MSK Patho Spine Flashcards
Spinal manipulation for pain inhibition is generally indicated for this condition True/False
- True
Pathology of spinal/intervertebral stenosis
- Congenital narrow spinal canal or intervertebral foramen, coupled with hypertrophy of the spinal lamina & ligamentum flavum or facets, as the result of age related degenerative processes or disease
- Results in vascular and/or neural compromise
Signs and symptoms of spinal/intervertebral stenosis
- Bilateral pain & paresthesia in back, buttocks, thighs, calves, & feet
- Pain decreases in spinal flexion, increases in extension
- Pain increases with walking
- Pain relieved with prolonged rest or activity modification, such as leaning on a shopping cart
What position is the cervical spine placed in for optimal intervertebral foraminal opening during traction
- 15º of flexion
Contraindications to traction
- Joint hypermobility
- Pregnancy
- RA
- Down syndrome
- Any other systemic disease that affects ligamentous integrity
Symptoms of internal disc disruption
- Most common in lumber spine
- Constant deep, achy pain
- Increase pain with movement
- No objective neurological findings although pt may have referred pain in lower extremity
What patient education should be given for internal disc disruption injuries
- Proper body mechanics
- Positions to avoid
- Limiting repetitive bending & twisting movements
- Limiting upper extremity overhead & sitting activities
- Carrying heavy loads
Posterolateral bulge/herniation is the most commonly observed disc disorder of the lumbar spine due to 3 structural deficiencies
- Posterior disc is narrower in height than anterior disc
- Posterior longitudinal ligament is not as strong & only centrally located in lumbar spine
- Posterior lamellae of annulus are thinner
Pathology of posterolateral bulge/herniation
- Overstretching and/or tearing of annular rings, vertebral endplate and/or ligamentous structures, from high compressive forces or repetitive micro trauma
- Results in loss of strength, radicular pain, paresthesia, and inability to perform ADLs
How to perform positional gapping for a posterolateral disc bulge/herniation on the left
- Pt side lying on right side with pillow under right trunk
- Flex both hips/knees
- Rotate trunk to left (or pelvis to right)
- Pt can be taught to perform this at home
Pathology of a central posterior bulge/herniation
- Commonly observed in cervical spine
- Same as posterolateral disc bulge/herniation for etiology and symptoms
Pathology of DJD
- Part of normal aging process due to weight-bearing properties of facets & intervertebral joints
- Results in bone hypertrophy, capsular fibrosis. hypermobility or hypomobility of joint, & proliferation of synovium
Symptoms of DJD
- Reduction in mobility of the spine
- Pain
- Possible impingement of associated nerve roots, resulting in loss of strength & paresthesia
Pathology of facet entrapment (acute locked back)
- Caused by abnormal movement of fibroadipose meniscoid in facet during extension
- Meniscoid does NOT properly reenter joint cavity & bunches up, becoming a space occupying lesion, which distends capsule & causes pain
- Flexion is most comfortable and extension increases pain
Appropriate treatments for facet entrapment
- Positional facet joint gapping
- Manipulation
Signs and symptoms of whiplash associated disorder (WAD)
- Early: HA, neck pain, limited flexibility, reversal of lower cervical lordosis & decrease in upper cervical kyphosis, vertigo, change in vision/hearing, irritability to noise/light, dysesthesias of face & bilateral UE, nausea, difficulty swallowing, & emotional lability (constant change)
- Late: Chronic head/neck pain, limitation in flexibility, TMJ dysfunction, limited tolerance to ADLs, disequilibrium, anxiety, & depression
What are the Canadian C-spine rules for referring for an x-ray
- Any high risk factor AND age ≥65 OR dangerous MOI OR paresthesias in extremities = radiograph if YES
- Any low risk factor that allows safe assessment of ROM AND simple rear-end MVA OR sitting position in ER OR ambulatory at any time OR delayed onset of neck pain OR absence of midline c-spine tenderness = radiograph if NO
- Able to actively rotate neck 45º to the left/right = radiograph if NO/UNABLE
In SIJ 2 of the following 4 tests should be positive to indicate SIJ or 3 out of 5 when Gaenslen’s test is included
- SI gapping
- SI compression test
- Gaenlen’s test
- Sacral thrust
- Thigh thrust
Metastatic (spread) bone cancer has primary sites in
- Lung
- Prostate
- Breast
- Kidney
- Thyroid
Primary tumors include
- Multiple myeloma (most common primary bone tumor)
- Ewing’s sarcoma
- Malignant lymphoma
- Chondrosarcoma
- Osteosarcoma
- Chondromas
Signs and symptoms of bone tumors
- Pain that is unvarying and progressive
- Pain not relieved with rest and/or analgesics
- Pain is more pronounced at night
Esophageal cancer symptomatology
- Pain radiating to the back
- Pain with swallowing
- Dysphagia (difficulty/discomfort swallowing)
- Weight loss
Pancreatic cancer symptomatology
- Deep, gnawing pain that may radiate from the chest to the back
Acute pancreatitis may manifest itself as
- Mid-epigastric pain radiating through to the back
Cholecystitis may present wiith
- Abrupt, severe abdominal pain & right upper quadrant tenderness, nausea, vomiting, & fever
Common signs and symptoms of TMJ conditions
- Joint noise
- Joint locking
- Limited flexibility of jaw
- Lateral deviation of mandible during depression/elevation
- Decreased strength/endurance of muscles of mastication
- Tinnitus
- HAs
- Forward head posture
- Pain with movement of mandible
What is Rocabado’s jaw opening
- Flexibility and muscle strengthening exercises of the mandible
- Jaw opening while maintaining the tongue in contact with the palate & isometric mandibular exercises
