Mod 4 - Facts Blast Flashcards
cSMT and VBAs = chances are ?
1 in 1.5 M
NP Prevalence
2-12%
NPTF Rule of Thirds
R?
I?
P?
Recurrence
improvement
persistent
% of people who have Recurrence of NP
50-85%
Likelihood of a VBA stroke post cSMT?
1 in 1-2 M
What % of NP patients also have CFJS?
50%
90% of CDH occur at what level?
C5-C6
Incidence of WAD in Ontario?
0.6/thousand people/year
____ km/h is considered a “dangerous” MOI
100
(delta)v of ____ km/h is considered within ST tolerance?
8 km/h
Neck musculature responds requires up to ___ ms
220 (aka. far too late)
Upon impact in an MVA - G forces through the neck can be up to ____ times
5
Timeline for WAD
Acute
Subacute
Chronic
Last
2-4 weeks
4-8 weeks
12-16 weeks
full recovery
__% of WAD patients will recover within 6 months - 2 years?
75
WAD2 patients - what % will still have residual pain?
40-70%
Even though it is critical to catch it early on, AS patients tend to have a delayed Dx __-__ years
5-12 years
Name 3 scenarios where you will need to update informed consent
new condition
change in health status
> 2 years since they have last signed (even if they have been seeing you, or if they haven’t been into the office)
2 most frequently reported complications post-cSMT
VBA strokes (post rotary cSMT)and CES
List 7 Reg Flags or Contraindications of SMT
Recent high fever/infection, fractures, instability, unexplained weight loss/gain, night pain, corticosteroid use, cancer, acute myelopathy, CES, acute arthropathies
T or F: women are more likely to get NP and have longer/complex prognosis
T
T or F: torticollis is not a Dx but an observation
T
3 types of torticollis - differentiate them
congenital - muscular - good prognosis if addressed early on - conservative care and parental exercises (asso w/ hip dysplasia and plagiocephaly)
congenital - bony - limited Tx
acquired - usually post traumatic (unaddressed) or patho (disease-related)
3 most common symptoms with TOS
neuro symptoms down medial arm (usually ulnar)
aching pain down same arm
weakness and fatigue of the arm
What forces is the vertebral artery vulnerable to?
mechanical compression. shearing, stretch
General steps to a stroke
tear of intima turbulent flow clot factors aggregation clot formation embolism
Onset of signs and symptoms of VAS/VBA
temporal relationsihp
immediate onset of symptoms
thrombosis
5 D
1 A
3 N
diplopia, dizziness, dysphagia, dysarthria, drop attacks
ataxia
nystagmus, nausea, numbness
4 commonly discussed RF for VA dissection
MOSH
hypertension
smoking
oral contraceptives
migraines
What is PICA and how is it asso w/ Wallenburg syndrome
posterior interior cerebellar artery (ischemia of the medulla oblongata can elicit autonomic or balance dysfunctions)
Locked-in syndrome asso w/ what?
pontine artery occlusion
3 main causes of VBA dissection/occulsion
iatrogenic (due to medical folks), neck manip, trauma
GBD Index - causes of disability
1)
7)
8)
13/15)
GBD Index - causes of disability
1) LBP, NP
7) Migraines
8) Other MSK
13/15) Falls/OA
When it comes to CFJS, why may you hold off on SMT for the first few days of week?
facet hemoarthosis - may cause bleeding
Facet restricted motion - usually pain or no pain?
usually no pain…yet
Facet mechanical lock
locking due to intra-articular inclusions/menisci
Facet painful block. Responds well to which type of exercise?
bits of the synovial folds getting caught
isometric (multifidus involvement)
CFJS may present similarly to which two other conditions?
disc patho, stenosis, myofascial
What differentiates CFJS with other ones that can cause localized pain, inter-scapular?
usually NO NEURO
IF CFJS left untreated - will heal with a natural prognosis of ___ weeks
8
What nerve innervates the IVD?
sinuvertebral nerve (only the outside)
T or F: DH usually occurs in dehydrated discs
F - usually well hydrated ones
T or F: by age 45 - risk of an overt DH is reduced
T
5 RFs for DH
male occupation (esp w/ vibrations) smoking heavy lifting/twisting board diving
1 symptom of a CDH?
arm pain
Aggravating factors for a DH
coughing, sneezing, straining, twisting, bending
What ortho tests would you do for a CDH? What other observations would you expect?
valsalva, sotto-hall, kemps, spurlings, ULTT
listing of the neck (torticollis) joint fixations and muscle guarding
T or F: with CDH - dermatomal patterns rarely exist
T
What is the prognosis for a CDH?
4-6 months to significantly decease pain and increase function
2-3 years for FULL RECOVERY
T or F: people with recurrent NP may be on their way to CDH
T
What is TrP?
area of a muscle which refers pain elsewhere in the body
What is the most common cause of peripheral vertigo?
