Final Flashcards
The shoulder has increased mobility at the cost of what
decreased stability, due to a shallow socket
how should we prioritize the mobilization of joints
mobilize proximal joints before distal ones
what muscle is the most commonly injured in rotator cuff injuries
supraspinatus
what is a watershed area in the shoulder
area that has no arterial supply, the point where the supraspinatus tendon connects
has bad healing potential
What is adhesive capsulitis
and what are extrinsic/intrinsic types of AC
Frozen shoulder, when the joint capsule gets smaller due to restriction of ROM
if it is extrinsic to the GH joint it is usually caused by systemic diseases (diabetes), and if intrinsic then it is caused by immobilization
What are some risk factors for adhesive capsulitis
female (around early menopause)
older age
trauma
diabetes
prolonged immobilization
What is the clinical presentation of adhesive capsulitis
capsular pattern of ROM loss (losing external rotation first, followed by losing abduction, and then internal rotation (exabin*))
ER has the greatest loss as arm is usually in a sling, and this causes increased tension for the back of the shoulder causing increased compression of the capsule
pain in all motions with less pain in flexion
What are the 3 stages for adhesive capsulitis
Freezing stage: symptom management phase - limited rom due to pain, lasts 2-9 months
Frozen stage: lessened pain, but shoulder is stiffer and using it is harder, lasts 4-12 months. Recommended to introduce aggressive protocols to regain ROM, as earlier mobilization leads to improved thawing stage improvement and regaining of ROM. If not done, ROM losses may be permanent
Thawing stage: thoulder starts to improve ROM, lasts from 5-24 months as the joint capsule starts to loosen up
How is adhesive capsulitis managed?
hot/cold compress
NSAIDs
Physical therapy (usually painful and deep)
TENS
Manipulation under anesthetic
What is subacromial impingement syndrome
increased superior translation with active elevation leading to compression of supra-humeral structures
caused by anterior instability and posterior capsule tightness, as well as mechanical abrasions of acromion
what are the risk factors for subacromial impingement syndrome
increased age (arthritis)
scapular dyskinesia (irregular shoulder blade movement, moves with flexion to 120 degrees)
postural dysfunction (rounded shoulders, shoulder be 1 hand space between blades)
overhead athletes
What is the clinical presentation of subacromial impingement syndrome
painful arc due to poor scapular rhythm
decreased willingness to move shoulder due to pain
anterolateral arm pain
pain lifting things above head
pain with abduction over 90 degrees
How is subacromial impingement syndrome managed
physical therapy
PRICE
NSAIDs
activity restriction
- *this is the general baseline and can be applied to a lot of other injuries too**
What is a SLAP Lesion
a superior labral lesion that is both anterior and posterior
results from single traumatic events from a FOOSH injury
can also be due to multiple repetitive microtraumatic injuries
What are the 4 types of SLAP lesions
Type 1 - fraying of labrum, lose horizontal abduction and external rotation
Type 2 - aka bankart (most common) pathalogical detachment of labrum and biceps tendon anchor leading to decreased stabilization, also includes fraying/peeling off of biceps tendon
Type 3 - Bucket handle tear, vertical tear of labrum, but the remaining labrum and biceps are intact
Type 4 - bucket handle tear with torn biceps tendon , involves extension of bucket handle tear into biceps tendon, causing displacement into the GH join causing pain
What is the clinical presentation for a SLAP Lesion
pain w overhead activities
catching/locking of the bucket handle in the subacromial space
loss of shoulder stability
How is a SLAP lesion managed
type 1 - non operative, physical therapy
Type 2/3/4 - operative, requires resect/reattach surgery and then PT for 16-20 weeks
What is rotator cuff pathology
damage to rotator cuff, usually the supraspinatus due to it being a watershed area and its location
caused by repetitive stress, compression, and tensile overload
What are the risk factors for rotator cuff pathology
