MSK 2 Flashcards
what are the most common levels of cervical impingement?
Joints: C5-C6 and C6-C7
Principles of MDT
- primary uses symptom response
- reproduce the symptoms they came in with
- decrease patient reliance on therapist
- utilize progression of forces and direction of prefrence
Centralizing
Describes the phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction.
Peripheralization
Describes the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction.
Disc model flexion:
Flexion- Anterior disc compress , Posterior disc stretch
NP “squeezed” posterior
Disc model extension:
Extension- Posterior disc stretch , Anterior annulus compress
NP displaced anterior
Postural syndrome
Pain remains local only to cervical spine and is time-dependent
No UE pain or parasthesias
cervical ROM is full and pain-free
Dysfunction syndrome
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
Derangment syndrome
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
Most important question on MDT form is knowing if it constant vs intermittent why?
intermittent means it can be more mechanical
Repeated motions are usually done how?
Seated
Tests for radiculopathy?
Spurling’s
Cervical distraction
Upper limb tension tests
when is Spurlings test positive
+) test is reproduction of pain or parasthesias into UE
What are the variations of Spurlings ?
- Head neutral
- Cervical spine extended
- Cervical spine extended and rotated
when is CERVICAL DISTRACTION TEST positive
(+) is decrease or relief of pain and parasthesias
What are the benefits of upper limb testing?
Excellent screen to rule out cervical radiculopathy
MDT cervical treatment principle: green light
decreased, abolished/ Better or Centralized
MDT cervical treatment principle: yellow light
no effect, produce no worse, increase no worse, decrease or abolish no better
MDT cervical treatment principle: red light
increase, pheralizing, remains worse, worse or pheripheralized
Examine sagittal motions first
Retraction
Retraction & Extension
Protrusion
Flexion
What is the progression of forces?
Repeated motions/sustained postures
Repeated motions with patient-overpressure
Repeated Motions with clinician overpressure
Mobilization
Manipulation
Dysfunction syndrome tx:
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
Treatment of derangement step 1
reduce derangement
Treatment of derangement step 2
maintain derangement
Treatment of derangement step 3
recovery of function
Treatment of derangement step 4
prevention of recurrence
Cervical MDT dosage:
initial pts require 10 reps every 2-3 hours
What are the 4 categories of neck pain?
- Neck pain with mobility deficits
- Neck pain with headaches
- Neck pain with movement coordination impairments
- Neck pain with radiating pain
Neck disability index out of 50 and what is the MDC and MDIC
– 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
Acute pain is
< 6 weeks
Sub acute pain is
6-12 weeks
Chronic pain is
> 12 weeks
What factors influence your interventions of neck pain?
– Classification – Identification of impairments – Stage of condition – Tissue irritability – Presence of psychosocial risk factors
What causes the tension type headache?
myofascial dysfunction and trigger point
what causes cervicogenic headache?
upper spine forward head posture
Neck pain with headache chacteristics?
Intermittent unilateral neck and suboccipital pain
decreased Cervical ROm
Decreased upper cervical segmental mobility
Cranial cervical flexion test
assess activation and endurance of deep neck flexors and how long they can be active for
Normal deep neck flexors can hold contraction for
26- 30 mmHg
Deep neck flexor test is positive when?
(+) = skin folds separate (loss of chin tuck) or occiput touches therapist’s hand >1 second
Neck pain with radiating pain symptoms
cervical rotation less than 60 degrees of involved side
signs of nerve root compression
success with reducing UE symptoms during exam and intervention
