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evidence based managment > L3 > Flashcards

L3 Flashcards

1
Q

What are three Outcome Assessments Tools

A
  • Neck Disability Index
  • VAS
  • Numeric Pain Scale
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2
Q

Cervical Disc Derangement

A
  • Disruption in Disc Integrity
  • Due to traumatic or gradual microtrauma
  • MC in 18-50 yo
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3
Q

MC location of Cervical Disc Derangement

A
  • C5/6
  • C6/7
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4
Q

Steps in Cervical Disc Derangement

A
  • Annular (radial) fissure damage
  • Nucleus herniates OUT DISC = Disc herniation
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5
Q

IVD Dz breakdown

A
  • MC in Lumbar
  • 2nd MC in Cervical
  • Least Common in Thoracic
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6
Q

What is the description of a Disc Protrusion

A
  • Base WIDER THAN Herniation
  • Confined to disc lvl
  • Outer annual fibers intact
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7
Q

What is the description of a Disc Extrusion?

A
  • Base NARROWER THAN Herniation
  • Extends above or below endplate
  • Complete annular tear
    *** uncontained **
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8
Q

What is the definition of a Disc Sequestration?

A
  • Disc herniation breaks off -> Spinal Canal
  • Symp. span across many N. Roots
  • Requires surgery
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9
Q

What is the definition of the Cervical Disc Derangement symptoms [4]

A
  • Neck pain / Arm pain
  • Worse w. cough/sneeze/bearing [Triad of Dejerine]
  • Worse w. Ext/Rot/LF
  • Pain referred to Occiput
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10
Q

What are some palliative factors to cervical disc?

A

derangement
chin retraction
good posture
cervical traction

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11
Q

You want to order an MRI in Cervical Disc Derangement if the following occur:

A
  • PT fails to improve w. conservative care
  • Worsens / Neuro Deficit
  • Red flags present
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12
Q

What are the 4 Medical Management of Cervical Disc Derangement [4]?

A
  • NSAIDS
  • Corticosteroids
  • N. Block
  • Surgery
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13
Q

What are the 5 Chiro Management of Cervical Disc Derangement [5]

A
  • Stim
  • Soft tissue / Traction
  • Mckenzie
  • F &D / Adjust
  • Taping / Rehab (Chin tucks, Wall angels)
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14
Q

What are three Causes of Cervical Radiculopathy?

A
  • Disc herniation
  • IVF encroachment
  • Chemical irritation
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15
Q

What are three Symptoms of Cervical Radiculopathy?

A
  • Pain / Numb / Tingling
  • Weakness in UE
  • Stiff neck -> Decreased ROM
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16
Q

What are three Imaging for Cervical Radiculopathies?

A
  • Radiograph
  • MRI
  • EMG (Studies N. Root)
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17
Q

What are 6 Chiro Management of Cervical Radiculopathy [6]?

A
  • Stim
  • Soft tissue / Traction
  • Mckenzie
  • F &D / Adjust
  • Tape / Rehab (Chin tucks, Wall angels)
  • N. Flossing
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18
Q

What is Cervical Myelopathy?

A
  • Compression of Cervical Spinal Cord
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19
Q

What are some Causes of Cervical Myelopathy [4]?

A
  • Post. Protruding Disc
  • OPLL
  • Degen change
  • Spinal stenosis
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20
Q

What are some Symptoms of Cervical Myelopathy?

A
  • Weak muscle (SPASTIC)
  • Gait Disturbance
  • Bowel/bladder Disturbance
  • Neck pain/stiffness
    Hyperreflexia in LE
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21
Q

What are some Signs of Cervical Myelopathy [5]?

A
  • Hand muscle Atrophy
  • HYPERreflexia below compression lvl
  • Neck flexion causes shock pain down back [L’Hermitte’s]
  • Finger escape sign
  • Inverted Radial Reflex
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22
Q

What is the Finger escape sign?

A
  • PT hold hand with extends fingers
  • Medial (4th/5th) will deviate with flexion
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23
Q

What is the Inverted radial reflex?

A
  • C6 root compression with cord compression
  • Weak brachioradialis reflex w. SPASTIC finger flexors
    they have C6 reflex diminished with spasticity at C8
24
Q

What is the Best IMAGING for assessing changes to Spinal Cord?

A
  • MRI
25
Q

What are some Chiro management of Cervical Myelopathy?

A
  • Contraindication to HVLA (DON’T ADJUST)
  • Managed by MD
  • Mobilize
  • Extension exercises
  • Rehab for limbs
26
Q

What are 4 mechanisms that cause Facet Syndrome?

A
  • Degeneration
  • Trauma
  • Inflammation
  • Cartilage erosion
27
Q

What are some Symptoms of Facet syndrome in C-Spine?

