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Neuromusculoskeletal > PT4 - Tspine Intro > Flashcards

PT4 - Tspine Intro Flashcards

1
Q

Why do we want to describe something as non-specific xyz?

A
  • gives us freedom
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2
Q

What are the 4 signs to TTT?

A
  • unilateral
  • mechanically stimulated/eased
  • no red flags
  • no radiations (usually there are some radiations)
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3
Q

When can we treat non-mechanical conditions? (E.g. cancer)

A
  • evidence must be clear
  • must be transparent with PT about evidence around getting better from TTT (level of evidence concerning TTT may be unclear)
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4
Q

How long can we leave a PT with neurological symptoms?

A
  • less than 12 weeks for recovery
  • longer start to be concerned that nerve may not recover
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5
Q

What age should we be concerned if it’s a new onset of S+S that are not familiar?

A
  • > 50 YO
  • humans are good at recreating pain experiences if we’ve had it before
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6
Q

What does fascia provide us with?

A
  • resilience
  • joins things together
  • blends with capsules, muscles, tendons, ligaments, connective tissues
  • Tensegrity to hold shape as long as those tissues are holding well
  • in standing not much work required (energy efficient)
  • when starting to move we thing about joints and fascia required more
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7
Q

What do bones provide the skeleton with?

A
  • provides shape
  • transmission of forces during standing
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8
Q

What do joints provide us with?

A
  • do not have good force transmission
  • when we move we use joints + lumbar spine (flexion, extension, sidebending)
  • limbs are attached to axial skeleton and lumbar spine
  • L5 (most analomous) facets are frontal facing (different from the rest of the Lsp) to assist with force transferal (wedge shaped VB). Assists with translation of rotational force in Lsp.
  • L5 have iliolumbar ligament from TPS onto innominate (L4/L5) => if L4 reduces risk of LBP. L5 does not resolve forces well (hence L4/L5 more prevelant to disc injury)
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9
Q

What happens at the hip + knee in locomotion?

A
  • hip helps us get our feet underneath us
  • forces like to travel in straight lines => knee already compromised
  • menisci are deformable (rounded condyles change shape) => improve congruity for force transmission => should be used for shock absorption
  • rotation of hip allows to move as biped
  • hip rotates externally => more medial knee tension (meniscus + capsule + MCL) ==> increased tension medial + knee rotates medially => pes planus
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10
Q

Where is a commons site for knee pain + why?

A
  • anterior knee pain
  • capsule becomes inflammed when stretching, capsule holds fluid (proprioceptive, mechanical to maintain MM tone => results in altered feedback if altered movement)
  • capsule influences VMO => VMO wastes => overuse laterally + underuse medially
  • capsule tears off medially => more inflammation
  • capsule works well in young people, not in older people
  • in older people there is more debris + fewer lysosomes cleaning up the joint
  • solution: educate PT on walking => heel first + lengthen gaze + PT stand slowly (wait for Baroreceptors to adjust; takes longer if they move)
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11
Q

Why can the shoulder girdle be maladapted?

A
  • shape is shallow (glenoid) w/ very big humeral head
  • lots of movement available => but cannot rely on bony congruity
  • rely on rotator cuff + contractile forces
  • ideal is for good posture => assists humeral head across deltoid, as soon as shoulder rounded capacity to deal with forces is reduced
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12
Q

Why is the neck a common presenting area?

A
  • OA/subocciptials
  • when head moves shouldn’t see too much shoulder movement
  • happy neck depends on happy thorax
  • thoracic health reduces as we age
  • thorax becomes kyphotic, more osseous and less cartilageonous
  • eyes + ears what to be presented with sensations => increase mechanical demand on tissues
  • failure to adapt to force effectively => neck pain
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13
Q

How can you improve adaptability?

A
  • movement assists by:

-> increasing CVS demand

-> respiratory capacity increased

-> hormone regulation => serotonin (calm/relax) => influence on parasympathetic/sympathetic nervous system, regulation of glucose (insulin + cortisol)

-> bones => increase calcium/bone density/regulation

-> ligaments => stronger, thickening, sacralspinous, sacrotuberous ligaments particularly important for posture

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14
Q

What happens to the Fiona Hendry balloon of adaptability as we age?

A
  • boundary of balloon diminishes as we age, meaning we come closer to injury
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15
Q

What is peripheral resistance?

A
  • micro vasculature working to keep blood pressure low
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16
Q

What happens when peripheral resistance increases?

A
  • blood pressure increases
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17
Q

What do you need to consider with adaptation?

A
  • is it cumulative towards failure?
  • what is the PT clinical temporal profile?
  • what has changed to result in maladaption?
  • can you change forces or/and improve adaptability?
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18
Q

Why is 10k steps a bad metric for exercise?

