side-lying or supine positioning
Generalized headache

50
Q

T4 syndrome
exam positive tests

A

Tender spinous process
+ Thoracic Slump Test
+ Upper Quarter Neurodynamic Tension Tests
Hypomobile thoracic segment

51
Q

scoliosis is named for the

A

convexity

52
Q

etiology of scoliosis

A

congenital or acquired

53
Q

zygapophysial arthropathy exam

A

Painful movement with closing of z-joints (AROM/ PROM)
Painful spring testing/ Hypomobility with joint mobility testing

54
Q

zygapophysial arthropathy symptomology

A

local and/or referred pain

55
Q

rib fracture concern over stability

A

Brachial plexus/ vascular structures (3-15% of upper rib fractures associated with this)

Laceration of pleura, lungs, abdominal organs

56
Q

rib fracture symptomolgy

A

Focal pain, radiating pain
Pain with inspiration
Pain with coughing/ sneezing

57
Q

rib fracture exam findings

A

Focal tenderness
Possible palpable defect

58
Q

costochondritis
symptomology

A

Pain and local tenderness at costochondral or chondrosternal articulations
- At rest
- Trunk movement
- Respiration

59
Q

costochondritis
what is it, when does it resolve

A

May be related to upward of 30% of ED visits related to chest pain
Involves >/= 1 rib
Proposed Pathophysiology:
Repetitive stress
Typically resolves within a year

60
Q

rib dysfunction (structural, torsional, and respiratory)

A

Structural: subluxation of joint (anterior or posterior)
Torsional: Rib held in rotated position
Respiratory: related to posture, may affect respiration

61
Q

rib dysfunction symptomology

A

Aggravated with deep inspiration, trunk rotation, sneezing/ coughing

62
Q

rib dysfunction exam findings

A

Diminished rib mobility (structural)
Pain/ hypomobility with joint mobility testing
Limited/ painful thoracic spine motion

63
Q

Thoracic outlet syndrome
compression

A

subclavian artery
subclavian vein
brachial plexus

64
Q

thoracic outlet syndrome
symptomology

A

UE pain, paresthesia, anesthesia/ weakness (Glove-like vs. particular distribution consistent with area of compression)
Chest/ anterior shoulder pain
Typically progressive/ insidious onset

65
Q

potential areas of compression TOS

A

scalenes
cervical rib
pec minor
first rib
clavicle

66
Q

thoracic outlet syndrome clinical presentation/history

A

history of neck trauma
cervical rib
raynaud’s phenomenon

67
Q

positive special tests for thoracic outlet syndrome

A

Roo’s Test
Hyperabduction Test
Adison’s Test
Cervical Rotation Lateral Flexion Test: Restricted 1st Rib
First Rib Spring Test: Restricted 1st Rib

68
Q

pectoralis strain
MOI

A

Direct trauma
- Direct blow
- Forced horizontal abduction with extension or ER mechanism (e.g., bench press gone wrong)

Indirect trauma:
- Increased tensile stress on lengthened muscle, especially eccentric loading
- Common athletic injury (e.g., rugby); can be non-athletic(e.g., catching oneself when falling)

69
Q

common history of pec strain

A

traumatic event with sudden onset of shoulder/ chest/ arm pain with audible “pop”

70
Q

pec strain can be confirmed via

A

MRI
ultrasound imaging

71
Q

intercostal strain
MOI

A

commonly excessive exertion of untrained muscle

72
Q

serratus anterior strain
who does it happen in and what do they feel

A

More likely with rowing and weightlifting
Pain at medial scapular border, possible radiation to anterior chest
Pain/ weakness with resisted scapular protraction

73
Q

internal/external oblique strain
MOI and what they feel

A

MOI: traumatic; eccentric contraction when muscle is lengthened
Uncommon, though more likely with cricket (bowlers), javelin, rowing, swimming, or hockey
Pain & TTP over lower 4 costal cartilages
Resisted ipsilateral lateral flexion painful

74
Q

SCHEUERMANN’S DISEASE
interventions

A

Postural control muscle performance
Modification of aggravating activities
Strengthening and stretching of the trunk
- Seated rotation
- Extension in lying (prone press up, prone on elbows, etc.)
- Thoracic extensor strengthening
- Scapular abductor strengthening
Bracing

75
Q

ANKYLOSING SPONDYLITIS
interventions

A

Spine extension & peripheral joint exercises
Breathing exercises
Prone lying several times/ day for spine/ hip extension
Sleeping on firm mattress & avoidance of SL position
Swimming

76
Q

Adolescent Idiopathic Scoliosis

thoracolumbar bracing

A

Prevention of curvature progression
Correction of abnormal curvature

77
Q

goal with exercise for scoliosis conservative management

A

Strengthen postural muscle
Address muscle length impairments/ strength impairments of extremity musculature
Maintain/ Improve respiration & chest mobility
Address back pain impairments
Resume functional tasks
Strengthen abdominals

78
Q

T4 Syndrome considerations

A

Thoracic manual therapy techniques (mobilization, thrust manipulation)
Scapulothoracic motor performance
Thoracic extensor strengthening

79
Q

DISC LESIONS
interventions

A

traction

Continuous or intermittent
Intermittent: twice as much separation proposed
Pt positioned sitting or supine
Duration recommendation 2 min – 24 hours
Generally 20-30 min recommended

80
Q

contraindications for traction with disc lesions

A

acute lumbago, instability, respiratory or cardiac insufficiency, respiratory irritation, painful reactions, large [disc] extrusion, medial disc herniation, altered mental state; this includes inability of the patient to relax

81
Q

ZYGAPOPHYSEAL JOINT PAIN:
interventions

A

Manual therapy interventions
- Mobilizations
- Oscillations
- Stretch mobilizations
Manipulation

Exercise
- Pain & guarding inhibition
- Neuro re-education (postural stabilizers, osteokinematic mobilizers into painful planes

82
Q

ZYGAPOPHYSEAL JOINT PAIN
common impairments

A

Muscle Guarding
Joint Hypomobility
Acute irritation/ dysfunction
Pain
ROM: commonly motions that close joint (extension, ipsilateral flexion, rotation)

83
Q

RIB DYSFUNCTION
interventions

A

Manual therapy interventions
- Rib mobilizations
–> Oscillations
–>Static stretch mobilizations
- Rib manipulation
- Soft tissue mobilization

84
Q

THORACIC OUTLET SYNDROME
considerations

A
  • Work/ activity modification
  • Nerve glides
  • Shoulder, upper rib/ thoracic manual therapy techniques
  • Scapulothoracic motor performance
  • Address tissue extensibility anterior trunk musculature
85
Q

mid trap exercises

A

Prone row
Prone horizontal abduction with 90 deg shoulder abduction & ER

86
Q

lower trap exercises

A

Prone full can
Prone shoulder ER at 90 deg of shoulder abduction
Prone horizontal abduction with 90 deg shoulder abduction & ER
Bilateral shoulder ER in shoulder neutral

87
Q

rhomboids and levator scap exercises

A

Prone Extension with shoulder ER
Prone row
Prone horizontal abduction with 90 deg shoulder abduction & ER

88
Q
A

MSK Spine (3 decks)

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