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DPT MSK - fall 22 > IDD - Exam 2 > Flashcards

IDD - Exam 2 Flashcards

1
Q

what parts of the disc tear in acute IDD?

A

annulus
end plate

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2
Q

persistent IDD is disc changes that allow for herniations that develop ________

A

gradually over time

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3
Q

is acute or chronic IDD the most prevalent?

A

chronic

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4
Q

the layers of the annulus are more like a _______ which means the annulus and nucleus move ____(together or separate)___

A

gradient
together

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5
Q

the outer annulus has greater type _____ collagen and resists _______

A

type I
tension

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6
Q

the inner annulus has greater type _____ collagen and resists _______

A

type II
compression

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7
Q

true or false. from outer to inner annulus, it goes hyper to hyponeural

A

true

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8
Q

annulus:
- vascular or avascular?
- concentric rings w/ ________ fibers
- compression produces _______ and vice versa

A
  • avascular
  • perpendicular
  • tension
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9
Q

nucleus:
- resists _______
- type ____ collagen
-high # of _______
- vascular or avascular?

A
  • compression
  • type II
    -GAGs
  • avascular (depends on diffusion to get nutrients)
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10
Q

Vertebral endplate: “pipeline of body and disk”
-highly _____ and _______
-assists w/ ________ for disk

-covers the _____ and MOST of annulus with __________
-_________is (type?) toward the vertebral body
-_________is (type?) toward the disc

A

-innervated and vascularized
-nutrient diffusion
-nucleus; specialized connective tissue
-articular cartilage type II
-fibrocartilage type I

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11
Q

The __________ is the weakest link of the intervertebral joining, especially at the annular connection.

A

vertebral end plate

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12
Q

What is made up of type I collagen and 6x stiffer and 3x thicker than a disc?

A

bone

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13
Q

Is IDD more often times persistent or acute?
Rare in what spinal region?

A

persistent
thoracic spine
(most common in lumbar spine)

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14
Q

Why is it rare to have internal disc derangement (IDD) in the T-spine?

A

because the t-spine is the narrowest canal which means it has less room to accept change.

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15
Q

Why is it rare to have IDD in the C2-C6 region?

A

because of the additional stability from the UV jts.
-creates more stability

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16
Q

What portion of the disc is the MOST common area
-Why?

A

posterolateral
-weaker, thinner, with more vertical and, less oblique annular fibers

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17
Q

The transition of the annulus into _______is the weak spot

A

endplate

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18
Q

Acute IDD is more commonly _______ tear and _______ avulsion
Less commonly ______________ herniation

A

-annular and end plate
-nucleus pulosus

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19
Q

Does the immune system respond when disc structures are damaged? why?

A

Yes
large autoimmune inflammatory response occurs –> more water –> spinal nerve and disc swelled –> spinal nerve sensitized to pressure/tension –> radiculopathy/radicular S&S –> excess water has no where to go because poor drainage = extended inflammatory phase

20
Q

typical postlat IDD acute symptoms:

A

dull/achy spinal pain
– annulus highly innervated
– less swelling due to less GAGs
radiculopathy
– segmental paresthesias within 24 hours into distal extremity because of additional water buildup
referred pain
decreased pain laying supine/unloaded
increased neck pain looking down (due to tension)
increased pain in morning

21
Q

how does S&S of acute IDD differ from age related joint changes and lateral stenosis? (regarding flexion and extension)

A

age & stenosis = pain increased looking up
acute IDD = pain increased looking down

22
Q

what are you going to find in a scan for postlat acute IDD?

ROM?
MMT?
stress test?
neuro?

A

ROM:
flx & contralateral SB/RT limited w/ increased extremity & spinal pain due to pressure toward spinal nerve
ext & SB/RT less limited w/ decreased extremity pain but may increase spinal pain due to increased hydrostatic pressure on disc

MMT:
variable

Stress test:
possible + with compression/distraction/PA pressures

neuro:
+ depending on severity and timing
myotomal fatigue
DTR- hyporeflexive
diminished dermatomes
+ dural mobility tests

23
Q

what is centralization?

