fellowship neuro Flashcards
What is the manual therapy lesion?
1 The neurological basis for dysfunction in the the musculoskeletal pathology
2 collagen trauma > receptor damage > reduction in muscle fiber recruitment > tonic fiber atrophy > reduced antigravity stability > motion around nonphysiologic axis > trauma acute locking > pain and guarding
How do hypomobilities lead to MTL?
1.immobilization leads to collagen breakdown and receptor loss
How can the MTL effect posture?
Postural progressions as you loose kinesthetic awareness and muscle recruitement
What is the autonomic nervous system?
- innervates blood vessels, viscera, glands, and non striated musculature
- ANS changes the activity of somatic structures via afferent and efferent functions
- ANS is made up of the parasympathetic and sympathetic nervous systems
How does the sympathetic nervous system play a role in muscular contraction?
SNS is 100% motor and keeps the muscles at 70% contraction during rest and can reach 100% contraction when stimulated even when the nerve is exhausted
Where do you find the parasympathetic preganglionic cell bodies
preganglionic fibers are found in oculomotor, facial, glossopharyngeal, vagus, and spinal accessory cranial nerves and the sacral nerves 2-4
Parasympathetic mechanical dysfunction can mimic what other regional pathology
Upper cervical dysfunction because upper cervical hyper extension can compress the brainstem in the foramen magnum and produce symptoms in CNs III, IV, iX, X, XI
Where are the preganglionic cell bodies of the sympathetic nervous system located
Preganglionic cell bodies are in the intermedediolateral horn gray matter of the thoracic and lumbar spine and emerge from the spinal cord as mylinated or white rami communicans to the sympathetic trunk
What is the pathway for sympathetic white rami synapsing with the gray rami?
- synapse with the second order neuron in the trunk at the same level it exited. Then the axon of the second order neuron travels the chain to reach the target organ
- it can enter the chain and travel to the desired level then synapse with the second order neuron to reach the target organ
- they can enter the chain travel up to where they need to go exit the chain and synapse with the second order neuron on the target organ
what part of the spine does the cervical sympathetics come from?
upper thoracic
What are the basic functions of the parasympathetic nervous system?
responsible for (1) protecting the internal environment (2) maintaining homeostasis (3) nutrition and (4) replacing energy stores depleted by the sympathetic nervous system. Does not go to musculoskeletal system
What are the basic functions of the sympathetic nervous system?
goes to every tissue in the body via vascularity, concerned with performance of the body as a whole, greatest influence is over the musculoskeletal system, mainly involved in moment to moment adjustment to environmental demands via visceral, circulatory, and metabolic function
What specific influences does the SNS have on the body?
- stimulating SA node, 2. stimulate cardiac muscle, 3. Peripheral vasculature constriction, 4. Stimulates GI smooth muscle of sphincters to contract, 5. Relaxes respiratory smooth muscle in the bronchi, 6. Dilation of the pupils, 7. erection of the hair on the skin, 8. Boost skeletal muscle recruitment, 9. increases frequency of afferent receptor discharge (spindles, tactile, taste, olfactory, pacinina, retina), 10. SNS stim required for rapid lipolysis, 11. slows healing rates by decreasing anastomosing of blood vessels
What is RSD and how does it present?
- chronic increase in sympathetic activity can lead to disparities between severity of pain and degree of injury
- Often presents by vasospasm, hyperhydrosis, cyanosis, edema, trophic changes (increased thickness of the skin and nail, increased hair growth, muscle atrophy, shortening of tendons, osteoporosis, degenerative changes)
What are the different parts of the cervical sympathetic chain?
- superior cervical ganglion
- middle cervical ganglion
- inferior cervcial ganglion
- stellate ganglion
Where is the superior cervical ganglion located?
located between the carotid sheath and prevertebral fascia
Where does the superior cervical ganglion receive its preganglionic fibers from?
T2 and T3 are the primary sources
What are the branches of the superior cervical ganglion?
- internal carotid
- deep petrosal
- caroticotympanic
- exteranal carotid
- facial artery
- branches to glossopharyngeal, vagus, and hypoglossal CNs
The internal carotid branch of the superior cervical ganglion further divides in to which branches?
medial, lateral and terminal
What cranial nerves does the superior cervical ganglion serve?
1.medial internal carotid branch- occulomotor (III), trochelear (IV), opthalmic division of facial (V)
2lateral internal carotid branch- trigeminal (V), abducens (VII)
What symptoms might you notice with a superior cervical ganglion dysfunction?
- facial mosture
- facial fatigue
- toungue or chewing isssues
- vocal quality
- sinus infections or issues
- difficulty looking upper lateral quadrant (trachlear superior oblique muscle)
- difficulty looking any other direction (occulomotor)
- pupil dialation or poor light accommodation
- cardiac function
- dural tightness
The deep petrosal branch of the superior cervical ganglion effects what region?
nasal cavity, pharaynx and palate
The external carotid branch of the the superior cervical ganglion effects what region?
- external head, face and neck
2. errector pillorum, sweat glands and facial muscle vasculature
What symptoms might you notice with dysfunction of the deep petrosal branch of the superior cervical ganglion
decrease function of the lacrimal glands and humidity of nasal passages with nasal mucosa glands
Facial dryness might indicate what sympathetic branch?
external carotid branch of the superior cervical ganglion
What symptoms might you expect with superior cervical ganglion dysfunction?
facial moisture, facial pain or fatigue, tongue or chewing issues, vocal issues, vocal quality, sinus infection, difficulty looking upper lateral quadrant (trochlear), difficulty looking any other direction (occulomotor), pupil dilation or poo light accommodation, cardiac function, dural tightness
Where is the middle cervical ganglion located?
located at the the transverse process of C6/7 between logus coli and anterior scalenus
What are the branches of the middle cervical ganglion?
