Lecture Midterm Flashcards
Range of motion measurement is viewed by some authorities as one of the few ___ tools to measure improvement and/or disability.
Objective
Gross ranges of motion contribute ___ to arriving at a diagnosis, and provide ___ measure of clinical progress.
Little; Only a very rough
True or False: It is usually necessary to document range of motion measurements in most cases, especially medicolegal cases.
True
What is the normal value for cervical range of motion in flexion?
50 degrees
What is the normal value for cervical range of motion in extension?
60 degrees
What is the normal value for cervical range of motion in right lateral flexion?
45 degrees
What is the normal value for cervical range of motion in left lateral flexion?
45 degrees
What is the normal value for cervical range of motion in right rotation?
80 degrees
What is the normal value for cervical range of motion in left rotation?
80 degrees
Which layer of the annulus fibrosus contains nociceptors and will cause pain when torn?
The outer 1/3rd
True or False: Most sources indicate that blood vessels and sensory nerve endings are present in the nucleus pulposus.
False (Correct: Blood vessels and sensory nerve endings are believed to be absent from the nucleus)
Beginning in the teenage years, the mucoid tissue of the nucleus pulposus is replaced with ___ arising from the ___ of the ___.
Fibrocartilage; Hyaline cartilage; Vertebral endplates
What happens to the nucleus pulposus during adulthood (by the age of 40)?
Dehydration throughout adulthood leads to the following characteristics of the nucleus by the age of 40:
- Dry
- Ligamentous
- Composed of fibrocartilage
- Islands of hyaline cartilage and tendon-like materials
- Little-to-no proteoglycans
How does the role of the disc in the cervical spine compare to that of the lumbar spine?
In the cervical spine the disc plays a greater role in resisting forces during rotation and translation, and less of a role in resisting axial load forces (unlike the discs in the lumbar spine)
What is another name for the uncovertebral joints?
Joints of Von Luschka
What are the uncovertebral joints?
They are the articulations between uncinate processes (on the posterior-lateral superior rim of the vertebral bodies) and the inferior bodies of the superior vertebra
Where are the uncovertebral joints found?
C3-C7
Describe the degenerative arthritic process of the uncovertebral joints?
As the vertebral discs degenerate and disc height decreases, the uncinate processes begin to approximate with the body of the vertebra above and results in degenerative changes
What are some adverse effects that may occur in response to degenerative arthritis of the uncovertebral joints?
Osteophytes can form and project into the disc space or intervertebral foramen, compressing the nerve roots and possibly producing radicular-like symptoms (pain that radiates in a pattern that coincides with the distribution of a nerve root)
True or False: The uncovertebral joints are sometimes considered to be “psuedojoints” because they have a synovial membrane with synovial fluid, but no true joint capsule
True
In the cervical spine, the nucleus pulposus is ___% of the entire disc by adulthood?
25%
In the lumbar spine, the nucleus pulposus is ___% of the entire disc by adulthood?
50%
True or False: The nucleus pulposus is smaller (in proportion to the entire disc) in the cervical spine than in the lumber spine
True
Where is the center of the nucleus pulposus found in the disc?
Posterior to the midline of the disc
What are the roles of the uncinate processes?
- Limit pure lateral flexion to only a few degrees
- Serve as guides to couple lateral flexion with rotation
True or False: In the mid-cervical spine (C3-C7), lateral flexion is coupled with physiologic rotation to the contralateral side
False (Correct: In the mid-cervical spine, lateral flexion is coupled with physiologic rotation to the ipsilateral side)
What are the motions of the cervical facet joints?
- During flexion, the facet joints glide anterior (“open up”)
- During extension, the facet joints glide posterior (“close down”)
- Closed-packed position is maximum extension
What is the orientation of the facet joints in the cervical spine?
20-45 degrees from the transverse plane (fit together like shingles on a roof)
Which joints have some studies implicated as being the main pain source in 54-67% of patients with chronic neck pain?
Facet joints (richly innervated with nociceptive nerve fibers)
True or False: Facet joints are true synovial joints.
True
___ occupy nearly half of the space in the cervical IVF.
Neural structures
Including:
- Ends of the ventral and dorsal spinal nerve roots
- Dorsal root ganglion
- Spinal nerve
- Meninges
- Recurrent meningeal nerve
True or False: Abnormalities in the cervical lordosis can be a significant factor in relation to severity and duration of a cervical trauma
True
Harrison et al proposed a mathematical model for the “ideal spine” based on what ratio?
Height-to-length ratio
What is the name of the technique that aims to achieve an “ideal spine”?
Clinical Biometrics of Posture (CBP), formerly known as Chiropractic Biophysics
What should be considered when deciding whether or not to treat an “abnormality”?
- Decision should be based on the needs of the patient, not just the presence of a perceived “abnormality”
- There should be a clear and meaningful clinical benefit to justify the additional therapy necessary to achieve a “correction”
How do you asses for joint dysfunction?
- Palpation for segmental tenderness over the posterior joint surfaces (facet joints) is the most sensitive test
- Manual joint palpation (motion scan) assessing “stiffness” is also fairly sensitive for the presence of joint dysfunction
What causes the “pop”?
Tribonucleation
What are cavitations?
The “collapse” of a partial vacuum within the joint fluid
What is tribonucleation?
A process where opposing surfaces resist separation until a critical point where they then separate rapidly creating gas bubbles
True or False: Cavitations release energy through shockwaves and can potentially cause damage to nearby surfaces
True
What is myofascial pain?
Pain attributed to muscle and its surrounding fascia
True or False: Myofascial pain syndrome can be diagnosed clinically with laboratory tests
False (Correct: There are no confirmatory laboratory tests available for myofascial pain syndrome)
The presence of trigger points within skeletal muscle upon examination is characteristic of what?
Myofascial pain
What is a trigger point?
A hyperirritable area located in a palpable taut band of muscle fibers (known to elicit local pain and/or referred pain in a specific recognizable distribution)
What are the two types of trigger points?
Active and latent
What is an active myofascial trigger point?
A site marked by the generation of spontaneous pain or pain in response to movement
What is a latent myofascial trigger point?
A site that may not produce pain until it is directly compressed
