NMS 2 Exam 2 Flashcards
Thoracic Radiculopathy is associated w/:
-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
Thoracic Myelopathy associated w/
-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
Rib Fractures: Symptoms
-Breathing Issues (pain on inspiration and dyspnea)
-Coughing spells
-Most common in elderly d/t osteoporosis
-Athletes: upper and middle ribs
Postural Syndrome
-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
Tietze Syndrome: Most common regions/associations
-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
Which structures are removed in TOS surgery
Removal of 1st rib* or cervical ribs, removal of adhesive bands or anterior scalenectomy*
Thoracocostal Facet Sprain: Causes/Symptoms
-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
Case study: Older person w/ rash
-Rash: Shingles* (Radicular pattern)
-No rash: Nerve root compression*
Intercostal Neuralgia
-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*
Scoliosis
-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
How many hours should a brace be worn for scoliosis
-Milwaukee brace: Worn 23 hours/day in most cases
-Boston brace: Easier to wear
Fracture of rib causes
-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
Scapular Bursitis/Crepitis is associated w/
*Clicking/popping
-A crepitus at the superior medial angle of the scapula
-Patient reports feeling a catch in the upper back (Restricted scapular motion)
Which muscles are involved with TOS
1st rib or cervical ribs, anterior and middle scalenes, space between the clavicle and ribs, and pectoralis minor
Vertebral artery syndrome
Migraines: Types/Causes/Who it affects
-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
Syncope: Types/Symptoms
-Temporary loss of consciousness usually related to insufficient blood flow to the brain
-Types: Nervous stress, orthostatic hypotension, cardiac function, endocrine function, neurologic
Vertebral artery dissection
-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
Temporal Arthritis: Associations/Definitions
-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
Types of Auras
Visual, sensory, motor or any combination
TOS Symptoms
-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
Postural Syndrome: What muscles are tight, what muscles are loose?
-Tight posterior upper back musculature
-Weak deep neck flexors/rhomboids/serratus anterior
Scoliosis: Functional vs. Structural
-Functional: Compensatory, Postural, can usually be corrected with stretching, joint mobilization, strengthening and postural training
-Structural: Idiopathic, congenital, mesenchymal disorder, trauma, vertebral neoplasm, metabolic
Cervicogenic Headaches
-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
Which headache is associated with a viral infection?
Sinus Headaches; Sinus congestion
What types of headaches are associated with papilledema?
Pathologic Headaches
Scoliosis: Clinical Presentation
-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
Scoliosis: Treatment (By degrees)
-<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
Costochondritis
-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
Cluster Headaches
-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
Types of cluster headaches
-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)
Who do cluster headaches affect
-20-50 year olds
-More common in males
Clinical presentation of cluster headaches
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
Hypertension headaches
-Caused by fluctuations in blood pressure (>200/120mmHg)
-Most commonly presented as a headache that occurs in the morning accompanied by dizziness
Post-Traumatic Headaches
-Caused by a subdural head bleed after trauma
-Associated w/concussions, contact sports, whiplash
Withdrawal Headaches
-Caused by acute substance use or exposure, medications
-Examples include opioids, caffeine, hormones
Ice Pick Headaches
-Sudden stabbing pain in the face or head
-Sharp, intense pain for up to 30s
-Can occur several times during the day