being older than 40, and being an overhead athlete
what is the clinical presentation of rotator cuff pathology
pain, weakness/loss of ROM, painful arc, dull ache radiating into upper arm, worse pain when lying on affected side
What is a AC joint sprain
acromioclavicular joint sprain
injury to AC and CC joint
caused by trauma (car accidents, sports injury like FOOSH, or direct trauma)
FOOSH most common
WHat are the grades for AC joint sprain
grade 1 - partial tear, but still usable
grade 2 - full or partial AC tear with partial CC tear, pain and limited ROM
grade 3 - full AC and CC tear, full loss of function/no strength or stability and a visible bump
What is the clinical presentation of an AC sprain
assymetry of injured and noninjured side
tenderness on palpation of the AC joint
positive cross-arm adduction test
decreased flexion and abduction
how is an AC joint sprain managed
PRICE
physical therapy
surgery
What is the empty can test
pt stands while examiner forward flexes the arm to 90 degrees, then forcibly medially rotates the shoulder
tests for impingement, very poor specificity tho
WHat is the Speeds test
pt tries to flex shoulder while examiner holds arm down while pt is in supinated, pronated, and then fully extended
positive test causes tenderness in bicipital groove, especially with supination, due to biciptal paratendonitis
poor specificity
What is the hawkins-kennedy test
examiner forward flexes arm to 90 degrees and then forcibly medially rotates the shoulder
positive pain indicates supraspinatus tendonosis or secondary impingement
poor specificity
What is the Neer impingement test
pt arm is passively fully elevated in scapular plane with arm being medially rotated by examiner, forcing GH head into subacromian space
indicates overuse injury to supraspinatus muscle
poor specificity
What is a diagnostic ultrasound
used to assess shoulder
uses transducers (device that sends and receives ultrasound waves) and measures time it takes for waves to be reflected back to produce an image
high frequency imaging with low amplitude
What are the indications for a diagnostic ultrasound
can be used to diagnose superficial pathologies
used for soft tissue injures, tumors, bone infections, arthropathy, and to evaluate bone mineral density
What are the advantages to diagnostic ultrasound
readily available,
cheaper than other modalities,
no ionizing radiation
non invasive
allows for real time imaging
what are the disadvantages to diagnostic ultrasound
small field of view, high presence of artifacts
What is Naproxen
NSAID used to treat tendonitis, arthritis, gout, and pain
must ask if pt has heart conditions before giving
what are the contraindications for naproxen
asthma or use during coronary artery bypass surgery
What are the side effects of naproxen
edemas, rashes, abdominal pain/constipation, dizzyness, headache, dyspnea
What is the shoulder pain and disability index?
13 item questionaire that assesses pain (5 item) and disability (8 item)
0-100 scale
can detect change in pts with shoulder injury, with no floor/ceiling effect
MDC = 19.7 points
MCID = 20 points
What is the role of a sport psychologist
enhance performance using mental strategies
cope with competition pressures
recover from injuries/deal with pain
keep up with exercise program
enjoy sports again and promote healthy self esteem
What is an integrated support team
team of people that support coaches/athletes
may include : physiologist, sports psychologist, biomechanist, nutritionist, physical therapist/athletic therapist, and physician
goal to ensure athletes are ready for optimal performance
WHat are the 3 phases of rehabilitation
acute - inflammatory tissue healing
recovery - strengthening and correcting biomechanical abnormalities
functional - requires adequate strength and full ROM, involves advanced strengthening of scapular stabilizers
What are the components to return to sport
promote return to previous activity level
sport specific goals
typically return once full ROM and strength is obtained
What is the percentage of tear for the 3 grades of muscle injuries
grade 1 - 0-19%
grade 2 - 20-99%
grade 3 - 100%
better to just say complete or incomplete tear
What are the 3 stages of muscle healing