A
  • Axial neck pain [Unilat]
  • Pain w EXT. + ROT.
  • Tender palpation
  • Refer to Shoulder / Mid Back
28
Q

What are some Clinical Evaluation of Facet Syndrome?

A
  • Compression & Distraction tests helps INDICATE
29
Q

What is the GOLD STANDARD for Facet Syndrome Dx?

A
  • Medial branch block (anesthetic injection)
    ** (+) = Response to 2 diagnostic blocks @ 2+ lvls **
30
Q

What are 5 Chiro management of Facet Syndrome [5]?

A
  • TENs
  • Shockwave (Performs better than other stim)
  • Pulse electromagnetic
    therapy
  • Myofacial soft tissue massage
  • Tape / Rehab
    *** Manipulation w. exercise encouraged by literature **
31
Q

What is Whiplash?

A
  • Trauma resulting in Musculolig. sprain/strain
32
Q

What are some Causes of Whiplash?

A
  • Sudden accel. / decel. of Head relative to Trunk
  • In ANY PLANE
33
Q

Whiplash can even occur at ______ mph

A
  • 5 mph
34
Q

MVA what can cause Whiplash [4]

A
  • Roller Coaster
  • Sports
  • Punched
  • Shaken baby
35
Q

Amount of car damage is..

A
  • Inversely proportional to Whiplash incidence
36
Q

Grades of Whiplash

A

0: No complaints
1: Neck pain, no physical signs
2: Decrease ROM, point tenderness
3: Neuro signs
4: Neck pain w Fx

37
Q

Median time to RECOVER from WAD (Whiplash)

A

~ 101 days
** Still not recovered after 1 yr **

38
Q

Paresthesias assoc w. WAD can attribute to… [4]

A
  • TOS
  • Myofascial injury
  • Stretch injury of Brachial Plexus
  • Central cord injuries
39
Q

WAD injuries include these 5 components:

A
  • C-Spine muscle tear
  • C-Spine Lig tear
  • Disc Herniation
  • Instability / Sprain
  • Esophageal Hematomas
40
Q

4 causes of Retropharyngeal Hematoma

A
  • Hyperextension to airbag
  • Cough / Sneeze / Vomiting
  • WAD
  • Trauma
41
Q

What is Myelomalacia?

A
  • Softening of spinal cord
  • Can bring Hemorrhagic Infarction to spinal cord
42
Q

UNILATERAL facet dislocation causes ________

BILATERAL facet dislocation causes ____

A

Radiculopathy
Cord injury (compression)

43
Q

What are 3 Affects of muscle spasm?

A
  • Wide open sensory gate and blocked mechanoreception
  • Metabolic waste accumulation
  • Prolonged spasm leads to myofascial pain syndrome
44
Q

Explain the Tonicity scale [1-4]

A

+1 : Sustained contraction, mild resistance in passive ROM
+2 : Sustained contraction, moderate resistance in passive ROM
3+ : Muscle rigidity, complete resistance to passive ROM
4+ : Spasm, triggered by movement to EX. irritation (poking muscle causes spasm)

45
Q

What is the WAD PT intake protocol:

A
  • Cervical radiographs w. Flex/Extension
  • Normal / Mild loss of lordosis
46
Q

Traditional management of WAD [4]

A
  • Rest
  • Analgesic (Anti-Inflam)
  • Oral meds / Injections
  • Collar
47
Q

What are 4 chiro management results of treating WAD?

A
  • Heal soft tissue 1st
  • Aim to reduce pain / inflammation
  • Expedite healing
  • Encourage mobility
48
Q

When to REFER in WAD Patient?

A
  • Fx
  • Instability
  • Soft tissue damage
  • Neuro deficit
49
Q

What is the Purpose of C1/C2?

A
  • Support occiput
  • Provides greatest ROM in C-Spine while maintaining support
50
Q

What are two Conditions that lead to Upper cervical instability?

A
  • Down Syndrome (30%)
  • RA (25%-80%)
51
Q

What are the 4 Types of Upper Cervical Instability?

A

I: simple rotary displacement with intact transverse
2: anterior displacement, 3-5mm, deficiency of transverse
3: anterior displacement beyond 5mm
4: posterior displacement of C1 on C2

52
Q

Explain Type 3 & 4 Upper Cervical instability:

A
  • Highly unstable and require ER immediately
53
Q

3 main Radiograph requirements for C-Spine instability:

A
  • 3mm or 25% ANT. body movement
  • 25% vertebral body compression
  • 11 degree of angular instability
54
Q

Asymptomatic Cervical unstable patients can be minored with what?

A
  • Be monitored with MRI
    ** if worsens, neuro consult is required **
55
Q

Cervical Instability & Chiro management can be used for:

A
  • Type 1 & 2 are co manageable
  • Type 3/4 are surgery
    ** NO HVLA at all ***

evidence based managment (8 decks)

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