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NAIOMT Cervical Spine Exam C-516 > Pathoanatomical Diagnosis/Illness Scripts Info > Flashcards

Pathoanatomical Diagnosis/Illness Scripts Info Flashcards

1
Q

Healthy nerve root irritation signs/sx

A

paresthesia

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2
Q

Mechanical Neck Pain [MNP]

A
  • related to activity

- can reproduce and find relief positions

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3
Q

C6 radiculopathy due to “soft disc” herniation of CS at C5-6

A
  • second most common level of HNP of cervical spine
  • posterior lateral most common - medial foramen, motor sign > sensory
  • material still contained within disc borders
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4
Q

Definition of “soft disc herniation”

A

-“non-degenerative” and the disc has not lost height or water content

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5
Q

The three basic types of disc herniations?

A
  1. prolapse
  2. extruded
  3. sequestered
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6
Q

Sign/sx of classic C6 radiculopathy from C5-6 HNP?

A

-sharp, inter scapular pain that is higher on the scapula close to the superior angle

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7
Q

Common signs/sx of C6 root pain

A
  • symptoms along volar aspect of forearm and radial side of hand into thumb, index finger
  • paresthesia common
  • weakness of key muscles common
  • neurological signs common
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8
Q

Differential Diagnosis of C6 root pain

A
  • thoracic outlet
  • carpal tunnel syndrome
  • lateral epicondylitis
  • acute subacromial bursitis
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9
Q

Pathological conditions that can affect cervical nerve roots other than disc herniations

A
  • auto-immune
  • viral neuritis
  • plexitis secondary to trauma
  • neural scarring
  • hypertonicity of scaleni muscle groups
  • neural sensitization
  • nerve degeneration conditions/diseases
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10
Q

Intervertebral disc as primary pain generator

A
  • cervical HNP
  • posterior lateral
  • fragments
  • annular and nuclear herniations
  • toxic to DRG
  • compression not necessary
  • chemicals in epidural space
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11
Q

Classic sign/sx seen with CS discography?

A
  • referral of nociceptive pain into the medial scapula when the lower cervical intervertebral disc was stimulated
  • this gives off referred pain that then turns into peripheral sensitization producing muscle and scapula pain due to lower thresholds producing allodynia or hyperalgesia
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12
Q

General cervical root symptoms & signs

A
  • distal paresthesia proximal pain
  • segmental reference
  • peripheral nerve = clear border of symptoms/atrophy/anesthesia
  • conduction deficits
  • motor = fatiguable
  • DTR’s = hyporeflexive
  • UMN - hyperreflexive
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13
Q

Differentiation between C6 & C7 radiculopathy

A
  • C6 = much less sensitive, want to “get rid of it”

- C7 = extreme sensitivity, seem “sick”

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14
Q

Prolapse HNP

A

-nuclear material is contained and more in periphery than in center of disc

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15
Q

Extrusion HNP

A

-outer annular wall disrupted, more disc material out than in

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16
Q

Sequestration HNP

A

-annular or nuclear fragments

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17
Q

Consequences anatomically if material reaches the epidural space?

A
  • the disc material (HNP’s can consist of annular and nuclear material or both) can wrap around neural structures and move up and down the posterior longitudinal ligament and produce massive amounts of macrophages and cytokines when herniated
  • the DRG which houses the cell bodies is extremely sensitive to pressure and inflammatory cells
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18
Q

Innervation of outer third of disc

A

sinuvertebral nerve

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19
Q

Consequence of sinuvertebral nerve when disc is injured?

A

-the SN starts growing inward toward the inner third of the disc which has been postulated being a cause of chronic neck or low back pain

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20
Q

C7 root pain

A
  • C7 root most sensitive of all cervical roots
  • pain lower scapula, back of shoulder, arm into middle fingers
  • weakness of elbow extension, long finger flexors
  • rarely reduction of triceps reflex
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21
Q

Differential diagnosis of C7 root pain

A
  • triceps tendonitis
  • winging of scapula
  • calcified tendonopathy
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22
Q

Importance of PT with radiculopathy

A
  • no MRI can diagnose radiculopathy
  • PT’s are able to based off of clinical exam
  • ONLY profession that can do this with history, exam, etc.
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23
Q

Cervical primary disc lesions

A
  1. less common than lumbar disc
  2. most prominent levels: C6-7 > C5-6, C4-5
  3. radiculopathy - clinical diagnosis confirmed by imaging
  4. can resolve 3-4 months untreated
  5. history = episodic inter scapular region with progression
  6. age = uncommon below 30
  7. common in 30-48 age group
  8. following HNP disc height changes affects alignment, slightly flexed segment
  9. evolution involves more distal symptoms and neuropathic pain
  10. later stages (50-70 y/o) central or foramina stenosis
  11. foramen is funnel shaped from medial to lateral
    - anterior funnel osteophytes off uncovertebral joints, disc
    - posterior funnel superior facet, lig flavum, neural cysts
  12. paresthesia/weakness in dermatomal reference without neck pain = classic stenosis
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24
Q

Misdiagnosis of classic cervical primary disc lesions?