destruction - muscle fibre and connective tissue sheaths are disrupted
repair - hematoma/collagen/ matrix formation and satellite cells proliferate/differentiate into myofibrils
remodelling phase - regenerated muscle matures and contracts with reorganization of scar tissue
Anatomy of the hand that is vulnerable if you have a fall
Distal Radial region
Scaphoid on ulnar side => the hook of hamate or pisiform
*hint
Arterial Supply of the hand (and watershed areas)
there are watershed areas around the scaphoid causing avascular necrosis becasue blood flows DISTAL to PROX (less flow)
- if a fall occurs the artery gets severed
*hint
Triangular Fibrocartilage complex tear classes
Class 1A: central tear of the fibrocartilage disk tissue (I)
Class 1B: ulnar-sided peripheral detachment (II)
Class 1C: tear of the volar ulnar extrinsic ligament (III)
Class 1D: radial sided peripheral detachment (IV)
*hint
Triangular Fibrocartilage complex tear etiology
axial loading, ulnar deviation, and forced extremes of forearm rotation
eg. pushups w/wide grip
Triangular Fibrocartilage complex tear presentation
ulnar-sided pain between the carpal bone and ulnar bone
- pain doing the mechanism that caused the injury
- swelling, crepitus (only 1B and 1D)
- weakness/instability
- TOP and very localized
Triangular Fibrocartilage complex tear treatment
activity modification
- wrist strngthening
- PRICE (can apply to anything with enough justification)
- endurance training if RSI related
Scaphoid Fracture
Un-displaced/displaced fragment of the scaphoid
Scaphoid fracture etiology
FOOSH
Scaphoid fracture complications
Avascular necrosis (watershed area) => degeneration and loss of bone density
scaphoid fracture clinical presentation
posterior radial sided wrist pain
- tenderness over snuff box
- swelling
- dec concavity of snuff box
scaphoid fracture treatment
fracture protocol
- progressve loading
-protocol is dependent bc load bearing bone
standard scaphoid fracture treatment
first xray even if negative - immobilize for 7-10 days
- the xray is shit at picking up the fracture
get 2nd xray after 7-10 days
- if +ve => 6 weeks cast
*hint
is xray for acute scaphoid fracture able to detect
no they not
Distal radial fracture types
Colles: whole wrist moves posteriorly
Smith: whole wrist moves anteriorly
barton: articular wrist fracture of the distal radius
*hint
distal radial wrist fracture eitiology
colles: FOOSH
smith: fall on flexed wrist
barton: direct and violent injury to wrist or sudden pronation of the distal forearm on the fixed wrist
Distal radial fracture risk factors
inc age
female
distal wrist fracture clinical presentation
swelling
gross deformity
dec ROM
TOP
distal radial fracture treatment
splint?
progressive overload - est for barton bc its low recovery and icn bony growth dec rom
wrist sprain
a ligament is stretched, twisted, lacerated, or torn
wrist sprain eitiology
FOOSH
wrist sprain clinical presentation:
swelling around wrist joing
- pain on ulnar or radial deviation
- bruising, difficulty w wrist movemement
wrist sprain treatment
activity mod
wrist strengthening
PRICE (bc you cant narrow down injury w/o imaging)
NSAID
complex regional pain syndrome (CRPS) types
CRPS Type 1: pain syndrome reflex sympathetic - dystrophy pain syndrome is triggered by a harmful event - not limited to damage to a single peripheral nerve
CRPS type 2: pain syndrome causalgia - direct or partial or complete injury to a nerve or 1 of it’s major branches
CRPS aetiology
exaggerated inflamm response or autonomic dysregulation with an overly active sympathetic nervous system
CRPS Clinical Presentation (stages)
Stage 1: sever pain; pitting edema; redness; warmth; inc hair and nail growth; hyperhydrosis; OA may begin
Stage 2: continued pain; brawny edema (hard); periarticular thickening; cyanosis or pallor (lack of O2 = blue fingers); inc OA
stage 3: pallor; dry; cool skin; atrophic soft tissue (dystrophy); contractures; bad OA
*Hint
CRPS clinical diagnosis requirements
didnt have CRPS before noxious event or without nerve lesion
- spontatneous pain, hyperalgesia
- edema, skin flow, sudomotor abnormalities, motor symptoms
CRPS treatment
meds
psycho/behavior therapy
pt/ot
lifestyle changes
alternative therpy
- its a lifelong condition not curable
