Midterm

Question 1

Contraction vs contracture

Answer 1

Contraction: Movement of a muscle following the reception of an action potential resulting in muscle shortening

Contracture: shortening of tissue following immobilization or injury

Question 2

Define Central sensitization

Answer 2

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

Question 3

Define convergence-projection

Answer 3

Ascending neurological pathways from the low back converge with pathways from the leg in the spinal cord

Question 4

Define radiculopathy

Answer 4

AKA radicular pain. Pain originating from a nerve root and expressed in dermatomal pattern

Can occur due to nerve root compression or irritation

Question 5

In Radicular Pain, what does patient report?

Answer 5

Sharp, shooting, and/or electrical

Question 6

Define dermatome

Answer 6

Structures innervated by single nerve root

Question 7

Define allodynia

Answer 7

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.

Question 8

What are WDR neurons?

Answer 8

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.

Question 9

What are LTMs?

Answer 9

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.

Question 10

How does muscle spasm produce pain?

Answer 10

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.

Question 11

What factors increase or decrease the development of degenerative joint disease (osteoarthritis)?

Answer 11

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

Question 12

Differentiate nerve root compression from irritation

Answer 12

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

Question 13

Differentiate radicular pain from deep referred pain

Answer 13

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.

Question 14

3 nerve root issues resulting in radicular syndrome

Answer 14

Irritated nerve roots
Compressed nerve roots
Both irritated and compressed

Question 15

Symptoms of radicular syndrome from irritated nerve roots

Answer 15

Pain perception, paresthesia, increased sensitivity

Question 16

Symptoms of radicular syndrome from compressed nerve roots

Answer 16

Loss of function, loss of sensation, strength or reflex

Question 17

Symptoms of radicular syndrome from irritated AND compressed nerve roots

Answer 17

Hodgepodge of irritated and/or compressed symptoms

Question 18

Differentiate radicular pain from deep referred pain by patient history

Answer 18

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

Question 19

Differentiate radicular pain from deep referred pain by PHYSICAL EXAM

Answer 19

Radicular: positive tension test, muscle atrophy, loss of motor strength, depressed DTR, sensory loss

Deep referred: negative tension test, no neurological deficits

Question 20

List 4 possible MSK sources of referred pain from low back

Answer 20

Disc
Joint capsule
Tendons
Muscles
*anything except the nerve root

Question 21

List 3 mechanical and 2 neurological effects of spinal manipulative therapy

Answer 21

Neurological

• suppress both local and referred pain perception
• reduce muscle hypertonicity

Mechanical

• restore proper proprioceptive input
• activate inhibited muscles
• restore segmental/global mobility

Question 22

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.

Answer 22

C. Radicular syndrome with evidence of both root compression and irritation

Question 23

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.

Answer 23

D. deep referred pain syndrome.

Question 24

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.

Answer 24

A. radicular syndrome, specific evidence of root irritation

Question 25

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.

Answer 25

C. radicular syndrome, specific evidence of BOTH root compression and irritation

Question 26

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.

Answer 26

C. radicular syndrome, specific evidence of BOTH root compression and irritation

Question 27

Anything with the word “radicular” refers to what location? And what is the distribution?

Answer 27

Nerve root; dermatomal pattern