BPPV
Two types of vertigo?
subjective - sensation of you spinning
objective - sensation of the world spinning around you
Most common type of vertigo?
idiopathic
T or F: carotid artery disease does not cause dizziness or vertigo
T - carotid artery does not supply cerebellum
2 mechanisms of BPPV
canalithisasis
cupulolithiasis
otoconia gets stuck in either the canal or cupula
What is the best Tx for PC BPPV? 80% success rate
Epley’s canalith repositioning procedure
What is the most common neuro spinal cord disorder after middle age?
CSM - cervical spondylotic myelopathy
CSM is usually at which levels?
C4-C7
UMNL (in the spinal cord) leads to what?
LMNL (in the nerve root) leads to what?
hyperreflexia
hyporeflexia
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T or F: A headrest set too low can accentuate the hyper-EX
T
T or F: there are twice as many WAD2 as there are WAD1 in Ontario
T
What is stop-light braking?
when the person is unaware of impact - foot comes off the brake immediately and body and neck absorbs a lot of the forces
T or F: there are many structures in the spine to limit hyper EX
false (another than ALL)
Describe the mechanism for hyper EX and hyper FL injuries
hyper-EX = straining of the ant cervical musculature and deep cervicals
hyper-FL = straining of the post cervical muscles and capsules of the facet joints and compression forces on the discs
What is the best criteria to evaluate injury likelihood?
(delta)v the impact adds to the person’s body. better predictor than absolute v
What happens at 44ms and 100ms in a rear end?
44 - c spine thrusts upwards
110 - c spine goes into s configuration (lower c is hyper EX, upper c is hyper FL)
Aside from the Can C-Spine rules - what other criteria was there? How does it compare to CCSR?
NLRC - nexus low risk criteria - less specific/sensitive (misses a lot of people who are positive)
no SP pain
no drugs
no neuro deficit
no painful distraction injury
Headrests can prevent the ramping. Headrests can decrease injury risk by __%
25
1 Symptoms of WAD
NP and stiffness
Grades of WAD
WAD 0 - no complaints of physical signs WAD 1 - neck complaint + stiff/tender - no physical signs WAD 2 - neck complaint + MSK WAD 3 - neck complaint + neuro WAD 4 - neck complaint + fx/dx
Name some evidence based Tx for WAD
pain control - IFC SMT + mobs activation education + reassurance**** LL laser therapy exercises Qigong/I-Yoga (OPTIMA)
Definition of a “minor injury”
any one or more sprain, strain, WAD, contusion, abrasion, laceration, or subluxation and any clinically associated sequalae
Vertebral compression fractures often occur in young patients how?
direct fall on bum or hyper FL - hydrated discs may break endplates
What is ankylosing spondylitis known as now?
MC in men or women?
axial spondyloarthritis
men (5:1)
To be Dx with AS - 2/4 of these criteria have to be +………….
morning stiffness (>30 mins)
relieved with movement, aggravated with rest
awake with back pain later into night
alternating buttock pain
HLA B27….
genetic marker/component of AS
Key sign on a radiograph of an AS patient
trolley track signs
Differentiate between an incomplete vs. complete lesion
complete - loss of neuro/sensory/autonomic
incomplete - still hurts, pain generation
What are some characteristics of intercostal nerve lesions (although rare)?
sharp, superficial, burning
How is shingles (herpes zoster) related to varicilla zoster?
infection of the DR ganglia
subclinical chicken pox
lays latent in DRG (antibodies against the virus decreases with age - leading to re-activation of the virus)
What is post-herpetic neuralgia?
post shingles pain
50% get rashes in T region
Critical zone for t spine is found where (thoracic disc disease)
T4-T9
MC cause of thoracic radiculopathy
diabetes
Which nerve transmits pain from CVJs of 1-2 to arm?
kuntz
MC cause or aggravation of costochondritis
heavy breathing, coughing/sneezing, laying prone
__% of scoliosis are idiopathic. Do they progress?
80
nope!
minimum >___ deg to diagnose scoliosis
10
minimum >___ deg of scoliosis to warrant surgery
45
4 theories of why F>M scoliosis
slenderness
VB height:width growth
hormonal
growth spurts during times of minimal kyphosis
Structural scoliosis could be due to a NM cause or ?
congenital
What hormone has been called out for scoliosis?
melatonin
T or F:
For adult scoliosis - you are Tx based of the degree of deformity of scoliosis
For young people w/ scoliosis - you are Tx based on the subjective symptoms and physical signs
F - other way around
T or F: overall physiotherapy scoliosis specific exercises have proven to be highly effective in modulating progression
FALSE - POOR EVIDENCE FOR EXERCISES + SCOLIO IN GENERAL
Epidemiology of Sch-D
children - more active, taller, heavier
