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Physiotherapy 2.3 > PTA 2.4 > Flashcards

PTA 2.4 Flashcards

1
Q

What are the types of primary head ache?

A

Tension Type Headache

Migraine

Cluster Headache

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2
Q

What are the types of secondary headache?

A

Cervicogenic headache

Medication overuse headache

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3
Q

Which headache has the highest prevalence?

A

Tension Type Headache TTH (69%)

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4
Q

Which headache has the lowest prevalence?

A

Head ache due to brain tumor (0.1%)

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5
Q

What is the peak age of having headaches?

A

40 years

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6
Q

How many sick days per 1000 employees are there for migraine?

A

270 days

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7
Q

How many sick days per 1000 employees are there for TTH?

A

820 days!!!

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8
Q

When and in wich gender is cervicogenic headache more prominent?

A

Females

43 years

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9
Q

When and in which gender is TTH more prominent?

A

Females

20-45 years

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10
Q

When and in which gender is migraine more prominent?

A

Females

35-45 years

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11
Q

When and in which gender is cluster head ache more prominent?

A

Males

20-40 years

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12
Q

Where is pain located, where does it start and what type of pain is associated with cervicogenic headache?

A

Starts in the neck

Unilateral without sideshift

Dull not throbbing pain

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13
Q

Where is pain located, where does it start and what type of pain is associated with TTH?

A

Pain starts in occipital edge

Bilateral (like a band)

Oppressive pain

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14
Q

Where is pain located, where does it start and what type of pain is associated with migraine?

A

Starts in frontotemporal region

Unilateral with sideshift

Throbbing pain

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15
Q

Where is cluster headache located?

A

Unilateral

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16
Q

How intense is cervicogenic headache?

A

Medium to severe intensity

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17
Q

How intense is TTH?

A

Moderate to medium intensity

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18
Q

How intense is migraine pain?

A

Medium to severe

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19
Q

How intense is cluster headache

A

Very high intensity - suicidal headache

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20
Q

What are the episode characteristics of cervicogenic headache?

A

Varying duration

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21
Q

What are the episode characteristics of TTH?

A

30 minutes to 7 days

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22
Q

What are the episode characteristics of migraine?

A

4 to 72 hours

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23
Q

What are the episode characteristics of cluster headache?

A

7 days to 1 year with pain free periods of above 1 month

Chronic = over 1 year without pain-free periods

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24
Q

Is cervicogenic headache triggerable?

A

Yes

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25
Q

Is TTH triggerable?

A

No

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26
Q

Is Migraine triggerable?

A

(No)

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27
Q

Which areas can also be affected in cervicogenic headache?

A

Ipsilateral arm or shoulder pain (not radicular)

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28
Q

Which types of headaches usually don’t cause other pain areas like arm or shoulders?

A

Migraine and TTH

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29
Q

Which type of headache is often associated with ROM limitation of the cervical spine?

A

Cervicogenic headache

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30
Q

Which type of headache can possibly show ROM limitation?

A

TTH

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31
Q

Which type of headache usually doens‘t show ROM limitations?

A

Migraine

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32
Q

Does not get worse during exertion

Possible photo-phonobia

Possible nausea

Which type of head ache is this?

A

Cervicogenic headache

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33
Q

Does not get worse during exertion

Possible photo-phonobia

No nausea

Which type of headache is this?

A

TTH

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34
Q

Photo-phonobia present

Nausea present

Auras possible

Which type of headache is this?

A

Migraine

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35
Q

Red eyes

Tears

Swollen drooping eyelid

Sweating face

Constricted pupil

Stuffy/runny nose

Restlessness

Which type of headache is this?

A

Cluster headache

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36
Q

Indomethacin, sumatriptan, ergotamine show no effect in which type of headache?

A

Cervicogenic headache

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37
Q

Amitriptylin, short-term paracetamol and NSAIDs are common medication for which type of headache?