A
  • 10k steps is arbitrary, breads complacency => where is the CVS activity in that? Need to increase HR
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19
Q

What is a good metric and what happens when you’re unwell?

A
  • Resting HR is a good metric
  • Goes up by 4-5 bpm when unwell
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20
Q

How can we help the patient with exercise?

A
  • rotation for thoracic compliance
  • relieve on locomotion
  • PT wants to be as fluid as they can be
  • applicator is never resting on ligamentus tissue (esp. w/ hypermobile people), come to max and return to neutral
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21
Q

Why do we have a NSP diagnosis?

A
  • non-pathological
  • no red flags (safety)
  • unilateral
  • mechanically aggravated/eased
  • may have mild radiations => evidence that OTM can help these individuals
  • designed by GPs + physios as a diagnosis of exclusion
  • for osteo’s it’s a diagnosis of inclusion
  • NSP is not a diagnosis
22
Q

What are the most sensitive tissues in the body?

A
  • MM due to neuroreception
23
Q

What happens when a PT stops going to the gym?

A
  • reduced adaptability of tissues
24
Q

When should you treat a patient?

A
  • don’t treat 2-3 days post injury => let the body do what it’s best at, PT may need to seek pain relief, gentle mobilisation
  • then triage 7 days post trauma
25
Q

If you have a 35 YO PT w/ 4-5 week injury, it is recovering, unilateral, aggravated by movement, no red flags, known onset, with healthy habits and lifestyle, what is their prognosis?

A
  • good prognosis of recovery
26
Q

PT is standing for long periods of time, presents with chronic inflammation throughout their body, which is symmetrical, what might you need to consider

A
  • ligaments around joints might be chronically inflammed
  • suggested to tone up core and change footware (trainers vs hard soled shoe)
27
Q

What do we look for in a healthy spine?

A
  • no Fasciculation
  • lumbar rounds on flexion
  • extension largely eradicates kyphosis
  • SB translates through hips and lower back
  • CSP shoulders don’t move if on shoulder comes up then ribs may not be moving so well. CSP should move through thorax
  • look for signs of measureable change
28
Q

Where is a common site for OA?

A
  • thorax
  • big VB => big exits, means we don’t feel dysfunction in thorax
29
Q

What is nonspecific thoracic spine pain?

A
  • pain in tsp mechanically aggravated + not clearly caused by pathology/trauma/discal disease
  • associated with altered movement/range of thoracic/rib movement active +/or passively
  • no objective neurological deficit
  • may be accompanied by referred pain
  • may also involve shoulder, csp, UEX or LBP
  • > = 70% population with suffer from NSTSP
  • higher in children + adolescents + women
  • associated with sitting duration
30
Q

What other findings are there associated with Tspine pain?

A
  • thorax most common site for degenerative change
  • asymptomatic thoracic disc herniations are common
  • symptomatic are rare (5:1000 herniations)
  • tsp relatively commons site for inflammatory degeneration, metabolic, infective and neoplastic conditions
31
Q

What DDX are associated with tsp pain and dysfunction?

A
  • primary + secondary osteoporosis (primary => aging, secondary => trauma)
  • AS
  • OA
  • Scheuermanns disease
32
Q

What are the risk factors for NSTSP?

A
  • 5% male: 15% female
  • age
  • being tall
  • frequent sustained trunk bending
  • lack of variety in tasks/lack of recovery
  • posture/use of back pack
  • extended sedentary work
33
Q

What are the red flags for TSP pain?

A
  • violent trauma
  • minor trauma
  • first ones <20 or >50
  • illness - fever/chills/weight loss
  • severe, constant, progressive pain
  • non-mechanical

-severe morning stiffness

  • severed/progressive neurological deficit in LEX
  • pain not managed with drugs
34
Q

What are the functional impacts of NSTSP?

A
  • loss of healthy function at an area can affect the other integrated areas
  • e.g. upper rib dysfunction may affect scapular position => humeral orientation + rotation cuff action
  • functional change/loss of agency can involve/affect ANY of the functions of the thorax e.g. reduced scapula function after bad cough/cold
  • TTT to thorax before rotator cuff => think architecture (predisposing/maintaining factors)
35
Q

What are the functions of the thorax?

A
  • ventilation - involves tsp vertebrae + ribs
  • locomotion - axial rotation (determined by facet direction) + use of upper limb
  • shoulder function - integrated movement + force transmission
  • force dissipation => compression/torque via ribs
  • protection - viscera/CNS
  • adaptability + compensation
36
Q

What is the specialised structure of the ribs?