A
  • shoulder pain
  • bursitis
  • rhomboid strain
  • previous history of neck pain
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25
Q

Treatment for HNP with radiculopathy in CS

A
  • rest and medication
  • traction #1 every day!
  • manual (depending on severity of pain)
  • e-stim
26
Q

Key testing of HNP with radiculopathy

A
  • reflexes
  • sensation testing [toothpick, hyper or hypo-esthesia]
  • fatiguable weakness: cannot hold initial resistance w/ triceps testing MMT
  • remember: dermatomes can cross each other quite a bit
27
Q

Plexopathy

A

trauma to plexus

28
Q

RTC differential dx signs/sx vs. CS

A
  • inflammation/irritation
  • age, pain with arm elevation
  • unable to open a jar
  • location of pain not as close to shoulder
29
Q

Definition of arachnoiditis?

A
  • type of chronic pain caused by inflammation in the spinal canal
  • chronic pain disorder caused by inflammation of the arachnoid membrane and subarachnoid space that surround the nerves of the spinal cord
30
Q

Definition of polyarthropathy?

A
  • any type of arthritis that involves 5 or more joints simultaneously
  • it is usually associated with autoimmune conditions and is not age or sex-specific
31
Q

Chronic fatigue syndrome

A
  • insidious condition, with fever, aching, and prolonged tiredness, depression
  • typically occurring after a viral infection
32
Q

Pathobiological - beyond the “cause effect relationship”

A
  • pain mechanisms - related to input, processing, and output
  • peripherally evoked - neuroma, carpal tunnel, cervical radicular
  • centrally evoked - abnormal sensitivity, facilitated segment, altered axoplasmic flow
33
Q

Pathomechanical

A
  • inability of neural tissue to move with surrounding tissue
  • interfaces with soft tissue, fascia, bone, etc.
  • fibrosis possible - scarring
  • intra-neural edema
34
Q

Why do muscles hurt with neuropathic pain?

A

-the nerve brings proteins to the muscle

35
Q

Positive effect of neural mobilization techniques?

A
  • positively affects axoplasmic flow of the axon

- stretching disease nerve is not reasonable but moving the nerve is reasonable

36
Q

Neural Intra-Unit Dysfunction

A

Chronic tissue irritation -> inflammation -> edema -> scarring -> impaired gliding/axoplasmic flow altered ->

37
Q

Cervical Spondylosis

A
  • DJD and spondylosis are same thing
  • HA in morning, 3-4/10 pain
  • capsular pattern with extension most limited = hallmark clinical finding
  • multiple levels of involvement
  • osteophytosis
  • gross loss of lower cervical motion
  • upper cervical motion
38
Q

Cervical Spondylosis: UCS vs. Lower CS

A
  • typically in the elderly, cervical spondylosis can affect upper or lower portion of neck
  • when it involves upper segments it can lead to vestibular cervical and ocular problems causing symptoms beyond pain and stiffness. Light headedness, wooziness, difficulty focusing their eyes, etc.
39
Q

When do you see osteophytosis?

A

-with end plate changes

40
Q

Osteophytes - uncovertebral joints

A
  • can lead to foraminal stenosis
  • rare cases - compromise vertebral artery
  • vertebral spine attempt at stability
  • places segment in capsular pattern
  • spondylosis truly restricts them myo-articular complex especially the contralateral translation of the CS
  • find degeneration in UVJ’s - why patients have limited SB
  • shorter statures = higher probability of stenosis
41
Q

Severe Cervical Spondylosis

A
  • most common levels: C5-6, C6-7
  • multisegmental involvement
  • muscle spasm secondary to reflexive imbalance of tonic and phasic muscle
42
Q

Alterations in physical structure of cervical muscles with chronic MNP

A
  • widespread atrophy
  • pseudohypertrophy
  • fatty replacement of cervical extensor muscles
  • changes most noticeable in suboccipital and deep multifidus muscles
43
Q

Chronic instability

A
  • slack in fibers of the capsuloligamentous ligament at the facet joint
  • unstable
  • bones lay osteophytes to try to stabilize - trying to stiffen joint but there is no cushioning
44
Q

Phase transition of MNP

A
  • more dysfunction, less control
  • certain set of exercises: do not feel better treatment to treatment - make sure to educate that to patient and will feel ultimate effects ~6 mo’s down the road
  • more neck-friendly activities
  • can’t change cross-sectional area but synchronization
  • neuro re-ed all the time
45
Q

Clinical Instability

A
  • most of the time not painful
  • phase transition from initial stage of degeneration and the final stages of degeneration
  • facet tropism
  • body types
  • sensitive nervous systems
  • advancing on the spectrum of instability usually due to loss of disc height & slack of the capsuloligamentous complex - most likely will need inter body fusion later in life if disc degeneration continues
46
Q

