Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Orthopedics > MDT for Cervical Spine > Flashcards

MDT for Cervical Spine Flashcards

1
Q

What are the cardinal features of MDT (mechanical diagnosis and therapy)

A
  • Classification of subgroups
  • Focus on centralization
  • Self-treament & patient education
  • Progression of forces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does MDT differ from other treatment approaches

A
  • Repeated movements used to assess & manage condition
  • Patient independence
  • Avoids dependence on therapist
  • Minimal intervention/least amount of force used to treat
  • Directional preference exercises used for pain relief
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the MDT classifications

A
  • Derangement
  • Dysfunction
  • Posture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is postural syndrome

A
  • Intermittent pain brought on only by prolonged static position
  • Rarely seen in clinic
  • Pain is localized
  • No pain with movement
  • No ROM deficits
  • Posture correction abolishes symptoms
  • Exam is normal and only has pain in the painful posture and once corrected it goes away
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe management of postural syndrome

A
  • Education on link b/w posture & pain
  • Education on link b/w lumbar & cervical postures
  • Education on posture correction: attain posture & maintain posture
  • Education on avoidance of aggravating postures
  • Posture correction
  • Slouch-Overcorrect
  • Can implement use of lumbar posture support and/or cervical night roll
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe dysfunction classification

A
  • Pain caused by mechanical deformation of structurally impaired soft tissue: contracture, scarring, adherence, adaptive shortening of tissue
  • Intermittent pain that oNLY occurs at end range of the restricted movement
  • Gradual onset due to lack of use or 6-8 wks post-trauma
  • Pain is localized (except in case of adherent nerve root)
  • Symptoms do NOT persist after repeated movement testing
  • Named for the ROM deficit
  • Recovery can take 6-8 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe management of dysfunction

A
  • Long recovery
  • Perform the restricted movement 10-15 reps every 2-3 hrs
  • Exercise must produce their pain every rep
  • Pain should subside following exercise within 10 min
  • If pain persists, overstretching has occurred or maybe you have exposed an underlying derangement
  • Maintenance: once ROM restored & without pain perform 1-2 times daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe adherent nerve root

A
  • Hx of radiculopathy or spine surgery
  • Intermittent symptoms into arm/forearm
  • Consistent reproduction of symptoms with loading: typically shoulder abd, elbow extension, wrist extension with contralateral cervical lateral flexion or cervical flexion
  • No rapid change & no lasting reproduction of distal symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe management of adherent nerve root

A
  • Cervical flexion
  • Cervical flexion with patient overpressure
  • Cervical lateral flexion (away from the pain)
  • Cervical lateral flexion with patient overpressure
  • Elbow ext. in shoulder ABD with lateral rotation
  • Elbow ext. in shoulder ABD/lateral rotation with wrist extension
  • Elbow ext. in shoulder ABD/lateral rotation with neck flexion/lateral flexion
  • Will take several wks at least for recovery
  • With each movement perform the opposite C-spine movement to expose underlying derangement if present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is derangement

A
  • Most common classification
  • Onset can be gradual or sudden
  • Somatic, radicular, or combination
  • Symptoms are variable & inconsistent
  • Pain can change sides, move distal/proximal = CENTRALIZATION & PERIPHERALIZATION
  • Movement can increase/decrease symptoms
  • Sustained postures can increase/decrease symptoms
  • Temporary deformity may be present: wry neck or kyphosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the hallmarks of derangement

A
  • Centralization
  • Peripheralization
  • Rapid change
  • Variable symptoms
  • Mechanically determined directional preference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a mechanically determined directional preference

A
  • Postures or movements in one direction decrease, abolish, or centralize & restore movement
  • Postures & movement in opposite direction can worsen/peripheralize & reduce ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe pain

A
  • Sensory, cognitive, & emotional components
  • Nociception is how our body detects & processes painful stimuli
  • Nociceptors are activated by thermal, mechanical stress, & chemical/inflammatory
  • Innervated structures of lumbar spine that can produce pain: facet joint capsule, outer layer of annulus fibrosis of intervertebral disc, vertebral bodies, dura mater, nerve root sleeve & connective tissue of nerves, spinal musculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the different types of pain

A
  • Somatic: MSK structures, when referred is deep ache, vague
  • Radicular: nerve root pain, follows dermatomal pattern
  • Central: pain related to abnormal CNS problem
  • Visceral: organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the McKenzie pain phases and their identifiers

A
  • Chemical: constant, acute onset, signs of inflammation (swelling, rumor, color, tenderness), all movements are painful, & no movement reduces Sx
  • Mechanical: intermittent but can also be constant, certain repeated movements reduce or abolish/centralize Sx, & movements in one direction may lessen Sx whereas Sx in another direction may increase Sx
  • Chronic: may not be influenced by mechanics alone, need to account for psychosocial factors, length of time present does not mean mechanical assessment & treatment are not beneficial, may take longer than pts that are not chronic, & chronic pain may not respond to treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications to MDT

