Lecture Final Flashcards

1
Q

What is cervical radiculopathy?

A

Any process that causes irritation, compression, or dysfunction of one or more of the cervical nerve roots

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2
Q

What is implied when there is a diagnosis of radiculopathy?

A

The presence of objective signs of nerve pathology (motor, sensory, reflex changes)

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3
Q

What are the two major causes of true cervical radiculopathy?

A
  1. Herniated cervical disc
  2. Lateral canal stenosis
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4
Q

What is the most common cause of cervical radiculopathy?

A

Herniated nucleus pulposus

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5
Q

What is the definition of herniated nucleus pulposus?

A

A focal displacement of nuclear material outside the peripheral disc margin

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6
Q

True or false: Nucleus pulposus herniation is less common in the cervical spine than in the lumbar spine

A

True

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7
Q

What age group typically experiences nucleus pulposus herniations due to disc desiccation?

A

Patients under 40 years of age

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8
Q

What is herniated nucleus pulposus often associated with?

A

Acute trauma

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9
Q

What are the 4 stages/types of disc herniation?

A
  1. Disc degeneration
  2. Protrusion (also called prolapse or bulge)
  3. Extrusion
  4. Sequestration
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10
Q

What is disc protrusion?

A

The disc protrudes into the spinal canal but the nucleus pulposus is contained within the annulus fibrosis

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11
Q

What symptoms are associated with disc protrusion?

A

Often asymptomatic

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12
Q

What is disc extrusion?

A

The nucleus pulposus leaks out through the annulus but still remains within the disc

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13
Q

What symptoms are associated with disc extrusion?

A

Pain (the nuclear material stimulates an inflammatory response)

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14
Q

What is disc sequestration?

A

The nucleus pulposus breaks through the annulus fibrosis and fragments become free in the spinal canal

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15
Q

What symptoms are associated with disc sequestration?

A

The free fragment can cause unpredictable and severe nerve compression, as well as possible permanent neurological damage

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16
Q

What causes lateral canal stenosis?

A

Bony spurs forming as a result of cervical spondylosis (degenerative changes)

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17
Q

True or false: Degenerative changes are always associated with symptomology

A

False

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18
Q

Which age group typically experiences lateral canal stenosis?

A

Patients over 40 years of age

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19
Q

True or false: Patients with lateral canal stenosis often have a history significant acute trauma

A

False (correction: often no history of acute trauma)

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20
Q

The C5 nerve root exits from which disc level?

A

C4/C5 disc

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21
Q

What is the pain pattern characteristic of C5 radiculopathy?

A

Neck, shoulder, medial border of the scapula, and upper arm

22
Q

What is the sensory disturbance of C5 radiculopathy?

A

Deltoid area and the radial aspect of the upper arm

23
Q

What is the reflex disturbance of C5 radiculopathy?

24
Q

What is the pattern of motor loss that is characteristic of C5 radiculopathy?

A

Deltoid, biceps, supraspinatus, and infraspinatus

25
The C6 nerve root exits from which disc level?
C5/C6 disc
26
What is the pain pattern characteristic of C6 radiculopathy?
Neck, shoulder, medial border of the scapula, radial aspect of the upper arm and forearm, thumb, and index finger
27
What is the sensory disturbance of C6 radiculopathy?
Thumb and index fingers, radial aspect of the hand and forearm
28
What is the reflex disturbance of C6 radiculopathy?
Biceps and brachioradialis
29
What is the pattern of motor loss that is characteristic of C6 radiculopathy?
Biceps, brachioradialis, and wrist extensors
30
The C7 nerve root exits from which disc level?
C6/C7 disc
31
What is the pain pattern characteristic of C7 radiculopathy?
Neck, dorsal and palmar surfaces of the forearm, medial border of the scapula
32
What is the sensory disturbance of C7 radiculopathy?
Middle finger
33
What is the reflex disturbance of C7 radiculopathy?
Triceps
34
What is the pattern of motor loss that is characteristic of C7?
Triceps, wrist flexors, and finger extensors
35
The C8 nerve root exits at which disc level?
C7/T1 disc
36
What is the pain pattern characteristic of C8 radiculopathy?
Neck, scapula, ulnar aspect of the upper arm and forearm, ring fingers, and pinky fingers
37
What is the sensory disturbance of C8 radiculopathy?
Ring finger, pinky finger, and medial forearm
38
What is the reflex disturbance of C8 radiculopathy?
There is no reflex
39
What is the pattern of motor loss that is characteristic to C8 radiculopathy?
Finger flexors and abductor pollicus brevis
40
What are the 3 keys signs that indicate cervical radiculopathy should be included as a differential diagnosis?
1. Spurling sign 2. Relief with manual cervical distraction 3. Bakody's sign
41
What is Spurling sign?
Pain that radiates down the arm during extension, lateral flexion, and axial loading on the affected side
42
What is Bakody's sign?
Relief of arm pain by placing and resting the patient's forearm on the top of the head
43
What is reverse Bakody and what does it suggest?
Increased arm pain when resting the forearm on the top of the head, which suggest TOS
44
Are the 3 clinical signs (spurling sign, relief with distraction, bakody's sign) sensitive or specific?
Highly specific, but only about 50% sensitive
45
True or false: A patient with all 3 clinical signs (spurling sign, relief with distraction, bakody's sign) is very likely to have radiculopathy, but a person with radiculopathy may not have any of these signs
True
46
What is pseudoradiculopathy?
Neck pain radiating into the arms that is not necessarily due to cervical nerve root irritation
47
Pain associated with pseudoradiculopathy is commonly caused by ___ referral
Sclerotome-like (pain patterns do not follow a typical dermatomal distribution)
48
What causes pain to refer in a sclerotome-like pattern?
Myofascial trigger points in paraspinal musculature and shoulder girdle muscles
49
What are the typical referral patterns of scalene trigger points?
Pain may refer into the shoulder and arm, as well as the hand, medial border of the scapula, and chest
50
What is referred to as the "anatomical bermuda triangle"?
The scalene muscle group
51
Which muscles have trigger point referral patterns that resemble cervical radiculopathy?
Scalenes, infraspinatus, and supraspinatus
52
What are the common causes of pseudoradiculopathy?