Cervical Spine Myelopathy

A
  • cord gets displaced posteriorly
  • ligamentum flavor loses extensibility - buckles into canal - this is the main reason for myelopathy
  • “tight stenosis” - injections don’t work
  • degenerative bony changes lead to narrowing of canal
  • most common occurrence with degenerative processes (cervical spondylotic myelopathy)
  • neural tissue ischemia from compression and from loading of neural tissue
47
Q

Clinical signs/sx of cervical spine myelopathy

A
  • neck and extremity pain are variable
  • LE weakness (non-myotomal) and velocity-dependent hypertonia
  • sensory impairment of UE’s and LE’s (non-dermatomal)
  • UMN signs in LE’s (e.g. reflexes increased, Babinski, gait incoordination)
  • atrophy of intrinsic muscles of hand (secondary to necrosis of anterior horn cells)
  • presence of + Hoffman’s reflex is accurate test for cervical myelopathy
  • temporal pattern of initial subtle gait disturbance followed by UE numbness and loss of fine motor control is thought to be most common presentation of spondylitic myelopathy
48
Q

“Young” cervical spine stenosis

A
  • occurrence rate of 26 to 100,000
  • Hoffman reflex cervical or lumbar
  • Canal length 17-18 mm’s cord is uniform at 10 mm
  • canal smaller at extension/flexion: ligamentum flavum buckling in extension and PLL and disc bulging in flexion
  • young defined as < 50
  • no difference in gender
  • age alone does not potentially exclude CSS
49
Q

Cervical dizziness damage to mechanoreceptors:

A
  • trauma - stretch, micro tears injure nerve terminals
  • mechanical - excessive joint loading
  • degenerative cascade - genetically predisposed
  • stress - sympathetic output is altered
  • produces a mismatch of information between cervical and vestibular input
50
Q

Summary of literature review with Cervical Dizziness

A
  • level III evidence
  • lack of systematic RCT
  • expensive testing does not improve outcomes
  • facet arthritis more common in upper cervical spine
  • manual therapy, acupuncture effective greater than 70% of the time - do not do well with manipulation because it is too forceful
51
Q

Meniere’s Disease

A

-hearing loss and vertigo due to endolymph buildup medical and surgical intervention is helpful along with diet and diuretics

52
Q

Perilymph Fistula

A

-disruption between middle and inner ear results in leakage of perilymph into the middle ear. trauma to head without fracture. Vertigo/disequilibrium develops and sensitivity to certain frequencies of noise is apparent

53
Q

Acoustic Neuroma

A

-tumor on CN VIII causes loss of hearing, tinnitus, disequilibrium, and vertigo

54
Q

Migraine Related Dizziness

A

-variant of peripheral vestibular dysfunction - no findings of peripheral vestibular dysfunction related to vasodilation of the vessels of the vestibular system

55
Q

Vasculogenic Cervical Arteries

A
  • sources of upper cervical symptomatology usually involves more than dizziness due to its network of vascularity to the brain
  • case studies indicate that primary sx can mimic mechanical neck pain with the exception of:
    1. hemodynamic changes produces HA/dizziness
    2. usually more than dizziness is involved (ptosis)
56
Q

Vasculogenic HA vs. Cervicogenic HA

A
  • vasculogenic HA = 8-9/10

- cervicogenic HA = 6-7/10

57
Q

Morphological changes with Chronic Neck Pain

A
  • changes in muscle with neck pain from Type I fiber (tonic) to type IIC (fast twitch):
    1. longus coli, suboccipitals
    2. consistent with loss of endurance
    3. loss of control and craniocervical stability
    4. upper trapezius cellular changes
  • spondylogenic = loss of cervical lordosis alters afferent input (throws neck into loss of proprioception
  • motor control = craniocervical imbalance torque producers versus segmental stabilizers
58
Q

Alterations in Sensory Processing with Chronic Neck Pain

A
  • allodynia
  • hypersensitivity to cold therapy = indicative of neural sensitivity
  • hypersensitivity mechanical pressures (face, neck)
  • central sensitization = loss of endogenous pain control and neurophysiological adaptations
59
Q

Classic symptoms of Cervical Myelopathy?

A

-hand weakness, balance/walking/gait changes

60
Q

Systemic Arthropathy (list of possibilities)

A
  • rheumatoid arthritis
  • ankylosing spondylitis
  • psoriatic arthritis
  • undifferentiated spondylitis
  • reiter’s disease
61
Q

Reiter’s Disease

A

-a medical condition typically affecting young men, characterized by arthritis, conjunctivitis, and urethritis, and caused by an unknown pathogen, possibly a chlamydia.

NAIOMT Cervical Spine Exam C-516 (4 decks)

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