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?

25
What are some Chiro management of Cervical Myelopathy?
- Contraindication to HVLA (DON'T ADJUST) - Managed by MD - Mobilize - Extension exercises - Rehab for limbs
26
What are 4 mechanisms that cause Facet Syndrome?
- Degeneration - Trauma - Inflammation - Cartilage erosion
27
What are some Symptoms of Facet syndrome in C-Spine?
- Axial neck pain [Unilat] - Pain w EXT. + ROT. - Tender palpation - Refer to Shoulder / Mid Back
28
What are some Clinical Evaluation of Facet Syndrome?
- Compression & Distraction tests helps INDICATE
29
What is the GOLD STANDARD for Facet Syndrome Dx?
- Medial branch block (anesthetic injection) ** (+) = Response to 2 diagnostic blocks @ 2+ lvls **
30
What are 5 Chiro management of Facet Syndrome [5]?
- TENs - Shockwave (Performs better than other stim) - Pulse electromagnetic therapy - Myofacial soft tissue massage - Tape / Rehab *** Manipulation w. exercise encouraged by literature **
31
What is Whiplash?
- Trauma resulting in Musculolig. sprain/strain
32
What are some Causes of Whiplash?
- Sudden accel. / decel. of Head relative to Trunk - In ANY PLANE
33
Whiplash can even occur at ______ mph
- 5 mph
34
MVA what can cause Whiplash [4]
- Roller Coaster - Sports - Punched - Shaken baby
35
Amount of car damage is..
- Inversely proportional to Whiplash incidence
36
Grades of Whiplash
0: No complaints 1: Neck pain, no physical signs 2: Decrease ROM, point tenderness 3: Neuro signs 4: Neck pain w Fx
37
Median time to RECOVER from WAD (Whiplash)
~ 101 days ** Still not recovered after 1 yr **
38
Paresthesias assoc w. WAD can attribute to... [4]
- TOS - Myofascial injury - Stretch injury of Brachial Plexus - Central cord injuries
39
WAD injuries include these 5 components:
- C-Spine muscle tear - C-Spine Lig tear - Disc Herniation - Instability / Sprain - Esophageal Hematomas
40
4 causes of Retropharyngeal Hematoma
- Hyperextension to airbag - Cough / Sneeze / Vomiting - WAD - Trauma
41
What is Myelomalacia?
- Softening of spinal cord - Can bring Hemorrhagic Infarction to spinal cord
42
UNILATERAL facet dislocation causes ________ BILATERAL facet dislocation causes ____
Radiculopathy Cord injury (compression)
43
What are 3 Affects of muscle spasm?
- Wide open sensory gate and blocked mechanoreception - Metabolic waste accumulation - Prolonged spasm leads to myofascial pain syndrome
44
Explain the Tonicity scale [1-4]
+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
What is the WAD PT intake protocol:
- Cervical radiographs w. Flex/Extension - Normal / Mild loss of lordosis
46
Traditional management of WAD [4]
- Rest - Analgesic (Anti-Inflam) - Oral meds / Injections - Collar
47
What are 4 chiro management results of treating WAD?
- Heal soft tissue 1st - Aim to reduce pain / inflammation - Expedite healing - Encourage mobility
48
When to REFER in WAD Patient?
- Fx - Instability - Soft tissue damage - Neuro deficit
49
What is the Purpose of C1/C2?
- Support occiput - Provides greatest ROM in C-Spine while maintaining support
50
What are two Conditions that lead to Upper cervical instability?
- Down Syndrome (30%) - RA (25%-80%)
51
What are the 4 Types of Upper Cervical Instability?
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
Explain Type 3 & 4 Upper Cervical instability:
- Highly unstable and require ER immediately
53
3 main Radiograph requirements for C-Spine instability:
- 3mm or 25% ANT. body movement - 25% vertebral body compression - 11 degree of angular instability
54
Asymptomatic Cervical unstable patients can be minored with what?
- Be monitored with MRI ** if worsens, neuro consult is required **
55
Cervical Instability & Chiro management can be used for:
- Type 1 & 2 are co manageable - Type 3/4 are surgery ** NO HVLA at all ***