Midterm Flashcards
Disc lesion: Patient leans away from the side of pain
Lateral disc lesion
Disc lesion: patient will lean toward the site of pain.
Medial disc lesion
Disc lesion: Patient will lean forward or not at all.
Subrhizal disc lesion
Disc lesion: Patient will have bilateral pain or switching pain and antalgias
Central disc lesion.
How long does it take to resolve a lateral disc lesion?
2 weeks
How long does it take to resolve a medial disc lesion?
4 weeks
How long does it take to resolve a subrhizal disc lesion?
4-6 weeks
How long does it take to resolve a central disc lesion?
6 weeks
Ortho and Neuro:
- Valsalva/determines
- SLR + at 45 degrees
- Neurological package (mildly + in 50% of disc pts)
- Pain pattern correlation
Chiropractic exam: ??
- Scope - sympathetic run to pain may be inconclusive.
- Static palpation - A lot of fluid and muscle guarded/spasms.
- Motion palpation - Difficult to perform but is still done.
- Percussion/vibration - (+) on spinous of involved segment.
- X-ray - APOM Full spine 14X36 and Lat. Full SPine (2 exposure) *May perform a standing lumbar regional series ONLY if the patient is leaned over too much with an antalgique position to get a proper full spine view.
OPQRST associated with Disc lesion:
Rapid onset radiating pain, made worse by sitting, standing, and walking and relieved by rest with the knees flexed.
Chiropractic management of Disc lesion:
1- Ice over affected disc.
2- Pump the disc. (Repeat until pt. can tolerate it well.)
3- Side Posture Pull Adjustment, contacting spinous BELOW the affected side.
Patient home care instruction: ??
How many time a day can a patient be seen for disc lesions? (How many hours apart?)
Can be seen 2 times a day, 6 hours apart.
*EVERYDAY until symptoms are noticeably improved and antalgique is reduced or gone.
Patient home care instruction:
4 indications
Ice every 20 minutes/hour
Walk at least for 5 minutes each hour.
Mild stretching of LB
NO SITTING
What is the appropriate follow up care for disc lesion?
With improvement:
- Adjust once/day afternoon or evening
When symptoms subside:
- Re-x-ray (14x36 FS) and continue subluxation correction
The layers of the annulus fibrosis are oriented : ?
How many layers surrounding the nucleus?
At 30 degrees to the horizon in a “criss-cross” pattern.
20-30 layers.
Which part of the annulus fibrosis of the lumbar spine is thin and tightly packed?
Posterior
What is an incomplete lamella?
Where is it most common?
One that ceases to pass around the circumference of the disc.
Posterolateral quadrant 50% of total, 40% is seen in any other quadrant.
Which “GAG” glycoaminoglycans are found in the IVDs?
- Chondroitin-6-sulphate
- Chondroitin-4-sulphate
- Keratan sulphate and hyaluronic acid.
What are the 2 types of proteoglycans?
Proteoglycans Units:
Several GAGs linked to a peptide chain.
Proteoglycans Aggregate:
Several proteoglycan unit linked to hyaluronic acid.
The annulus is about __-__% water by weight.
Where is the proteoglycan gel found?
60-70%
B/w each layer of collagen in the annulus, binds the lamellar together to prevent buckling or fraying.
The consistency of a healthy disc is like?
Toothpaste, it’s 70-90% water bound in a matrix.
Making the Matrix:
What are the % of dry ingredients that make up the matrix.
65% proteoglycans
25% proteoglycans aggregates
Pinch of Type II collagen which holds the proteoglycans together.
Annulus and nucleus have the same components just different ratio. Annulus had more _____ and Nucleus has more ________.
A: more collagen Type I and II
N: more proteoglycans