what is osteopenia
dec in bone mineral density between 1-2.5 standard deviations below yound/adult mean of BMD
what is osteoporosis
a bone mineral density more than 2.5+ standard deviations under the normal mean
- type 1 - postmenopausal
- type 2 involutional (aging)
- occurs in 50% women 50+y/o
- inc risk of vertebral wedge, hip fracture, wrist fracture
Osteoporosis and osteopenia risk factors
Non-modifiable: genetics, female, family history
modifiable: pregnancy at early age
smoking/ alcoholism
sedentary / prolonged bed rest
dec Ca+ intake
anorexia
*hint
does eating calcium supplementation inc regional bone mineral density
no - neither in femur or spine
does eating vit D supplementation inc TOTAL bone mineral density
no but there was an inc in femoral neck BMD
lift test
for triangular fibrocartilage complex
- place palms flat on backside of table and aksed to lift table
- local pain in ulnar side of wrist and difficulty applying force pos+ tear of TFCC
press test (sitting hands test)
placing both hands on chair arm rests to get up nad apply pressure
- stress of axial load on wrist - synovitis or wrist pathology
watson test
put wrist in full ulnar deviation
press thumb and pinch on scaphoid on palmer side
radially deviate
- should cause sublux of scaphoid if its unstable (wtf thas wild)
watson test in predicting scaphoid injury
no - shit specificity and ok sensitivity
patient rated wrist evaluation
2 scales : pain and function
- 5 items - severity, intensity, and frequency of pain
- 10 items for function
- everything is 0-10 scale (10 is worst) calculated /100
can the patient rated wrist evaluation detect change in pain and function in wrist fractures
yes it can detect meaningful change in patients w/wrist fractures
DEXA Scan
duel xray absorptiometry
- high precision, short scan time, low radiation and accurate
when is thumb spica cast indicated
pain with anatomical snuff box pain - 3 weeks then xray
is spica thumb cast good for fracture healing
no (ded) its actually detrimental to healing (wtf)
- you atrophy and regression of the ROM and joint thats fractures
what is a dietician and who would u send to a dietician
regulated health professionsla about potential of food
- science of nutrition
- pateints with:
diabetes, malnutrition, cancer, heart health, preggo
- not the same as nutritionist
*hint
What is lateral epicondylitis
tennis elbow (hella common)
inflammation with degeneration at the origin of extensor muscles
affects the extensor carpi radialis brevis and usually due to gradual overuse
what are the risk factors for lateral epicondylitis
35-50 years old
female (less muscle mass and more torque to elbow)
smoking history
what is the clinical presentation for lateral epicondylitis
distal swelling and pain in the area distal to epicondyle
tenderness
increased pain with resisted wrist extension
cant lift or carry shit on that side
what is the treatment for lateral epicondylitis
PRICE
physical/active therapy
NSAIDs
Bracing - can lead to dependance on bracing due to psychosocial reasons
steroids
WHat is triceps tendonitis
asympotmatic tendinosis to complete rupture
tendon thickening and degeneration, progressing to collagen fibre rupture
caused by repetitive extension of arm
what are the risk factors for triceps tendonitis
weightlifting
steroid use
what is the clinical presentation for triceps tendonitis
localized tenderness of the triceps insertion that is aggravated with resisted elbow extension
What is the treatment for triceps tendonitis
PRICE physical/active therapy
NSAIDS
Bracing
steroid injections
WHat is radial tunnel syndrome
compression of the deep branch of the radial nerve in the radial tunnel
radial tunnel shrinks when supinator muscle swells up
caused by direct nerve trauma, compressive neuropathies, neuritis
What is the clinical presentation of radial tunnel syndrome
poorly localized burning or shooting pain over radial aspect of proximal forearm
weakness of finger/thumb extensors
tenderness in extensor muscles in forearm
how is radial tunnel syndrome treated
PRICE
physical therapy
NSAIDs
Bracing
steroid injection surgery
what is olecranon impingement syndrome
mechanical abutment of bone and soft tissues in posterior compartment of elbow
