MSK Flashcards
How do you treat hypomobility?
joint and soft tissue mobilization
What is treated with stabilization movements?
Hypermobility and instability
OA movement occipital condyles on atlas what movements occur here
movement include nodding (forward and backward bending) and side bending
AA atlas on axis, what is the primary motion and how much of it occurs at the AA?
primary motion: rotation
50% of cervical
What are principle movements?
upslides and downslides at facet joint
translatory movements at lateral inter-body articulations
What is the degree orientation for the mid cervical spine?
45 degrees
What is the degree orientation for the mid thoracic spine?
60 degrees
With forward nodding what happens arthrokinematically?
- occiput rolls foward on atlas, glides posteriorly
- atlas translates foward on axis
- axis translate foward and up on C3
With backward nodding what happens arthrokinematically?
Occiput rolls back on atlas and glides anteriorly
- Atlas translates backward on axis
- Axis translates back and down on C3
With side bending what happens arthrokinematically?
Primarily at OA
Example of SBR:
• Occiput rolls Right on atlas and glides Left
Atlas translates Right
With rotation what happens arthrokinematically?
Primarily at AA
• Example of rotation Right:
Occiput and atlas rotate to Right on axis
Atlas translates to the Left
Physiological motion
combines sidebend and rotation to the same side
Non-physiological motion
SB - head is forward
Rotation - head remains upright
What is mid-cervical facet capsular restriction on left facet?
look at the lack of upslide restrictions at right rotation, right side bend, and forward bend limited with possible left deivation
subcranial facet capsular pattern for forward nodding?
deviate away from restriction
subcranial facet capsular pattern for backward nodding?
deviate towards the restriction
In mid cervical vs upper cervical involvement a limitation in side bend to right maybe b/c of limitation to what?
limitation in mid cervical right downslide or left upslide
limited right side glide of OA and left rotation of AA
PIVM graded as
normal, hypermobile, hypomobile
Cervical PAIVMS test for what
assess for resistance to motion and pain provocation
Patient is presented with hypertonicity and decreased ROM from an injury/trauma/dsyfunction…what are they presenting with?
involuntary muscle guarding
Patient is presented with pt apprehension and decreased AROM/PROM from fear of pain/pain…what are they presenting with?
voluntary muscle guarding
Patient is presented with loss of muscle bulk and weakness from lack of use/stiff joints?
muscle atrophy
Patient is presented with normal muscle tone and loss of flexibility/ROM and caused by muscle held in shortened posture and think posture?
adaptive shortening
facet restriction causes?
immobility and resolved joint synovitis and hemarthorsis
facet restriction signs and symptoms?
decreased ROM in facet capsular pattern
patient is presented to you with head held at angle away from midline and pain with DOWNSLIDE. Patient say she slept weird wtf is wrong with her?
Wry neck
Hypermobility instability shows this on x ray
osteophytes
what are facets positioned at in the C Spine?
45 degree angle
Pathway of the vertebral artery?
thru c6 and up
A of ABCs
alignment
B of ABCs
bone density
C of ABCs
Cartilage
s of ABCs
soft tissue
What is the atlantodens interval?
radiolucent line anterior to the articular facet of dens
ADI in adults, what is abnormal? (atlanto-axial dislocation)
more than 3 mm
ADI in adults, what is abnormal? (atlanto-axial dislocation)
more than 5 mm
How do you examine the Odotnoid AP view of c1/c2?
open patients mouth and assess and ask about trauma
what is the purpose of the candian C spine rule?
determines if the patient with acute trauma do not require imaging
Canadian C spine: Step 1-If YES to any then radiograph needed:
ge >/= 65
• Dangerous MOI
• Fall >/+ 3 feet or 5 stairs
• Axial load to head
• High-speed MVA (>100 km/62 mph) or with rollover or ejection
• Motorized recreational vehicle accident
• Bicycle struck or collision
- paresthesias in extremities
Canadian C spine: if NO to any of these, pt needs radiograph
- Simple rear-end MVA
- Able to sit in ED
- Ambulatory
- Delayed onset of neck pain
- Absence of midline cervical tenderness
Canadian C spine: if NO pt needs radiograph
Able to actively rotate neck 45 degrees to right and left
Nerve root compression symptoms
- Diminished or absent DTRs
- Diminished or absent sensation to light touch in dermatomal pattern
- Muscle weakness along a specific myotome
Causes of cervical spondylosis
osteoarthritis, DDD, DJD
Cervical stenosis: what is lateral cervical stenosis
unilateral UE symptom, LMN signs, usually 1 segment
Cervical stenosis: what is central cervical stenosis
B/L UE symptoms, multi-segmental, UMN signs
Cervical myelopahty signs:
Sensory disturbance of 1 or both hands and/or feet • Muscle wasting of hand intrinsics • Unsteady gait • (+) Hoffman’s Reflex • (+) Babinski sign • Hyperreflexia of UE & LE • Clonus at ankle • Bowel & bladder disturbances • Multi-segmental weakness and/or sensory changes below level of compression
In cervical radiculopathy DTRs are ?
hyporeflexive
In cervical Myelopathy DTRs are?
hyper-reflexive
Cervical instability hyperflexion injuries:
sprain posterior ligamentous structures & possible fx
Cervical instability hyperextension injuries:
sprain anterior ligamentous structures and soft tissue
Cervical instability: atlanto-axial dislocation
Distance between the anterior surface of dens and posterior surface of anterior arch on C1
vertebral artery supplies how much blood to the brain?
20 percent
80 % of blood supply brain is from what?
carotid artery system
vertebral artery proximal:
origin to entry to cervical spine
vertebral artery transverse:
entry to cervical spine to C2 transverse foramen
vertebral artery suboccipital:
Exit from C2 to entry to foramen magnum
vertebral artery intracranial:
entry to foramen magnum to formation of basilar artery
Where is the vertebral artery most vulnerable?
suboccipital portion
During rotation which side of the Vertebral artery is most vulnerable?
contralateral side
What are the 5 Ds?
- Dizziness
- Drop attacks
- Diplopia
- Dysarthria
- Dysphagia
What are the 3 Ns?
- Numbness
- Nausea
- Nystagmus
what is the average time between event and onset of symptoms for CAD and stroke?
2-3 days
IFOMPT decision making red light?
- high number/ severe nature of RF, low predicted benefits for therapy, avoid treatment
IFOMPT decision making yellow light?
Moderate number and nature of RF, moderate predicted benefits of PT, avoid or delay tx then reassess and monitor
IFOMPT decision making green light?
low number and low RF, low to high predicted benefit and treat with care, monitor and make sure new symptoms do not arise
