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Chiropractic Tech IV > Pain > Flashcards

Pain Flashcards

1
Q

Name six mechanical theories of joint dysfunction and etiology of low back pain

A
  1. SI joints
  2. Facet joints and meniscoid entrapment
  3. Internal disc disruption and the intradiscal lesions (contained)
  4. Disc herniation with radiculopathy (non-contained)
  5. Trauma (micro included)
  6. Muscle imbalance
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2
Q

According to research, the prevalence of pain generators in LBP are:
39% ___
15% ___
10% ___ (younger)
>30% ___ (older)

A

39% disc
15% SI joint
10% Z-joints (younger)
>30% Z-joints (older)

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3
Q

Given that numbers vary, what is recognized as the predominant pain generator in the low back?

A

Disc

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4
Q

Where is low back pain perceived?

A

Region between T12 spinous and S1 and between S1 and sacrococcygeal joint, medial to PSISs
(lumbar and sacral are both low back)

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5
Q

What is somatic pain?

A

Arising from stimulation of nerve endings in a bone, joint, ligament, or muscle/fascia

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6
Q

What is referred pain?

A

Perceived in a region innervated by nerves other than those that innervate the actual source of pain

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7
Q

What is the physiologic basis of referred pain?

A

Convergence: sensory neurons from different peripheral sites converge in the spinal cord and thalamus, then are relayed to higher centers

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8
Q

What is radiculopathy?

A

Neurological condition (disease process) in which conduction is blocked in the axons of a spinal nerve or its roots

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9
Q

radiculopathy

Conduction block in sensory axons results in ___ and in motor axons result in ___

A

Sensory axons= numbness
Motor axons= weakness

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10
Q

Does radiculopathy lead to pain?

A

Not necessarily

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11
Q

What is the cause of radiculopathy?

A

Compression or ischemia
ie. from disc herniation, foraminal stenosis, infection, or other intraspinal disorder (cysts, tumors)

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12
Q

What is radicular pain?

A

A symptom: pain arising from irritation of a spinal nerve or its roots

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13
Q

radicular pain

In order to cause pain at a nerve root, there must be ___ and not simply compression.
Why is this?

A

there must be irritation because healthy nerves when compressed are not painful

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14
Q

What is the most common cause of radicular pain?
What is the likely source of irritation in this case?

A

Disc herniation
Source of irritation is likely chemical (non-compressive) from nuclear material which has escaped the annulus

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15
Q

Any symptoms down an extremity due to an abnormal environment around the spinal nerve root is usually referred to as…

A

radiculopathy (because radiculopathy is frequently accompanied by radicular pain symptoms)

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16
Q

What is the clinical presentation of somatic referred pain?

A

Constant, deep ache that is diffuse or poorly localized

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17
Q

What is the clinical presentation of radiculopathy?

A

(This is a condition/disorder)
Sensory and/or motor neurological loss (numbness or weakness) with corresponding neurological exam or electro diagnostic test findings

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18
Q

What is the clinical presentation of radicular pain?

A

(This is a symptom)
Sharp, shooting pain travelling along a band usually no more than 2 inches wide, in a somewhat dermatomal pattern

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19
Q

What is LMNOPQRST?

A

History taking… idk what it stands for lol

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20
Q

The SI joint has a dual function of:

A
  • Stability and stiffness (to transmit forces)
  • Flexibility (to relieve torsional stress on bony pelvic ring)
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21
Q

SI excursion is on order of ___ degrees on average

A

2 (small but important especially in symmetry)

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22
Q

In the SI joints, asymmetrical motion may provoke pain in…

A

the more mobile of the 2 joints (due to ligamentous and articular irritation from excess torsional strain)

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23
Q

With SI pain, you do not just adjust…

A

where the pain presents

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24
Q

Treatment of SI pain may include:

A
  • Manipulation of the stiffer/restricted SI
  • SI support belt to help with pain
  • Stabilizing exercises
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25
Q

When patient is pointing out SI pain, how might they report it?

A

Pointing to SI joint or PSIS (almost always below L5 and unilateral), may report “hip pain”

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26
Q

With SI pain, which position is mostly tolerable?

A

Sitting (unless prolonged)

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27
Q

What movements may provoke SI pain?

A
  • Transition to standing and initial weight bearing
  • Side-stepping and stairs
  • Shifting/turning in bed (nonspecific)
28
Q

Where may pain refer from the SI joint?