caused by fibrous deposits and chondral injury, or excess bone growth
what are the risk factors for olecranon impingement syndrome
boxing/throwing
what is the clinical presentation of olecranon impingement syndrome
crepitus
swelling
posterior elbow pain
locking/stiffness
how is olecranon impingement syndrome treated
depends on cause, if inflammation then control, tightness then stretch, bone spur needs surgery, and rupture of surrounding structures needs removing of scar tissue and structures
What is de quervains tenosynovitis
inflammation of abductor pollicis longus and extensor pollicis brevis tendon sheaths, the tendons pass thru sheath and that can be compressed leading to this
very common, can be caused by wringing towels, over exertion with any hand intensive activities
what is the clinical presentation for de quervains tenosynovitis
pain in lateral wrist during grasp and thumb extension with tenderness
stiffness and local swelling around radial radial styloid
What is carpal tunnel syndrome
fiberous hypertrophy of synovial flexor sheath
caused by repetitive wrist activities or sustained wrist flexion
what are the risk factors for carpal tunnel syndrome
being 35-55 years old
what is the clinical presentation for carpal tunnel syndrome
muscle atrophy, pain/numbness in medial nerve distribution, nocturnal pain
what is throacic outlet syndrome
compression of neural or vascular anatomic structures that pass thru thoracic outlet
usually compressed in interscalene triangle, first rib/clavicle/subclavious, or the coracoid process/pec minor
can be
traumatic
chronic (muscle sprain of scap stabilizers)
developmental (improper decending of scap on posterior thorax
what is the clinical presentation for thoracic outlet syndrome
pain when arm elevated above 90 degrees
pain localized in neck, face, head, and chest
can lead to numbness, weakness, tingling, swelling, etc
What is trigger finger
swelling of flexor tendon sheath that doesnt let the tendon glide normally
caused by repetitive trauma
what are risk factors for trigger finger
diabetes and arthritis
very correlated to systemic diseases
what is the clinical presentation of trigger finger
snapping, triggering or locking of finger as it is extended and flexed
tenderness and tender nodule over metacarpal head
what is olecranon bursiitis
swelling of bursa, caused by trauma or repetitive grazing
what are the risk factors for olecranon bursitis
aged 20-50
students
what is the clinical presentation of olecranon bursitis
swelling over elbow and discomfort when elbow is flexed past 90 degrees
warmness and redness indicated infection
What is cervical radiculopathy
dysfunction of nerve roots exiting spinal cord, causing compression of roots
caused by poor posture and pathologies that cause lateral stenosis (hole gets smaller)
What is the clinical presentation of cervical radiculopathy
triceps, wrist, and finger extension weakness
pain in arm
how is cervical radiculopathy treated
correct posture
physio/rehab
steroid injections
surgery
What is cozens test
examiner resists pronation, radial deviation, and extension of wrist. if pain then positive, shitty test tho
what is mills test
forearm is passively pronated, flexed, and elbow extended, lateral epicondyle pain is positive
shitty test
what is the finkelstein test
used to determine if dequervains exists
1st proximal interphalangeal joint is flexed, positive if pain over abductor pollicis longus and extensor pollicis brevis
high false positives
what is the write test
arm is elevated above head to test for compression in costoclavicular space
very sensitive, but not accurate in detecting TOS
what is the phalen test
wrists are flexed and pushed together for 1 min, positive is indicated by tingling in median nerve fingers, caused by carpal tunnel
not good test for carpal tunnel syndrome
What is tinels sign
area of ulnar nerve in the groove is tapped and should cause tingling in forearm
most distal point of tingling is limit of nerve regeneration
poor specificity and sensitivity
what are neural tension tests
tests to determine if neural tension exists, poor specificity/sensitivity due to poor setups
What is the DASH questionaire
30 item survey to describe disability of upper extremity over time
