Midterm Flashcards
Contraction vs contracture
Contraction: Movement of a muscle following the reception of an action potential resulting in muscle shortening
Contracture: shortening of tissue following immobilization or injury
Define Central sensitization
Nociceptive signals from injured tissue in the back can hypersensitive the WDR that also receives input from the leg
So now the leg can activate nociceptive p/way even though its not injured
Define convergence-projection
Ascending neurological pathways from the low back converge with pathways from the leg in the spinal cord
Define radiculopathy
AKA radicular pain. Pain originating from a nerve root and expressed in dermatomal pattern
Can occur due to nerve root compression or irritation
In Radicular Pain, what does patient report?
Sharp, shooting, and/or electrical
Define dermatome
Structures innervated by single nerve root
Define allodynia
Central pain sensitization following non-noxious, often repetitive, stimulation.
e.g. temperature or physical stimuli can provoke allodynia, which may feel like burning.
Different from hyperalgesia, which is extremely exaggerated reaction to a stimulus which is typically noxious.
What are WDR neurons?
Wide Dynamic Range Neurons are associated with gate control theory of pain. WDR neurons are responsible for eliciting a response to both painful and non-painful stimuli.
What are LTMs?
Low-Threshold Mechanoreceptor (non-noci input) are sensory receptors that respond to mechanical pressure or distortion. The theory indicates that stimulation of LTM neuron is responsible for the non-noxious stimuli associated with Gate Control Theory of pain. Providing the “over-riding” input to mask a pain/noxious stimulus.
How does muscle spasm produce pain?
Muscle spasm can lead to hypomobility.
Loss of mobility can lead to early degenerative changes.
Loss of mobility at one joint may promote hypermobility in another joint.
Pain because of lack of local circulation of synovial fluid.
What factors increase or decrease the development of degenerative joint disease (osteoarthritis)?
Hypomobile joints lead to degeration: 4-8 weeks of fixation leads to degenerative changes (based on animal model)
4 weeks - changes begin at articular surface of facets
8 weeks - osteophytes form from the facet
Changes did not appear to be reversible after fixation was removed.
Mobilization of joints can help reduce development of DJD
Differentiate nerve root compression from irritation
Compression: neurological deficits such as diminished sensation, diminished reflexes, motor weakness.
Irritation: dermatome pain/paresthesia and positive nerve tension test.
Simply put: compression = numbness while irritation = more pain
Differentiate radicular pain from deep referred pain
Radicular pain is caused by irritation, compression or damage to nerve roots.
Deep referred pain is usually NOT due to irritated nerve roots and nerve tension tests are often negative.
3 nerve root issues resulting in radicular syndrome
Irritated nerve roots
Compressed nerve roots
Both irritated and compressed
Symptoms of radicular syndrome from irritated nerve roots
Pain perception, paresthesia, increased sensitivity
Symptoms of radicular syndrome from compressed nerve roots
Loss of function, loss of sensation, strength or reflex
Symptoms of radicular syndrome from irritated AND compressed nerve roots
Hodgepodge of irritated and/or compressed symptoms
Differentiate radicular pain from deep referred pain by patient history
Radicular: dermatomal pain that might be sharp/electrical, dermatomal paresthesia, subjective numbness or weakness
Dee referred: diffuse pain, less likely to cross the knee/elbow
Differentiate radicular pain from deep referred pain by PHYSICAL EXAM
Radicular: positive tension test, muscle atrophy, loss of motor strength, depressed DTR, sensory loss
Deep referred: negative tension test, no neurological deficits
List 4 possible MSK sources of referred pain from low back
Disc Joint capsule Tendons Muscles *anything except the nerve root
List 3 mechanical and 2 neurological effects of spinal manipulative therapy
Neurological
- suppress both local and referred pain perception
- reduce muscle hypertonicity
Mechanical
- restore proper proprioceptive input
- activate inhibited muscles
- restore segmental/global mobility
CASE STUDY
A patient complains of low back pain that radiates into the posterior thigh and complains of numbness in the right foot. Physical exam reveals light touch and pain sensation are diminished over the symptomatic foot; ankle muscles test 4/5 on the mptomatic side; DTR’s are +2. Nerve tension tests aggravate the pain as far as the calf.
A. radicular syndrome, specific evidence of root irritation
B. radicular syndrome, specific evidence of root compression
C. radicular syndrome, specific evidence of BOTH root compression and irritation
D. deep referred pain syndrome.
C. Radicular syndrome with evidence of both root compression and irritation
CASE STUDY
A patient has pain that radiates into the groin and over the quadriceps; there are no neurological deficits; nerve stretch tests produce no symptoms.
A. radicular syndrome, specific evidence of root irritation
B. radicular syndrome, specific evidence of root compression
C. radicular syndrome, specific evidence of BOTH root compression and irritation
D. deep referred pain syndrome.
D. deep referred pain syndrome.
CASE STUDY:
A patient complains of subjective numbness in his toes as well as low back pain radiating to the foot. The SLR reproduces the pain, but only as far as the calf. There are no neurological deficits.
A. radicular syndrome, specific evidence of root irritation
B. radicular syndrome, specific evidence of root compression
C. radicular syndrome, specific evidence of BOTH root compression and irritation
D. deep referred pain syndrome.
A. radicular syndrome, specific evidence of root irritation
CASE STUDY
A patient presents with low back pain and right anterior thigh pain. The femoral stretch test creates a sharp pain along the front of the thigh but it does not cross the knee; the patellar DTR is +2, the patient has trouble resisting knee extension; there is no loss of sensation.
A. radicular syndrome, specific evidence of root irritation
B. radicular syndrome, specific evidence of root compression
C. radicular syndrome, specific evidence of BOTH root compression and irritation
D. deep referred pain syndrome.
C. radicular syndrome, specific evidence of BOTH root compression and irritation
CASE STUDY:
Pain radiates from the neck to the elbow. Shoulder depression and the brachial stretch test cause symptoms to the forearm. The biceps reflex is 0; shoulder abduction is mildly weak. The patient has no loss of sensation with routine “dull-sharp” and cotton ball testing.
A. radicular syndrome, specific evidence of root irritation
B. radicular syndrome, specific evidence of root compression
C. radicular syndrome, specific evidence of BOTH root compression and irritation
D. deep referred pain syndrome.
C. radicular syndrome, specific evidence of BOTH root compression and irritation
Anything with the word “radicular” refers to what location? And what is the distribution?
Nerve root; dermatomal pattern
