OPP Final 12/19/2022 Flashcards
Free nerve endings that are non-encapsulated, responsive to noxious stimuli
Nociceptors
Two types of pain fibers
- A(delta) - responsive to intense and mechanical stimuli; myelinated fast
- C fibers - responsive to various stimuli; non myelinated so thinner
How is pain suppressed?
The brain sends signals to inhibit pain input, blocking signals, also substance P inhibits AP from pain receptors. Interneurons change polarity of post synaptic so it can’t receive info from presynaptic neurons, usually inhibitory
What are two pathway of ALS (anterior lateral system)?
primary neuron is afferent, secondary are neurons in thalamus, and third is neurons in cortex. Neospinothalamic - fast adelta fibers, glutamate mediated, terminates in brain stem, thalamus, and lamina. Paleospinothalamic tract - slow C types, glutamte and substance P mediated
Describe the brain’s analgesia system.
Brain can suppress afferent pain signals. Periaqueductal gray and periventricular areas send signals to the raphe magnus nucleus. These efferent signals then travel to the pain inhibitory complexes in the dorsal horns of the spinal cord this blocks further afferent pain signals and withdrawal reflexes
How is pain suppressed?
Brain blocks afferent signals, pain receptors barely adapt so this makes you aware of tissue damage persisting
What does the ALS examine?
pathways to consciousness via secondary neuron to thalamus, and tertiary neuron to cortex
Fast Adelta fibers, glutamate mediated, terminate in lamina, excites second order neurons, decussate through anterior commissure, and terminates in brain stem/thalamus
Neospinothalamic
Older system, slow C fibers, glutamate and substance P mediated, terminate in lamina, excite second order neurons, decussate through anterior commissure
Paleospinothalamic
What is analgesia systems?
Periaqueductal gray and periventricular signals areas to raphe and nucleus reticularis. Brain suppresses affents via efferents that go to pain inhibitory complexes of dorsal horn.
How do drugs inactivate pain pathways
Exogenous opiates, endogenous opiates, these bind to mu receptors in brain and spinal cord which alter excitability of receptors. OMM can increase endogenous opoids
What are characteristics of visceral pain?
C type fibers, recruits nerves T1-S2, thalamus relays to insular cortex. You can’t always tell where pain is coming from because convergence of multiple AP
A non-noxious stimulus is painful
allodynia
How does sensitization occur?
raised resting membrane potential causes neuron to exists in a hyper-excitable state, less stimuli is required for AP. Leads to allodynia
A noxious stimulus is more painful than expected
Hyperalglesia
Greater noxious stimulus is required to trigger AP with pain shooting directly to max. intensity and long lasting
hyperpathia
Maintenance and Exacerbation of somatic dysfunction is cased by…
chronic inflammation, vasoconstriction, and muscle spasm
What are some red flags for back/costal pain?
bladder/bowel incontinence, acute onset for kids and elderly, neuro defects, explained weight loss/gain, IV use, immunosuppression, or history of malignancy
Funneled breast, genetically from marfan’s, cobbler chest. Associated with mitral valve prolapse, can compromise cardio pulm
Pectus excavatum
Pigeon breasted, comes from rickets, marfan’s, Congenital heart disease, kyphoscoliosis
Pectus carinatum
Kyphosis, COPD, emphysema
barrel chest
Rib Fracture
very localized, stabbing piercing pain treat with OMM on opposite side, C3-C5 treatment. Also use braces, opiates unless respiratory dysfunction, no injections
When 3 or more ribs are fractures in 2 places, floating segment of rib will exhibit paradoxial motion
This is flail chest, don’t treat with OMM because high respiratory morbidity
When pain is localized to costal cartilage, usually dull unless palpated, aggravated by shoulder motion, usually symmetric at 3rd, 4th, 5th ribs
Costochondritis
How can you treat costochondritis?
treat restrictions with counterstrain, but if true costchondritis use lidocaine patch, NSAIDs, oral injection
Which regions of visceral pain cause costal pain?
Heart, lungs, esophagus, Stomach, liver, pancreas. Look for somatic dysfunction
Cardiac causes of costal pain
mycardial infarction, can feel heart beat, tachycardia, pericarditis
Swelling irritation of thin tissue around heart, increases with deep breathe caused by irritated layers rubbing on each other
pericarditis
Respiratory causes of costal pain
COPD, Pneumothorax, Coughing, Sneezing, pleurisy
Inflammation of pleura, pleural friction rub head of ausculation
Pleurisy. Parietal is pain sensitive, and visceral is not. Treat with OMT depending on underlying cause
Fractured rib
Gastrointestinal causes of costal pain
cholecystitis, GERD, pancreatitis, IBS
Pain can radiate up to right shoulder, pain against lower ribs due to gallbladder
Cholecystits
Mimic heart attack, normally pain in mid ribcage, inflamed diaphragm
GERD
What are dermatological and infectious causes of costal pain?
Herpes zoster, pleurisy, Tietze, osteomyelitis, sclerodoma
“hard skin”, systemic sclerosis, caused by autoimmune disorder to CT; symptoms Raynaud phenomenon, puffy fingers, edema with erythema
scleroderma
Infection of bone due to spread from direct inoculation, usually with swelling
osteomyelitis
Classic dermatomal rash can be preceded by neuralgia
herpes zoster
Herpes Zoster treatments
use OMT to treat at level of rash, abdominal pump, splenic stimulation. Medications: Valacyclovir, Famcyclovir, Acyclovir
fusiform swelling, often 2nd 3rd costal cartilages, can be post parvovirus
Tietze which you can treat with OMT, lidocaine patch, NSAIDs, corticosteroids
Costal Diagnosis
when ribs are stuck in inhalation or exhalation, asymmetric position, asymmetric motion
What are the key ribs of inhalation and exhalation?
For inhalation it’s the bottom rib. For exhalation it’s the top rib
What’s treatment to fix inhalation?
Respiratory assist - resist inhalation, follow exhalation 5-7 times then release
What’s treatment to fix exhalation?
since muscles move bones, use the muscles attached to the ribs
A muscle in space
when it contracts both sides pull towards middle, hold one side down so the free side contracts towards fixed side
Scalene muscles
connect cervical vertebrae to ribs 1-2
Pectoralis minor
connects coracoid process to ribs 3-5
Serratus anterior
attaches the scapula to the ribs 6-8
Latissimus dorsi
Connection between 9-10 ribs to thoracolumbnar fascia
Quadratus lumborum
connects iliac crest to rib 12 (which pulls rib 11 with it)
What if tight scalenes pull ribs 1 & 2 up?
Do post isometric relaxation, stretch scalenes to restrictive barrier. Have patient push head to ease 3-5 seconds, resist, then reposition patient to new barrier 3-5 times. Reassess
articulate with sternum via their costal cartilages
ribs 1-7
articulates with vertebral body
head of rib
extends from head and terminates at the tubercle
neck of rib
comprises an articular facet where the rib articulates with the transverse process
tubercle