MDC is 19.0, if less than that likely due to chance so better to observe n wait
What is RULA
used to identify risk factors for upper limb, comprises 3 stages :
recording of working posture
scoring system
scale of action levels
high score=bad
What is ROSA
quanitfy risks of computer work for office workers
includes 3 sections:
chair
monitor/telephone
keyboard/mouse sections
no correlation w ROSA and upper limb disorders
What is lyrica
med that helps treat fibromyalgia, neuropathic pain, and diabetic neuropathy
cant take if hypersensitive to pregabalin
lots of side effects (dont need to know)
what is zoloft
used for depression, panic disorder, OCD and PTSD
cant be taken with MAOIs, pimzide, or disulfiram
inhibits serotonin uptake and acts as anti depressant
causes low sex drive, constipation/vomitting, and dizziness
What is physiotherapy
assess, treat, and manage pain, movement dysfunction, and chronic conditions
goal to empower, promote indepenance, and improve quality of life
many areas of practice
what are the 7 controlled acts a physio can do
- communicate a diagnosis identifying a disease or disorder
- move joints of spine beyond physiological range using fast, low amplitude thrust
- tracheal suctioning
- treating open wounds
- rehab/assess pelvic musculature
- order application of prescribed energy form
- administer substance by inhalation
what is worksafe BC
no fault insurance for workplace
promote prevention of injury illness and disease
provide fair compensation to those injured
what is the role of a worksafe bc case manager
show care and compassion while building successful relationships
apply law and policy to make decisions that address management/benefits
record and explain detailed/complex info
manage varied caseload w input from dif team members
what are the qualifications of a case manager
undergrad degree
min 3 years of adjudication experience
disability management experience
what are demographic risk factors for work related injuries
low education and high BMI
what are physical risk factors for work related injuries
high repetitive work, over 50kg lifted overhead per hour, and standing for over 30min per hour
what are psychosocial risk factors for work related injuries
low job satisfaction
why is there a relationship between workplace injuries and depression
losing job due to injury is like losing a part of identity, and this often results in depression
what ligament is responsible for resisting side head movement
alar ligament
what ligament prevents posterior/anterior sheering of head and keeps dens in place
transverse ligament of atlas
What are the 3 types of cervical fractures
occipital condyle fracture - head compression
dens fracture - anterior/posterior trauma
hangmans fracture - hyperextension of the neck (traumatic spondylolisthesis)
what are the risk factors for a cervical fracture
young males
what is the clinical presentation of a cervical fracture
constant cervical region pain
muscle spasms over a long period of time
may or may not lead to spinal cord injury
what is a cervical disk herniation
combination of mechanical compression of nerve by bulging nucleus pulposis and inflammatory cytokines
more likely to occur posteriolaterally due to thinner annulus fibrosis and less structural support
caused by repetitive trauma or microtrauma
Cervical disc herniation risk factors
- 45-55 y/o
- heavy manual labour
- smoking
- driving or operating vibrating equipment (sus)
cervical disc herniation clinical presentation
*radiculopathy presentation
- severe pain preventing comfortable position
- arm pain
-sensory and motor deficits
- neck pain and scapular pain
what is whiplash associated disorder
Injury going from extension => flexion forcefully
resulting damage can cause injruies to:
- soft tissue, joint capsule, ligament, Zjoint, central/peripheral nerves, interverbal disc & vascular structure
grades of whiplash associated disorder
Grade 1: subjective neck
- complaints of pain, stiffness, and tenderness - no physical signs
grade 2 (most common): musculoskeletal signs: dec ROM and TOP
Grade 3: neurological symptoms - muslce weakness or sensory deficits
Grade 4: fracture/dislocation
whiplash disorder aeitology
Motor vehicle accidents
