Pathology Flashcards

Question

treatment | HNP w/ nerve root

Answer 1

Reduce protrusion = restore normal posture Manual traction combined with passive axial ext and/or passive backward bending exercises is often effective “play” with angle of pull with manual traction

Answer 2

Acceleration Injuries to the Cervical Spine * Anatomic injury to longus-colli and SCM * Anterior column ligamentous tears * Annular tears of anterior discs * Sympathetic nervous system plexus damage * Nerve root trauma * Esophageal damage * Closed head injury

Answer 3

Majority of the cases, no injuries can be identified Symptoms attributes to musculo-ligamentous sprain Transfer of energy into the neck May result from rear-end or side impact collision Can occur with other accidents Impact of injury can occur on soft tissue and bone in the neck Can lead to a variety of clinical presentations known as WAD Whiplash injury feasible at 5 MPH

Answer 4

Localized and referred pain, paresthesias Diffuse muscular tension, tenderness, and weakness Movement restrictions in the upper quarter Headache Blurred vision Dizziness Dysphagia

Answer 5

Neuro screen clear / Imaging clear Specific findings: Suboccipital muscular tension, tenderness, tightness, symptoms provocation Unilateral or bilateral OA flexion limitations NDI = greater than 15/50 VAS = greater than 5/10 Expectations of recovery = poor expectations of recovery

Answer 6

40% of clients will continue to have symptoms at 6 months! 10-25% will continue to have symptoms at 2 years!

Answer 7

WAD 0 - No complaints or physical signs WAD 1 - Neck complaints only, but no physical signs WAD 2 - Neck complaints and musculoskeletal signs WAD 3 - Neck complaints and neurological signs WAD 4 - Neck complaints and fracture / dislocation

Answer 8

Reduce muscle spasm Passive modalities early Soft collar Proper weaning instructions are critical Proper fit is important Progress to active therapies Counseling/CBT PRN patient education and counseling strategies that promote an active lifestyle and address cognitive and affective factors (chronic neck pain with mobility deficits)

Answer 9

With RA an overactive immune system attacks the joints It usually takes many years for the disease to reach the neck BUT it has been reported that ~1/4 experience neck pain at the time of RA diagnosis Aggravating: morning & inactivity (different pattern than OA neck) **PRECAUTION: High cervical instability!!!!**

Answer 10

Pain, swelling and stiffness Neck pain and cervicogenic headache

Answer 11

Hands off the neck! Modalities, STM to proximal shoulder regions Gentle mid range postural awareness Isometric strengthening Positional support with ADLs

Answer 12

Risk factor is advancing age Chronic degenerative condition affecting: Contents of spinal canal-nerve roots and/or spinal cord Cervical vertebral bodies (eventually = degeneration facets) Intervertebral discs (IVDs) = disc space narrowing

Answer 13

Changes in the osseous and fibroelastic boundaries (DDD & DJD) of the spinal canal and/or lateral recess DJD and/or DDD → normal of spinal canal → myelopathy DJD and/or DDD → narrowing lateral foramen

Answer 14

Initial clinical presentation hypermobility of segment but progresses to chronic hypomobility * Disc bulges outward * Angle of tension on ligaments changed * Weight bearing develops on uncinate processes anterior-laterally

Answer 15

Slow onset * Can be asymptomatic for a long time * As the space for neural structures becomes smaller, the risk of developing motor and/or sensory disturbances increases Exacerbated by minor trauma Pain and muscle guarding * Localized * Referred Neuro – radiculopathy Diagnostic imaging Long term hypomobility and long term progressive stiffness

Answer 16

Reduced SB initial stages followed by reduced sagittal plane motion in later stages

Answer 17

Address limiting impairments Electrotherapeutic modalities to control pain and increase extensibility of the connective tissue Molded cervical pillows Limited immob of CS with collar if nerve root irritation is significant Manual techniques * Stretch adaptively shortened tissues * ROM exercises as tolerated * Isometrics and cervical stab as motion is restored

Answer 18

Chronic neck pain w/radiating symptoms (mechanical I/M) Chronic neck pain w/mobility deficits when combined with TS mob/manip & TE (I/M man or mech txn)

Answer 19

Associated with spondylosis(degenerative process) Usually in patients over 50 years Chronic and slowly progressive

Answer 20

Narrowing of the spinal cord Central or lateral Disc space narrowing leads to loss of cervical lordosis Loss of disc height also leads to buckling of the ligamentum flavum posteriorly Osteophytes form from the facets, uncovertebral joints, and posterior vertebral margins

Answer 21

* Neck pain; not always severe. * Pain, weakness, or numbness in the shoulders, arms, and legs. * Hand clumsiness * Burning sensations, tingling, and pins and needles in the involved extremity

Answer 22

Symptoms aggravated by extension of the neck: * In extension = narrowing of the spinal canal by 20%

Answer 23

Flexion exercises Note: In flexion, widening of spinal canal by 31%

Answer 24

A disorder in the cervical region of the spinal cord that disrupts or interrupts the normal transmission of the neural signals

Answer 25

Present in 90% of individuals by age 70 * Most common spinal cord dysfunction in people over 55 years * Males > Females * Asian Descent

Answer 26

Prognosis worse the more severe the stage Degenerative (cervical spondylotic myelopathy) Progresses in varying fashions

Answer 27

Direct compression of the spinal cord by bony or fibrocalcific tissues Ischemia caused by compromise of the vascular supply to the cord Repeated trauma secondary to normal flexion and extension of the neck

Answer 28

* Neck pain, HA, dizziness * Radicular arm pain * May have only bilateral LE sxs (no UE) * Bowel & bladder disturbance * Hyperreflexia (UEs & LEs), clonus * Multisegmental weakness and/or sensory changes * Intrinsic wasting and sensory disturbance of the hands * Hoffman’s & Babinski reflex * Loss of dexterity * Wide-based unsteady gait

Answer 29

* Gait Deviation; * (+) Hoffman’s; * Inverted Supinator sign (C6 DTR with Finger flexion); * (+) Babinski; * age > 45 years

Answer 30

Mild: involves hand and arm symptoms, but does not prevent performance of normal ADL’s Moderate: considerable difficulty using their arms and legs, which affects performance of ADL’s Severe: require ambulatory aides, and often confined to bed, chair or home