A

abolition of distal and/or spinal pain in a distal to proximal direction in response to repetitive motions or sustained positions

24
Q

what are you going to find in a biomechanical exam for postlat acute IDD?

A

+ stability tests

25
Q

central IDD (central vs postlat) is rare, but if found it would have what S&S? what would you do immediately after finding these S&S?

A

cord S&S
immobilize and emergency referral

26
Q

the McKenzie method is based on the belief that most of the pain comes from ___

A

injuries to the disc

27
Q

in the McKenzie method, the classification system is based on (2)

A

location of symptoms
positions that decrease symptoms

28
Q

McKenzie method is more effective in ______ spine
least effective in ______ spine

A

lumbar
cervical

29
Q

McKenzie’s method intends to put the patient in what position?

A

puts patient in positions that offset the symptoms

30
Q

true or false. aggressive nonsurgical treatment is not effective in treating disc injuries

A

false - still very effective using:
- intermittent traction
- specific therex
- oral anti-inflammatory medication
- patient education

31
Q

what are some Rx for acute IDD?

A

POLICED
intermittent traction may be helpful if no centralization
neural mobilizations
MET used for tissue proliferation and stabilization of local muscles –> targets deeper structures that help to handle stress better moving forward

32
Q

what is persistent IDD also known as?

A

degenerative disc disease
age related disc changes

  • no recent trauma
33
Q

IDD is more commonly found in _____ spine
if in cervical, what segment is most common? why?

A

lumbar
C5-6 –> C6 spinal nerve
– most involved because it has the largest diameter in C spine due to many innervations from brachial plexus

34
Q

what causes persistent IDD?

A

acute IDD
sedentary lifestyle / understressing (sitting all day)
genetics - can be modified by lifestyle changes

35
Q

how does persistent IDD come about?

A

in growth of nociceptive fibers from acute IDD healing can lead to persistent inflammation and nociplastic pain
–> persistent inflammation brings excessive and destructive proteins and a low grade infection to the disc

36
Q

what is happening to the disc in persistent IDD after the endplate is damaged from acute IDD?

A

persistent herniations gradually develop once changes occur with the disc

37
Q

what are the categories of herniation?
what is the most common herniation?

A
  1. protrusion - bulge
    ** most common herniation
  2. extrusion - nucleus migrates thru outer annulus
    – hole in cheek, tongue poking out
  3. free sequestration - nucleus breaks away from annulus
    – tongue out of cheek and cut
38
Q

what is likely to develop when the nucleus migrates into the vertebral body?

A

Schmorl’s nodes

39
Q

what three things narrow with persistent IDD?

A

disc - instability may develop
increased load bearing on facets - age related joint changes may occur
foramen - stenosis may develop

40
Q

quick or slow progression of symptoms with persistent IDD?

A

slower progression of symptoms because slow change allows tissues to adapt without symptoms

41
Q

onset of persistent IDD symptoms are _____

A

gradual
may be like acute S&S
need to consider other conditions that may develop & their respective S&S

42
Q

how would you treat persistent IDD?

A

possibly like acute IDD (POLICED) without inflammatory interventions
need to consider primary driver of symptoms from other conditions (instability, age related, stenosis)

43
Q

what is the prognosis for IDD? (2)

A

mostly good
extended timeline of healing for ligament and cartilage

44
Q

what is peripheralization? is it better or worse outcome than centralization?

A

sending more symptoms further down the extremity
worse outcome

45
Q

what is peripheralization significantly associated with? (5)

A

mental distress
non organic signs i.e. tumor
pain behaviors
somatisation - anxiety into bodily symptoms
fear of work

46
Q

what are MD treatment options for IDD? (5)

A
  • antibiotics - to treat infection
  • laminectomy (cut parts of the lamina to create space)
  • partial discectomy (shave off a portion of disc)
  • cervical fusion
  • total disc replacement (TDR): safe and effective treatment more than 5 years postop

DPT MSK - fall 22 (18 decks)

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