Fall 2015 written Flashcards
the ability to feel pain
nociception
what is nociception composed of (4)?
transduction, transmission, modulation, perception
when is the transition from an acute to a chronic pain staet?
3-6 months
chronic pain is due to permanent alteration in the _______?
dorsal horn
how is pain signal transferred to CNS?
double pain sensation: (1) fast/sharp pain (2) slow/chronic pain
which tract do fast pain fibers go thru?
neospinothalamic tract (glutamate)
which tract do slow pain fibers go thru?
paleospinothalamic pathway (substance P)
where mechanical and thermal pain receptors can elicit fast and slow pain, chemical pain receptors can ONLY elicit _____pain
slow
what substance is most responsible for causing pain following tissue damage?
bradykinin
the _____the rate of metabolism of the tissue, the more rapidly the pain appears
greater
how do muscle spasms cause pain? (3)
(1) direct stimulation of mechano-pain receptors
(2) compression of blood vessels–>ischemia
(3) incr metabolism rate–>worsened ischemia
increase in sensitivity of pain
hyperalgesia
causes of true visceral pain (5)
- tissue ischemia
- chemical damage
- smooth muscle spasm
- excess distension of a hollow viscous
- ligament stretching
what is trifurcation?
when the afferent nerves enter the spinal cord, they split into (1) branch into dorsal horn (2) ascending branch (3) descending branch
cutaneous pain can reach how many spinal cord levels?
2-3 segments
visceral pain can reach how many spinal cord levels
5+
stimulation or inhibition of A-beta sensory fibers from peripheral receptors can depress pain signal transmission
stimulation of A-beta sensory fibers
subacute pain is when?
pain >6 wks, but under 3 months
what can improve outcomes for acute LBP without radiculopathy?
spinal manipulation
what can long standing SD lead to?
disc pathology, facet arthritis or stenosis due to increased wear and tear.
do type 1 or type 2 lumbar segment dysfxns produce pain?
type 2 SD
do unilateral sacral flexions or extensions more commonly cause pain?
unilateral sacral flexions (downward sacral shears)
what is pelvic tilt syndrome? significance?
short leg (causes pain)
when L5 & sacrum rotate in the ____direction, it will produce pain
same
how do you know when you have successfully tx’d someone’s LBP?
The patient has been in CCP for two visits in a row and you have treated them for it.
in terms of what type of sacral dysfxns are most likely to cause LBP, what is the order?
backwards sacral torsions > unilateral sacral flexions > inominant upslips > forward sacral torsion
what is a 4/4 reflex grade?
hyperreflexia with sustained clonus
main root for quadriceps femoris reflex
L4 (patellar reflex)
main root for achilles/triceps surae reflex
S1
positive babinski?
extensor plantar response
what muscle strength: full range of motion (ROM) and full strength (normal)
5/5
what muscle strength: full ROM but with less than normal strength
4/5
what muscle strength: full ROM against gravity only (tested vertically and is overcome with ONLY one finger)
3/5
what muscle strength: 2/5: full ROM with gravity eliminated (usually tested horizontally)
2/5
what muscle strength: no joint motion, but a slight muscle contraction can be palpated or observed
1/5
what muscle strength: NO joint motion and no palpable or visualized muscle contraction
0/5
ankle plantarflexion?
motor level S1
CNS lesion associated with spastic or flaccid paralysis?
spastic paralysis
CNS lesion or PNS lesion assc’d with hyperreflexia?
CNS
CNS lesion or PNS lesion assc’d with hyporeflexia
PNS
CNS lesion or PNS lesion assc’d with significant denervation atrophy?
PNS
CNS lesion or PNS lesion assc’d with clonus, babinski, hoffmans’ positive tests?
CNS
CNS lesion or PNS lesion assc’d with fasciculations?
PNS
CCP: C2 is rotate and sidebent _______
left
CCP: The head side-bends ____
right
CCP: T1 rotates and side-bends_________
right
CCP: ______infraclavicular area is concave and easily compressible
right
CCP: T2-6 are neutral side-bent ____ and rotated _____.
T2-6 are neutral side-bent left and rotated right.
CCP: The lower thoracic area shifts ____ better than ____.
The lower thoracic area shifts left better than right
CCP: The pelvis rolls ___ better than _____
The pelvis rolls right better than left
CCP: The _____ iliac crest is more cephalad in the vertical plane.
left
CCP: The pelvis torsions ____
The pelvis torsions left (Posterior Left/Anterior Right).