- sport injuries that involve blow to head/neck region or heavy landing (diving)
- pulls and thrusts of the arms
- falls/landing on the trunk or shoulder
Whiplash disorder risk factors
(all MVA related)
- whether the seat back breaks
- the occupant hits the front of the occupant space (read end)
- differential motion between seat back and occupant
- hyperextension of neck in a restrain
- rebound neck flexion as head rebounds off the headrest
Whiplash presentation
- upper motor neuron syndrome
- periodic loss of consciousness
- dizziness
- doesnt move neck even slightly = fractured dens
-painful weakness of neck uscles (fracture) - gentle traction and compression of neck = pain (fracture)
- severe muscle spasm (fracture)
what is Z joint sprain/dysfunction
any acquired degeneration of trauma of the facet joints in teh cervical region of the head
- also entrapment of the synovial membrane by thte z-joint
zjoint dysfunction aeitology
trauma such as fall or MVA
treatment of zjoint dysfunction
PRICE, mobilize, strengthen
zjoint dyfunction clinical presentation
-unilateral neck pain
-locking of the neck after sudden movement
-muscle spasm/guarding
-dec rom in extension or ipsilateral rotation
-usually flexion makes it worse and ext makes it better bc the muscles of the vertebrae
what is acute torticollis (Wry neck)
injury to the muscles, joints or ligaments thru sleeping with the neck in unusual position
acute torticollis aetiology
acute form - over night in young and middle age adults
acute torticollis clinical presentation
-sore/painful neck - visible and palpable
-marked limitation in a ROM of neck
- pateint may hold head in a comfy position TOWARD stiff muscle
treatment of acute torticollis
dont do anything it resolves itself lmao
rest, stretch, hot/ice pack, not really an injury just a fuckin sore neck bitch
what is icbc
a group of money laundering assholes
- an insurance agency across BC (legislative) that gices people support after MVAs, vehicle repairs, settlements, and care and recovery
icbc care process
report it
go to dr get assessment
treatment
icbc will pay
recovery
what is the alar ligament stress test and spec/sen
patient lies supine, head in neutral and the pt stabilizes the axis and the side flexes the head and axis
spec = 0.90
sen = 0.91(depending on good/bad set up)
what is the neck diability index
-NDI is self-rated disability for neck pain
- pain intensity, personal care, lifiting, work, headache, concentration, sleep, driving, ,and reading and rec
- 0-5 (total = 50 - high score = disable like nav)
transverse ligament stress test
pt puts 2 thumbs on the ant. transverse process of C2 to stabilize it and a finger on the occiput applying a posterior force
spec= 0.99
sen= 0.65 depending on setup
spec/sen of NDI
NDI is reliable and is able to detect change in patients with neck pain
MCID: 10-19
what is cervical vertigo
originates from a neck disturbance of the tonic neck reflex from the vestibular nucleus
-from cervical joint dysfunction or SCM
- alteration to the proprioceptive spinal afferents from the mechanorecpetors of the neck
cervical vertigo aetiology
trauma and whiplash disorder
cervical vertigo clinical presentation
(lick my) neck, back, (pussy and crack) and suboccipital pain
- stiffness (in cock region)
- vertigo
- nystagmus
-headaches
cervical motion abnormalities
(sorry navie pls dont kick me off the flashcards <3)
cervical vertigo types and symptoms
Type 1: Barre-Lieou syndrome:
- sympt: headache pain dizziness nausea, tinnitus
- phys therapy and pain management
- not seen as medical condition
type 2 cervical proprioceptive vertigo:
-sympt: dizzy, neck pain, headache
- medical history, phys exam, imaging
- manage underlying cervical issues - therapy, exercises, medication
type 3 rotational vertebral artery vertigo:
- sympt: dec blood flow thru vertebral arteries during neck pos change (rotation) - vertebrobasilar artery insufficiency
type 4 migraine associated cervicogenic vertigo:
-sympt: vertigo, pain, migraines, light sensitivity, nausea,
cause: interaction between migraine and Cerv spine dysfunct
diagnosis: med image, history
treatment: migraine and cervical spine - physical therapy
*hint know
vertigo vs dizziness
dizzy = you cant stop moving after spinning