A
  • Buttock
  • Thigh
  • Groin
  • Knee
    (generally not past the knee)
29
Q

What is the primary function of the facets?

A

Guidance of motion

30
Q

The facets limit ___ motion of the superior vertebra

A

anterior

31
Q

When seated, nearly all weight is carried by…

A

discs and vertebral bodies (ignoring soft tissue)

32
Q

When standing, about 20% of body weight is transferred to…

A

facets

33
Q

What are examples of lesions of the facet joints?

A
  • Capsular tears
  • Adhesions
  • Fracture
  • Meniscoid entrapment
34
Q

Where can lesions of facet joints cause pain and why?

A

Pain in the buttock and thigh because they are highly innervated
Typically will not refer pain past the knee

35
Q

Facet/zygapophyseal joint pain is often involved in…

A

hyperextension injury

36
Q

Facet syndrome may involve:

A
  • Irritation of the capsule
  • Macro or micro trauma
  • Joint hypermobility
  • DJD
  • Facet tropism
  • Meniscoid entrapment
37
Q

How can spinal adjustment/HVLA treat adhesions of facet syndrome?

A

Breaks adhesions, restoring motion, which helps limit further inflammation and swelling

38
Q

What is DJD?

A

Degenerative joint disease/osteoarthritis

39
Q

How does DJD affect facets?

A

Alters z-joint function and can be a source of pain (especially in older patients)

40
Q

What is facet tropism?

A

Asymmetrical orientation of the right vs left fact joints

41
Q

Where in the spine is facet tropism common?

A

Common in the lumbar spine, especially L5/S1

42
Q

Facet tropism has a higher incidence in patients with…

A

low back pain (mechanism not well established)

43
Q

What is a meniscoid?

A

AKA synovial fold, a flap of fibro-adipose tissue within the synovium projecting into joint space as much as 5mm

44
Q

What is an “acute lock” and what is responsible for it?

A

Patient bends and cannot straighten again
Meniscoids in lower back or neck are responsible

45
Q

What is the theory of meniscoid entrapment?

A

Fibrous meniscoid gets trapped in the joint space and may indent the articular hyaline cartilage

46
Q

With meniscoids and low back pain, pain results from…

A

tension created on the pain-sensitive joint capsule

47
Q

In patients with meniscoid issues, what movement is typically limited?

A

Extension

48
Q

Facet syndrome is aggravated by…

A

extension (especially after sustained flexion)

49
Q

With facet syndrome, what position/movement is typically favored by the patient?

A

Flexion over extension

50
Q

How does standing up from sitting affect a patient with facet syndrome?

A

Not strongly provocative

51
Q

Where will pain refer to with facet syndrome?

A

Can refer into thigh, but rarely beyond the knee

52
Q

With facet syndrome, where is pain primarily experienced by the patient?

A

Lumbar paraspinal pain, one-sided or bilateral

53
Q

How does a healthy intervertebral disc respond to compression?

A

Does not fail by prolapsing (annulus bulging into spinal canal)

54
Q

How does a normal nucleus pulposus behave?

A

Intrinsically cohesive and resisits herniation

55
Q

internal disc disruption

What allows nuclear material to extend into the annulus?

A

Radial fissures

56
Q

Endplate fracture (or other initiating events) may proceed to…

A

disc disruption

57
Q

internal disc derangement

Nuclear degradation is ___, not ___

A

an active consequence of trauma, not a passive consequence of age

58
Q

internal disc derangement

Degradation changes the…

A

biomechanical support provided by the nucleus

59
Q

What creates the symptomatic presentation of internal disc derangement?

A

Annular fibers (which have radial fissures and possibly erosion) are pain-sensitive

60
Q

How does pain present with internal disc derangement?

A

Deep achy lumbar or L/S pain

61
Q

What exacerbates internal disc derangement pain?

A

Often exacerbated by sitting or bending forward and with coughing or sneezing

62
Q

How does internal disc derangement present pain when standing from sitting, compared to SI pain?

A

Sitting to standing is painful with stiffness contrasting to SI

63
Q

What might make a patient with internal disc derangement feel better?

A

Standing and moving about

64
Q

When a patient has internal disc derangement, back pain is worse… due to…

A

worse in the morning due to fluid inhibition during recumbency (increased disc pressure)

65
Q

Where can pain refer with internal disc derangement?

A

Pain can refer to buttock or thigh, but not below the knee

Chiropractic Tech IV (11 decks)

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