- to C5/6
- middle cardiac to vertebral artery plexus
- plexus on the inferior thyroid
What clincial findings might you expect with with middle sympathetic cervical ganglion dysfunction
- changes in thyroid function
2. changes in vocal quality
Where is the inferior sympathetic cervical ganglion located?
between the first rib and C7
What are the branches of the lower sympathetic cervical ganglion?
- branches to C6-8
- inferior cardiac nerve
- vertebral nerve following artery
What might you expect to find with with lower cervical ganglion dysfunction?
cardiac changes, vertebral artery function, lower cervical function
Where is the stellate gangion located
Often joined to the inferior cerivcal ganglion at C7 to T1
What are the branches of the stellate ganglion?
- C6-T2
- vertebral nerve
- inferior cardiac plexus
- subcalvian artery
- common carotid plexus
- phrenic nerve
- internal throacic artery- branch of subclavian traveling behind SC down the back of the sternum
How could arthopathy in the upper cervical spine effect tongue and cardiac function?
- the greater and lessor occipital branches of the upper cervical spine pass close to the upper cervical facets
- these cutaneous branches pass close to vagus and hypoglossal nerve and provide their vascular sympathetic supply
How will dysfunction of the the C4, C5, and C7 facets create interregional sympathetic dysfunction?
- C4-influences vertebral artery and cranial blood flow
- C5-effects the subclavian and brachial plexus
- C7-effects the cardiac plexus and phrenic nerve
Where are the branches of the thoracic sympathetics located?
rib heads except for the last two or three that are located on the lateral side of the vertebral body
What is the functional influence of the thoracic sympathetics?
Organ function
What are the two anatomical groups of the thoracic sympathetics?
- upper 5 segments
2. lower 7 segments
What are the branches of the upper thoracic sympathetics?
- greater splanchnic
- posterior pulmonary
- dorsal portion of the cardiac plexus
- esophagus
- trachea
What are the branches of the lower thoracic sympathetic chain
- greater splanchnic
- less splanchnic
- lower splanchnic
Where is the lumbar sympathetic chain located?
four ganglion located anterior to the vertebral column along the psoas major
What are the branches of the lumbar sympathetic chain?
- splanchnic branches
- upper lumbar and lower thoracic vascular branches to femoral, sphanouis, and obturator arteries
- lower lumbar vascualr branches to the popliteal artery
What how does the thoracic sympathetic chain differ from the cervical, lumbar and plevic?
The thoracic is the only region where white preganglionic fibers come off the spinal cord, thus the other regions are supplied by the thoracic sympathetics
Where is the plevic sympathetic ganglion located?
anterior sacrum medial to the sacral foramen
What are the branches of the sacral sympathetics?
- medial hypogastric
- plexus on the median sacral artery
- vascular branches to sacral plexus, tibial nerve, pudendal nerve, sup/inf gluteal, lymph nodes
What makes autonomic function of the craniofacsial region more complicated that other regions?
There is dual innervation of the sympathetic and parasympathetic nerves
What is the ANS dual innervation of the craniofacial region?
The four craniofacial ganglion contain SNS, PNS, and sensory nerves
What are the craniofacial ANS ganglion?
- cillary gangion
- sphenolplatine ganglion
- otic ganglion
- submaxillary ganglion
The dual innervations of the craniofacial region impact what target organs?
- intrinsic muscles of the eye
- salivary glands
- mucous membranes of the nose and pharynx
Where is the ciliary ganglion located?
between the optic nerve and lateral rectus muscle of the eye
What passes through the ciliary ganglion and where do they terminate?
- PNS-inferior occulomotor nerve from mid brain
- SNS-fibers from carotid plexus
- sensory- nosociliary brach of opthalmic
- terminate as the ciliary nerves to the ciliary muscles and iris
Where are the parasympathetic preganglion fibers located in the spinal?
- midbrain
- medulla
- S2-4
Where is the sphenopalatine ganglion located?
located in the ptergopalatine fossa
What nerves feed into the sphenopalatince ganglion?
- PSN-glossopalatine, superficial petrosal, vidina
- SNS-internal carotid plexus, deep petrosa
- sensory-maxillary and parts of CN VII (facial) and IX (glossophyrengeal)
Where do the fibers of the sphenopalatine ganglion terminate?
- nasal cavity
- pharngeal cavity
- palatine structure (uvula, tonsils, hard and soft palate)
- orbital rami to periosteum and lacrimal glands
Where is the otic ganglion located?
medial to the mandibular nerve just below the foramen oval in the infratemporal fossa
What nerve feed into the otic ganglion?
- PSN-lessor petrosal of CN IX (glossophyrengeal)
- SNS-plexus from middle menigeal artery from the superior ganglion
- motor-medial pterygoid of mandibular branch of CN V
Where do the fibers of the otic ganglion terminate?
- parotid gland- saliva gland
2. tensor tympani and tensor veli palatine
What is Vail’s syndrome?
Severe sudden attacks of unilateral often noctural neuralgic pains of the nose, face, eye, neck and shoulder attributed to neurlagia of the vividain nerve
What is Frey’s syndrome?
condition where salivation produces sweating and erythema at the parotid gland (dysfunction of otic ganglion)
Where is the submaxillary ganglion located?
Medial mandibule near the submaxillary duct
What fibers passes through or synapse at the submaxillary ganglion?
- PSN-branches from facial nerve
2. SNS-upper cervical ganglion
Where do the the fiber from the submaxillary ganglion terminate?
- oral mucosal
2. subligual and submaxillary gland for saliva