vertigo = the world is spinning but youre not moving
cervicogenic headache what is it
referred pain percieved in any part of the head - nociceptive source of the musculoskeletal tissues innervated by cervical terms
(its a fuckin headache)
aeitology of cervicogenic headache
whiplash
postural dyfunction
cervicogenic headache risk factor
desk/computer work dec cervical spine rom, inc neck pain, high NDI score
cervicogenic headache presentation
pain localized to neck and occipital -projecting to the head
pain aggravated by specific movement or sustained neck posture
resistance or limitation of active/passive physiological neck movement TOP or muscle tenderness
traumatic brain injury (concussion) what is it (primary and secondary)
Primary: diffuse axonal injury - laceration, contusion, hemorrhage casuing damage to neurofilament subunits within the axonal cytoskeleton
secondary: brain swelling (vasogenic/cytotoxic edema)
- release of excitotoxic levels of excitatory neurotransmitter
- impaired Ca+ homeo
- Oxy free radicals, and inflamm
=> leads to cerebral blood vessel constriction (ischemic neuronal death)
concussion aeitology
fall, strike by somthing, MVA
concussion clinical presentation
loss of cosciousness, Post trauma amnesia, sensory impairment
motor function impariment
impaired balance
minimally conscious or vegetative state
(concussion presentation is like youre absolutely plastered)
Benign paroxysmal positional vertigo (BPPV)
benign = nonthreat life
paroxysmal = suddenly
positional - triggered by certain head opsitions
vertigo - false sense of movement (rotational or swaying/rocking etc)
vestibular system overview (what is it does and the anatomy)
filled with endolymph
enlarged at one end = ampula - inside that = cupula with hairs and jello
saccule and utricle = otolith organ linear accel response thru the otoconia (crystals on the hairs)
BBPV Pathophysiology (2types)
cupulolithiasis: fragments of the otoconia break (crystal) and stick to the cupula (in jello) in the semicircular canals
canalithiasis: crystal (otoconia) floating freely in the semicircular canals
BPPV aeitology
-head trauma
-vestibular neutritis
- degeneration of the inner ear
-vestibular artery compromise
inc age = risk factor
BPPV Clinical presentation
- vertigo
- nystagmus
- sypt are 30-60 sec long
vertebrobasilar artery insufficiency (what is it)
damage or occlusion to the vertebral arteries, bc they are tooo close to the bony and ligaments of cervical spine
*hint (know for sure)
vertebrobasilar artery insufficiency aeitology
external: extracranial pressure, extracranial dissection due to trauma
internal: atherosclerosis or thrombosis in teh arteriovenous fistulas (tubes like arteries that connect vessels)
signs and symptoms of BPPV
-drop attacks
-dizzy
-dysphagia, diplopia, dysarthria
- nystagmus
- nausea/numbness
whats a ct scan and indicationsq
soft tissue imaging
- 3D Xray
- head trauma, stroke, headache
- lesions, seizures
hydrocephalus and hematoma
cranial nerve assessment tells us
about what nerve might be affected/injured depending on the abnormal response found by clinician
vertebrobasilar artery positional test and what the major downsides are
testing positions:
- sustained full neck and head extension
- sus full neck/head rotation right and left
- sus N&H rotation with left/right extension
=> lack of validity to detect dec blood flow
conflicting systematic responses cant predict or detect arterial disseciton and risk for manipulation
Dix-Hallpike test
- used to identify BPPV
- test is performed by having patient on a seated up table head rotated 30-45 deg
- patient is assisted into supine below horizontal and held for 30-60 sec
- do both side rotations and dizziness/nystagmus = pos test
cerebellar finger to nose /finger to finger
pos:
delay in movement initiation
terminal tremor (contractions)
dysmetria (inaccurate speed, force or distance)
cerebellar heel to shin (same as finger to nose but inclusive)
dysmetria
dyssynergia - flexing hip and knee in sequence cannot occur in a smooth pattern
= pos
rebound test
slap in the face test - braking the movement
rapid alternating movement
- Dysdiadochokinesia – difficulty
performing rapid alternating
movements by alternating thru pronation/supination