A
  • Spinal cord lesions
  • Fractures & ligamentous instability
  • Tumors
  • Spinal infection
  • Dizziness
  • Vertebrobasilar insufficiency
  • Gait/upper limb abnormality
  • Bilateral UE & LE symptoms
  • Hyperreflexia, bowel/bladder, spasticity
  • Recent surgery: fusion 3 mo to 1 yr for good stabilization, discectomy no concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Red flag clues

A
  • Age >55
  • Hx of CA (cancer)
  • Unexplained weight loss
  • Constant, progressive, non-mechanical pain, worse at rest
  • Systemically unwell
  • Persisting severe restriction of lumbar flexion
  • Widespread neurological deficit
  • Prolonged steroid use
  • Hx of intravenous drug use
  • Hx of significant trauma enough to cause fracture or dislocation (X-rays will not always detect Fx)
  • Hx of rival trauma & severe pain in potential osteoporotic individual
  • No movement or position centralizes, decreases, or abolishes pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Physical exam using MDT

A
  • Assess posture & effects of posture correction
  • Neuro exam if paresthia in UE, weakness in UE, or radicular symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is wry neck

A
  • Lateral deviation
  • Significant if occurs with onset neck pain
  • Unable to correct voluntarily
  • If able to correct cannot maintain
  • Right deviation = vertebra above has laterally flexed to right
  • Left deviation = vertebra above laterally flexed to left
  • Contrtalateral = head shifted away from painful side
  • Ipsilateral = head shifted toward painful side
20
Q

Describe the different upper limb tension tests

A
  • Ulnar: “eye hole” with thumb & index finger
  • Median: scapular depression, shoulder ABD, ER, elbow ext., supination, wrist ext.
  • Radial: scapular depression, shoulder ABD, IR, elbow ext. pronation, & wrist flexion
21
Q

Describe repeated movement testing

A
  • Assess mechanical baselines before movement
  • Pain after performing repeated movement
  • Is pain during movement? (PDM)
  • Is pain only at end range? (ERP)
  • Reassess mechanical baselines
  • Sagittal plane movements have greatest effect
  • Lateral movements used initially with wry neck, sagittal plane will not be tolerated
  • Testing in sitting is easier but this is loaded position & may not be tolerated
  • Once a repeated movement decreases, abolished, or centralizes pain further testing of movements is not always necessary
22
Q

Describe static testing

A
  • Indicated when repeated movements do not effect symptoms
  • Indicated if pt only reports symptoms with prolonged position: postural classification, intermittent derangements
23
Q

Terminology during movement

A
  • Increase: Sx already present increase in intensity
  • Decrease: Sx already present decrease in intensity
  • Produce (P): Sx produced that were not present
  • Abolish (A): No longer have Sx after testing
  • Centralizing: Movement of pain from distal to proximal
  • Peripheralizing: Movement of pain from proximal to distal
  • No effect (NE): Movement has no effect during testing
24
Q

Terminology after testing

A
  • Worse (W): Sx produced or increased w/ movement & remain aggravated after testing
  • Not worse (NW): Sx produced or increased w/ movement return to baseline after testing
  • Better (B): Sx decreased or abolished during movement remain better after testing
  • No better (NB): Sx decreased or abolished during movement or loading return to baseline after testing
  • Centralized: Distal pain abolished by movement that remains abolished after testing
  • Peripheralized: Distal pain produced during movement testing remains after testing
  • No effect: Movement or loading has no effect on Sx after testing
25
Q

What does LCDF stand for

A
  • Location: differentiate peripheral site pain vs radicular
  • Classification: derangement, dysfunction, postural syndrome, mechanically inconclusive, other
  • Direction: choosing the direction that best fits the assessment
  • Force: patient generated, loaded or unloaded, patient overpressure, clinician overpressure, clinician mobilization, manipulation
  • Build your care starting at L
  • Modify your care starting at F
26
Q

What is failure to classify

A
  • Classification should be confirmed within 3-5 visits
  • Recent neck trauma: whiplash associated disorder
  • Other conditions: stenosis, mechanically inconclusive, chronic pain state, shoulder
27
Q

Extension principle clues from the history (~60%)

A
  • Onset related to flexion task
  • Flexion activities worsen
  • Extension activities decrease or abolish
28
Q

Extension principle clues from the examination (~60%)

A
  • Poor posture
  • Posture correction affects Sx
  • Loss of multiple movements
  • Greatest loss of extension
  • Extension may be obstructed or painful
  • Lateral movements less limited than sagittal
  • Repeated flexion worsens mechanical presentation & Sx
  • Retraction/extension decreases, abolishes, or centralizes
  • Repeated retractions improves extension ROM
  • Presence of kyphotic deformity (fixed in protrusion/flexion)
29
Q