A
  • 1st rib => sliding articular movement
  • 2-5 ribs => rotation articular movement => pump handle
  • 6-9 ribs => sliding articular movement => performing ‘bucket handle’ movements
  • rotational effects on rib cage
37
Q

What are the thoracic relationships with the sterno-pericardial ligament?

A
  • diaphragm - pericardial ligaments
  • vertebral - pericardial ligaments (inferior C3-4 + superior C4-5)
  • descending group - sphenoid-pericardial from occiput & thyro-pericardium
38
Q

How to classify thoracic spine presentation

A
  • by symptom area/pain presentation
  • functional loss
39
Q

What are common thoracic pain presentations?

A
  • unilateral posterior thorax pain => commonly spinal/paraspinal mechanical pain + evoked by stretching + associated with local tenderness + MM tension
  • anterior radiation of pain => rib strain - intercostal MM involvement
  • interscapular pain => usually unilateral - main include referred pain + postural MM strain/overuse/imbalance
  • anterior thoracic pain
  • Tietzes syndrome
  • Trauma - WAD (whiplash associated disorder)
40
Q

What are the compensatory effects of a hypo mobile area in the Tsp?

A
  • primary hypermobile ridid zone = T2=>T4
  • results in secondary hypermobile zone superiorly C6-T1
41
Q

What are the Olsen classifications of function loss in Tsp?

A
  • thoracic hypomobility
  • thoracic hypomobility + UEX referred pain
  • thoracic hypomobility + neck pain
  • thoracic hypomobility + shoulder impairments
  • thoracic hypomobility + LBP
  • thoracic clinical instability
42
Q

What are the effects of thoracic dysfunction?

A
  • local pain - CV or CT
  • GH or clavicular pain/dysfunction
  • referred pain
  • thoracic outlet syndrome
  • Possible ANS disturbance - Horner’s syndrome
  • Altered scalene mechanics
  • Effect of Csp and Lsp mechanics
43
Q

What is Tietzes syndrome?

A
  • costochondrosis
  • usually in adolescent population
  • where rib meets cartilage or cartilage meets sternum + manubrium
44
Q

What is Horner’s syndrome?

A
  • problem with sympathetic nerve supply to one side of face
  • symptoms: miosis (constricted pupil) + ptosis (droopy eyelid). Anhidrosis (inability to sweat) => happen ipsilateral as damaged nerve (SPAM = sympathetic, Ptosis, Anhydrosis, Miosis)
  • damage along the occulosympathetic pathway e.g. spinal cord lesion above T1, compression to neuron (tumor), dissection of internal carotid artery
45
Q

What happens if a PT has a C6 facilitation?

A
  • skin pain in C6 dermatome (lateral part of forearm + thumb + index finger)
  • MM pain + deltoid + brachioradialis spasm => effects shoulder/elbow mobility
  • periosteal pain in radia head + lateral border of radius + radial stolid or thumb
  • angiotomal burning sensations over lateral extensor compartment of arm
46
Q

What structures are involved in rib cage dysfunction?

A
  • intercostobracial nerve
  • intercostal nerve => collateral branch + lateral cutaneous branch + terminates as anterior cutaneous nerve
  • special features: intercostobrachial nerve of T2 (sometimes T3)
47
Q

What are some DDx for thoracic pain?

A
  • csp referral
  • CVS presentations
  • scoliosis
  • shuermann’s disease
  • osteochondritis
  • thoracic discal disease
  • chest infections
  • polymalgia rheumatica (PMR)
  • osteoporotic crush fracture
48
Q

What happens when asymptomatic individuals have their thoracic spine MRI’d?

A
  • 73% had significant findings
  • 37% IVD herniation
  • 53% IVD bulging
  • 58% annular tear
  • 29% spinal cord deformation
  • 38% sheuermann end plate irregularities
49
Q

What happens to the structure as the thorax ages?

A
  • calcification of stool cartilages/chondrosternal joints
  • asymptomatic discal degeneration (large spinal canal + foramena)
  • reduced thoracic compliance from age 50 due to loss of collagen in ribs/reduced twisting capacity
  • stiffness + increase in kyphosis
  • reduced mid-thoracic ventilation - segmental degeneration
  • increased protraction of scapulae
  • reduced rib movement, reduced fluid movement at segmental level
  • reduced diaphragm excursion
  • increase in OA => reduced disc heigh, changes in facet joints, deformation of nerve roots + sympathetic chain
  • Heart _ lung function highly tolerant of changes
50
Q

What happens to the lungs as the thorax ages?

A
  • reduction in elastic recoil of lung
  • decrease chest wall compliance
  • decrease respiratory MM strength
  • increase in residual respiratory capacity (volume of air remaining in the lungs after expiration)

Neuromusculoskeletal (23 decks)

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