MSK 2

Question 1

what are the most common levels of cervical impingement?

Answer 1

Joints: C5-C6 and C6-C7

Question 2

Principles of MDT

Answer 2

• primary uses symptom response
• reproduce the symptoms they came in with
• decrease patient reliance on therapist
• utilize progression of forces and direction of prefrence

Question 3

Centralizing

Answer 3

Describes the phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction.

Question 4

Peripheralization

Answer 4

Describes the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction.

Question 5

Disc model flexion:

Answer 5

Flexion- Anterior disc compress , Posterior disc stretch

NP “squeezed” posterior

Question 6

Disc model extension:

Answer 6

Extension- Posterior disc stretch , Anterior annulus compress

NP displaced anterior

Question 7

Postural syndrome

Answer 7

Pain remains local only to cervical spine and is time-dependent

No UE pain or parasthesias

cervical ROM is full and pain-free

Question 8

Dysfunction syndrome

Answer 8

Similar to tissue shortening, scar tissue, etc. Pain is local to cervical spine.

No UE pain and/or parasthesias

Pain present > 8 weeks
No pain at rest, only at end-range
ROM HALLMARK = consisten

Question 9

Derangment syndrome

Answer 9

directional preference is an essential feature and centralizatoin is an important phenomenon observed in the spine

HALLMARK is RAPID CHANGE in symptom severity and location, as well as ROM, with repeated movements

Patient can have pain at rest, during movement, and at end-range of movement

Pain onset can be acute or chronic

Question 10

Most important question on MDT form is knowing if it constant vs intermittent why?

Answer 10

intermittent means it can be more mechanical

Question 11

Repeated motions are usually done how?

Answer 11

Seated

Question 12

Tests for radiculopathy?

Answer 12

Spurling’s
Cervical distraction
Upper limb tension tests

Question 13

when is Spurlings test positive

Answer 13

+) test is reproduction of pain or parasthesias into UE

Question 14

What are the variations of Spurlings ?

Answer 14

1. Head neutral
2. Cervical spine extended
3. Cervical spine extended and rotated

Question 15

when is CERVICAL DISTRACTION TEST positive

Answer 15

(+) is decrease or relief of pain and parasthesias

Question 16

What are the benefits of upper limb testing?

Answer 16

Excellent screen to rule out cervical radiculopathy

Question 17

MDT cervical treatment principle: green light

Answer 17

decreased, abolished/ Better or Centralized

Question 18

MDT cervical treatment principle: yellow light

Answer 18

no effect, produce no worse, increase no worse, decrease or abolish no better

Question 19

MDT cervical treatment principle: red light

Answer 19

increase, pheralizing, remains worse, worse or pheripheralized

Question 20

Examine sagittal motions first

Answer 20

Retraction

Retraction & Extension

Protrusion

Flexion

Question 21

What is the progression of forces?

Answer 21

Repeated motions/sustained postures
 Repeated motions with patient-overpressure
Repeated Motions with clinician overpressure
Mobilization
Manipulation

Question 22

Dysfunction syndrome tx:

Answer 22

repeated end range loading in direction of movement loss

movement has to produce pain and discomfort to be effective

pain should be abolished after loading is removed

Question 23

Treatment of derangement step 1

Answer 23

reduce derangement

Question 24

Treatment of derangement step 2

Answer 24

maintain derangement

Question 25

Treatment of derangement step 3

Answer 25

recovery of function

Question 26

Treatment of derangement step 4

Answer 26

prevention of recurrence

Question 27

Cervical MDT dosage:

Answer 27

initial pts require 10 reps every 2-3 hours

Question 28

What are the 4 categories of neck pain?

Answer 28

1. Neck pain with mobility deficits 2. Neck pain with headaches 3. Neck pain with movement coordination impairments 4. Neck pain with radiating pain

Question 29

Neck disability index out of 50 and what is the MDC and MDIC

Answer 29

– 0-4 = No disability – 5-14 = mild disability – 15-24 = moderate disability – 25-34 = severe disability – >34 = completely disabled ``` MDC = 5 MDIC = 5- 9.5 ```

Question 30

Acute pain is

Answer 30

< 6 weeks

Question 31

Sub acute pain is

Answer 31

6-12 weeks

Question 32

Chronic pain is

Answer 32

> 12 weeks

Question 33

What factors influence your interventions of neck pain?

Answer 33

``` – Classification – Identification of impairments – Stage of condition – Tissue irritability – Presence of psychosocial risk factors ```

Question 34

What causes the tension type headache?

Answer 34

myofascial dysfunction and trigger point

Question 35

what causes cervicogenic headache?

Answer 35

upper spine forward head posture

Question 36

Neck pain with headache chacteristics?

Answer 36

Intermittent unilateral neck and suboccipital pain decreased Cervical ROm Decreased upper cervical segmental mobility

Question 37

Cranial cervical flexion test

Answer 37

assess activation and endurance of deep neck flexors and how long they can be active for

Question 38

Normal deep neck flexors can hold contraction for

Answer 38

26- 30 mmHg

Question 39

Deep neck flexor test is positive when?

Answer 39

(+) = skin folds separate (loss of chin tuck) or occiput touches therapist’s hand >1 second

Question 40

Neck pain with radiating pain symptoms

Answer 40

cervical rotation less than 60 degrees of involved side signs of nerve root compression success with reducing UE symptoms during exam and intervention