Lateral principle clues (~20%)

A
  • Unilateral or asymmetrical Sx
  • Flexion & extension aggravate Sx
  • Directional preference for rotation or lateral flexion
  • Lateral movement is asymmetrical with major loss in one direction
  • Sx improve with lateral movements
  • Peripheralization or worsening of peripheral Sx with flexion/extension
  • Presence of wry neck (clinically relevant lateral deviation of the spine)
  • Sx unchanged with trial of sagittal plane
30
Q

Flexion principle clues (~5%)

A
  • Symmetrical or asymmetrical Sx
  • Anterior/anterolateral Sx
  • Pain or problems with swallowing
  • Recent MVA
  • Pain on neck flexion
  • Major loss of flexion
  • Pain free full extension
  • Repeated flexion increases ROM & decreases Sx
31
Q

What are the stages of management of derangement

A
  • Reduction
  • Maintenance of reduction
  • Recovery of function
  • Prevention of recurrence
32
Q

Describe reduction of derangement

A
  • Establish treatment principle that centralizes, abolishes, or decreases Sx & restores function
  • Regular performance of pain alleviating exercises
  • Posture correction
  • Force progressions if indicated
  • Ongoing re-evaluation of treatment principle if improvement ceases
33
Q

Describe maintenance of reduction for derangement

A
  • Avoidance of aggravating postures, positions, & activities: use of postural supports
  • Regular performance of directional preference exercise
34
Q

Describe recovery of function for derangement

A
  • restorre all movements once reduction is maintained ~5 days
  • Recovery of flexion “5 X 5 X 5”: 5 reps of flexion, 5 reps of extension, 5 times per day, progress force to self overpressure after 5 days, produce central pain not worse response is okay
  • Lateral flexion utilized in C-spine more than L-spine & therefore recovery of contralateral lateral flexion may be needed
  • Recovery of function not needed in anterior derangement
35
Q

Describe prevention for derangement

A
  • Continue with daily ORM to maintain full mobility
  • Avoid prolonged sustained postures
  • Lifelong use of lumbar support roll
  • maintain healthy active lifestyle
36
Q

What are the stages of force progerssion

A
  • Patient generated
  • Patient overpressure
  • Therapist overpressure
  • Mobilization
  • Manipulation
37
Q

Describe static patient generated force

A
  • Mid range
  • End range
38
Q

Describe dynamic patient generated force

A
  • Repeated motion mid range
  • Repeated motion to end range
  • Repeated motion end range with patient overpressure
39
Q

Describe clinician force

A
  • Patient motion in mid range with clinician overpressure
  • Patient motion to end range with clinician overpressure
  • Mobilization
  • Manipulation
40
Q

Describe force alternatives

A
  • Loaded vs unloaded position
  • Loading strategy in sitting may peripheralize/worsen Sx, however performing in supine may decrease & centralize Sx
  • Change direction: remember coupling of lateral flexion & rotation, one motion may be tolerated better
41
Q

Describe extension principle for retraction

A
  • Retraction
  • Retraction w/ pt overpressure ( have the patient rotate/”wiggle” their head a little)
  • Retraction w/ clinician overpressure
  • Retraction mobilization
  • Can be performed sitting, standing, supine, or prone
  • May need to perform on pillows & progress to no pillows
42
Q

Describe extension principle for retraction/extension

A
  • Retraction & extension
  • Retraction & ext. w/ rotation
  • Retraction & ext. w/ rotation & clinician traction (supine only)
43
Q

Describe lateral principle for lateral flexion

A
  • Can be performed sitting or supine
  • Lateral flexion
  • Lateral flexion w/ pt overpressure
  • Lateral flexion w/ clinician overpressure
  • Lateral flexion mobilization
  • Lateral flexion manipulation
44
Q

Describe lateral principle for rotation

A
  • Can be performed sitting or supine
  • rotation
  • Rotation w/ pt overpressure
  • Rotation w/ clinician overpressure
  • Rotation mobilization
  • Rotation manipulation
45
Q

Describe flexion principle

A
  • Can be performed sitting Orr supine
  • Flexion
  • Flexion w/ pt overpressure
  • Flexion w/ clinician overpressure
  • Flexion mobilization
46
Q

How do you fill out the McKenzie form

A
  • Circle activities/symptoms that are always there or always aggravate/alleviate Sx
  • Underline those that occur sometimes
  • Cross out those that never occur
47
Q

Progression of forces for least to greatest

A
  • Patient generated
  • Patient overpressure
  • Clinician overpressure
  • Mobilization
  • Manipulation

Advanced Orthopedics (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions