NMS 2 Exam 2

Question 1

Thoracic Radiculopathy is associated w/:

Answer 1

-Compressed nerve root* in the thoracic area of the spine
-Least common location for radiculopathy
-Common causes: herniated discs, tissue changes, bone spurs, spinal infections, and tumors
-Dermatomal distribution/can cause pain and numbness in front of body
-Sharp pain in back, worse with coughing

Question 2

Thoracic Myelopathy associated w/

Answer 2

-Cord pathology*; Compressed due to bulging or herniated discs, bone spurs or spinal trauma
-Degenerative conditions, central disc herniations, autoimmune disorders, cysts, hematomas, and spinal tumors
-Difficulty walking, loss of bowel control, issues w/balance and coordination, increased reflexes in extremities

Question 3

Rib Fractures: Symptoms

Answer 3

-Breathing Issues (pain on inspiration and dyspnea)
-Coughing spells
-Most common in elderly d/t osteoporosis
-Athletes: upper and middle ribs

Question 4

Postural Syndrome

Answer 4

-Chronic neck, back and arm pain secondary to postural fatigue of muscles in the shoulder girdle, anterior spine and prevertebral fascia
-Most commonly seen in students and office workers; Also common in the elderly
-Extremely common
-Slumping head forward d/t rounding of the shoulders; Increased kyphosis and compensatory cervical lordosis
-Caused by: Chronic stress and pain

Question 5

Tietze Syndrome: Most common regions/associations

Answer 5

-Most common regions: 2nd, 3rd, 4th rib; Any of the above* (Less common at sternoclavicular joint)
-Associated w/ Ostochondritis*
-Injury or lesions of the costosternal articulations
-Most common in women and those over 40 years old
-Can be due to trauma, chronic cough, previous injury or pectus deformities
-Mode: Often insidious, overuse, or sneezing/coughing
-Swelling in chest wall, usually unilateral

Question 6

Which structures are removed in TOS surgery

Answer 6

Removal of 1st rib* or cervical ribs, removal of adhesive bands or anterior scalenectomy*

Question 7

Thoracocostal Facet Sprain: Causes/Symptoms

Answer 7

-Sprain complex that involves the thoracocostal facets
-Causes: Trauma, chronic cough, prolonged slouched postures, or degenerative joint disease
-Feel like rib is out of place
-Difficulty breathing, short breaths

Question 8

Case study: Older person w/ rash

Answer 8

-Rash: Shingles* (Radicular pattern)
-No rash: Nerve root compression*

Question 9

Intercostal Neuralgia

Answer 9

-A neuropathic pain involving the intercostal nerves
-Tends to affect the thoracics, chest wall and upper trunk
-Burning, sharp or shooting pain
-Pain to the shoulder blade or pelvis
-Myelopathy*

Question 10

Scoliosis

Answer 10

-Convexity area of the spine, curve progression, high degree of curve*
-Lateral bending and/or rotary deformation of the spine named for the side of convexity
->7* axial trunk rotation on scoliometer
-Curves >60* may encroach IVD foramen/cardiovascular

Question 11

How many hours should a brace be worn for scoliosis

Answer 11

-Milwaukee brace: Worn 23 hours/day in most cases
-Boston brace: Easier to wear

Question 12

Fracture of rib causes

Answer 12

-Elderly: Osteoporosis
-Athletes: High force, recurrent movements of arms leading to stress fractures in the upper and middle ribs
-Coughing spells
-Pediatric: Non-accidental trauma

Question 13

Scapular Bursitis/Crepitis is associated w/

Answer 13

*Clicking/popping
-A crepitus at the superior medial angle of the scapula
-Patient reports feeling a catch in the upper back (Restricted scapular motion)

Question 14

Which muscles are involved with TOS

Answer 14

1st rib or cervical ribs, anterior and middle scalenes, space between the clavicle and ribs, and pectoralis minor

Question 15

Vertebral artery syndrome

Question 16

Migraines: Types/Causes/Who it affects

Answer 16

-2 Types: Migraines w/o Aura (80%) or w/ Aura (20%)
-Genetic: 4 out of 5 report a family history
-Women experience more than men 3:1; Hormones
-Usually in 20s-30s
-60% are unilateral

Question 17

Syncope: Types/Symptoms

Answer 17

-Temporary loss of consciousness usually related to insufficient blood flow to the brain
-Types: Nervous stress, orthostatic hypotension, cardiac function, endocrine function, neurologic

Question 18

Vertebral artery dissection

Answer 18

-Rare but increasingly recognized cause of stroke in patients younger than 45 years old
-Characterized by severe occipital headache with posterior nuchal pain following a head injury, followed by neurologic
-Signs: IL face dysesthesia, Dysarthia or hoarseness, CL loss of pain and temperature sensation in trunk/limb, IL loss of taste

Question 19

Temporal Arthritis: Associations/Definitions

Answer 19

-Associated w/ PMR* (Polymyalgia Rheumatica)
-Temporal arteries become inflamed or damaged
-Also called cranial arteritis or giant cell arteritis
-Delay on medical emergency means blindness/stroke

Question 20

Types of Auras

Answer 20

Visual, sensory, motor or any combination

Question 21

TOS Symptoms

Answer 21

-Diffuse arm pain/numbness/tingling (often 4th/5th digit), worse with over head activity
-Neck/shoulder pain
-Thenar atrophy
-Diminished grip strength
-Hand/arm swelling
-Cold distal extremity
-Pallor or discoloration of hand

Question 22

Postural Syndrome: What muscles are tight, what muscles are loose?

Answer 22

-Tight posterior upper back musculature
-Weak deep neck flexors/rhomboids/serratus anterior

Question 23

Scoliosis: Functional vs. Structural

Answer 23

-Functional: Compensatory, Postural, can usually be corrected with stretching, joint mobilization, strengthening and postural training
-Structural: Idiopathic, congenital, mesenchymal disorder, trauma, vertebral neoplasm, metabolic

Question 24

Cervicogenic Headaches

Answer 24

-IL head pain that is localized to the neck and occiput
-Pain may radiate to forehead, orbital region, temples, ears
-Cause: Neck movement or sustained position/head trauma
-More common in females

Question 25

Which headache is associated with a viral infection?

Answer 25

Sinus Headaches; Sinus congestion

Question 26

What types of headaches are associated with papilledema?

Answer 26

Pathologic Headaches

Question 27

Scoliosis: Clinical Presentation

Answer 27

-Progressive: Adolescent, idiopathic
-Acute: tumor, fracture, disc disease
-Previous diagnosis or family history
-Loss of balance and falls
-Asymmetric stress on lower limbs
-Low body image, self-esteem, depression

Question 28

Scoliosis: Treatment (By degrees)

Answer 28

-<10 degrees: Follow up every 6 months, osseous manipulation and joint mobilization as needed
-10-20 degrees: X-Ray every 3-6 months, conservative management, consider bracing if significant progression
-20-25 degrees: Same as 10-20 degrees
-25-40 degrees: Refer for brace therapy if >5 degree progression in one year
-40-50 degrees: Often considered a grey zone, Milwaukee bracing may not be necessary
->50 degrees: Surgery is usually necessary

Question 29

Costochondritis

Answer 29

-Inflammation of 1+ costal cartilages/localized pain on anterior chest wall
-More common in females 2:1
-Direct trauma, aggressive exercise or upper respiratory infections with cough
-Usually unilateral
-Decreased with rest or ice

Question 30

Cluster Headaches

Answer 30

-A primary neurovascular headache disorder characterized by severe, short duration, strictly unilateral pain
-Accompanied by prominent cranial fascial PS features
-Location of pain is periorbital (mostly) or retro-orbital

Question 31

Types of cluster headaches

Answer 31

-Episodic: Occurs in periods lasting 7 days to 1 year, separated by pain free periods of 2+ weeks (80% persist)
-Chronic: Occur for more than 1 year w/o remission or with remissions lasting less than 2 weeks (55% persist)

Question 32

Who do cluster headaches affect

Answer 32

-20-50 year olds
-More common in males

Question 33

Clinical presentation of cluster headaches

Answer 33

Severe UL periorbital head pain, that is “excruciating”
-Short duration, nocturnal attacks, sweating, tearing and rhinorrhea
-Triggered by stress, relaxation, extreme temperature, allergic, rhinoritis, and exercise

Question 34

Hypertension headaches

Answer 34

-Caused by fluctuations in blood pressure (>200/120mmHg)
-Most commonly presented as a headache that occurs in the morning accompanied by dizziness

Question 35

Post-Traumatic Headaches

Answer 35

-Caused by a subdural head bleed after trauma
-Associated w/concussions, contact sports, whiplash

Question 36

Withdrawal Headaches

Answer 36

-Caused by acute substance use or exposure, medications
-Examples include opioids, caffeine, hormones

Question 37

Ice Pick Headaches

Answer 37

-Sudden stabbing pain in the face or head
-Sharp, intense pain for up to 30s
-Can occur several times during the day