CCP: The sacrum torsions ___
The sacrum torsions left (Left-on-Left).
CCP: ______ arm is short
left
CCP: The left leg is ____/right is ______.
The left leg is long/right is externally rotated.
significant sacral SD (2)
- backward sacral torsion
2. unilateral sacral flexions
type 1 SD is maintained by dysfxnal _______muscles
long restrictor
TP in CCP: lev scap/upper trap
right
TP in CCP: lat dors/lower trap
left
TP in CCP: psoas
left
TP in CCP: hammies
right
LBP referred pain from visceral disease (4)
- PID
- prostatis
- dissecting AAA
- renal calculus
LBP related to activity (4)
- facet joint pain
- discogenic pain
- stenotic
- arthritic
is sciatica a dx?
No, it is decriptive; need to find out underlying dx
causes of sciatica (5)
- radiculopathy
- sciatic nerve neuropathy
- peroneal neuropathy
- myofascial trigger point referral
- sacroiliac joint ligament referral
what is cauda equina syndrome?
saddle anesthesia, recent onset of bladder dysfxn, progressive neuro defecit in LE
flexion loads _____, stretches____
loads anterior elements (vertebral body, discs), stretches posterior elements
extension loads _____, stretches _____
loads posterior elements (facets, pars interarticularis), stretches anterior elements
sidebending closes _____
neuroforaminal canal, opesn the facets on the other side
what capsular pattern is favored in lumbar spine
no direction is favored over another
straight leg raise tests? what nerve root levels?
sciatic nerve root irritation, dural tension from L4, L5, S1
bragard’s test
use post straight leg test
what type of sign is the straight leg raise?
dural tension sign (pulling sciatic nerve roots from the leg to the spine)
where might paresthesias occur during femoral nerve stretch?
anterior medial thigh (L2/L3), medial leg (L4)
what is another dural tension test for the femoral nerve root?
passive knee flexion
what to assess when examining neck movement (4)
- restriction in ROM
- weakness
- pain associated w/ movement
- location of pain
how to tx painful capsular pattern of restrictive ROM of neck?
OMM is contraindicated until dx is given
normal joint capsule will have what sort of end feel?
elastic
where extra-articular soft tissues engage against each other
tissue approximation
what is the contractile tissue pattern during restricted ROM?
pain on active & passive stretching direction + on isometric testing in opposite direction
what does contractile tissue pattern indicate?
musculotendinous lesion
when is spurlings test positive?
when radicular pain is reproduced
when is distraction manuever positive?
when decr in radicular pain
what does TART stand for?
- tissue texture changes
- asymmetry
- altered ROM
- tenderness
imaging of acute LBP recommended when?
only initially in 4-6 weeks with FINS (fracture, infection, neoplasm, severe neuro deficits)
when to refer to a physician spine specialist?
- disc diisease (HNP w/ radiculopathy)
- facet disease
- referred pain
when to refer to neurosurg?
- cauda equina syndrome
- spinal cord compression
- progressive neurodeficit
what is wolff’s law?
mechanical strain/pressure stimulates fibroblasts to produce collagen organized along the same stress lines as the direction of force
MFR utilizes which neurons?
gamma motor neurons
strain causes an incr in _____excitatory input
afferent
take the tissue where it wants to go & hold for a release - direct or indirect?
indirect release
FPR is enhanced by placing region in ______, and adding_____
enhanced by placing region in a neutral position, and adding a facilitating force
is the still technique an indirect or direct technique?
go indirect 1st, then take the tissue direct
what does still technique work very well for?
joint restrictions being held by fascial strains
wat are the fxns of the lymphatics? (4)
nutrition, maintaining fluid balance, purification/cleansing of tissues, defense
how much fluid leaks out of the capillaries per day?
30 liters, 90% drains back into them
how much fluid drains into lymphatics/
10%
when tissue is compressed, prssure inside the capillary _____ and the overlapping edges of the endothelial cells _____
increases, closes like valves
what allows diaphragms to move together in unison (3)
- neuro control
- fascial attachments
- pressure differentials generated by the thoraco-abdominal diaphragm
what is the flow rate of lymph back to the heart directly proportional to (2)
- rate of respiration
2. quality of respiration
what is the heart of the lymphatic system?
the thoracoabdominal diaphragm