A

TTH

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38
Q

Porfylacticum and Triptanen are common medications for which type of headache?

A

Migraine

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39
Q

Profylacticum, oxygen inhalation, sumatriptan, nose spray are common medications for which type of headache?

A

Cluster headache

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40
Q

What are the criteria to diagnose TTH?

A

Minimum 2 out of 4:
- Bilateral pain
- Pressing pain
- Moderate intensity
- Not influenced by daily activities

Additionally 1 of the following:
- No nausea and/or vomiting
- Photophobia and/or Phonophobia

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41
Q

Which type of migraine has disturbed vision on both sides?

A

Eye migraine/ophthalmic migraine

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42
Q

Which type of migraine has disturbed vision on one side?

A

Retinal migraine

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43
Q

With which findings can you diagnose migraine?

A

Minimum 2 of the following:
- Unilateral
- Pulsating
- Moderate to intense pain
- Exacerbated by daily exertion or avoidance of these activities

Minimum 1 of the following:
- Nausea and/or vomiting
- Photophobia and/or Phonophobia

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44
Q

Which form of neuralgia in headaches is most common?

A

Trigeminal neuralgia (cranial nerve 5)

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45
Q

What are pain characteristics of cranial neuralgia?

A

Pain has at least 1 of the following characteristics
- Intense
- Sharp
- Superficial
- Stabbing
- Trigger area or trigger factors

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46
Q

How often is trauma the cause of cervicogenic headache?

A

In 57% of cases

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47
Q

Which segment is most often symptomatic in cervicogenic headache?

A

C1/C2 (upper cervical spine)

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48
Q

How many patients with cervicogenic headache also experience other types of headache?

A

17.5%

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49
Q

Which characteristics should be given to diagnose cervicogenic headache?

A
  1. a1) Provocation by neck movements or separate main positions like (e.g. talking to neighbour while eating, painting the ceiling)
    a2) Painful pressure points on affected side in occipital region
    b) Decreased ROM
    c) Unilateral neck, shoulder or arm pain → vague, generally not radicular, sometimes though radicular pain
    → Combination of b) and c) is satisfactory but for scientific work only with a1)
  2. Sometimes anaesthetic blocks needed to confirm CGH (mandatory for scientific work)
  3. Usually unilateral without side change (for scientific work)
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50
Q

Excessive use of medication

Use of medication > 3 months

Paracetamol or NSAIDs for ≥ 15 days per month

Triptans ≥ 10 days per month

These factors indicate which type of headache?

A

Medication overuse headache

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51
Q

Which specific red flags require immediate action by the GP?

A
  1. Acute severe headache possibly combined with neck pain?
    -> meningitis, CVA, subarachnoid bleeding
  2. Neck stiffness/neurological symptoms?
    -> Meningitis, brain tumor
  3. Headache with fever and reduced consciousness?
    -> Meningitis
  4. Headache with focal neurological symptoms?
    -> Brain tumor
  5. Increase of headache less than 6 weeks after cranial trauma?
    -> sub/epidural hematoma
  6. Headache with atypical aura (> 1 hour), weakness?
    -> CVA
  7. Headache with aura after starting anti baby pill?
    -> CVA
  8. Headache during pregnancy (third trimester)?
    -> (pre-)eclampsia
  9. Headache, dizziness, nausea, lethargy
    -> CO-intoxication
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52
Q

Which region specific red flags for headache require immediate referral to another specialist?

A
  1. Headache < 6 years?
    -> Brain tumor, hydrocephalus
  2. New episode of headache age ≥ 50?
    -> Brain tumor, arteritis temporalis, malignant hypertension
  3. Headache with visual problems; acute loss of vision, diplopia?
    -> Arteritis temporalis, acute glaucoma
  4. New headache in patients with cancer, HIV, immunodeficiency?
    -> Brain tumor, brain abscess, meningitis
  5. Progressive increase of headache within weeks or longer?
    -> Brain tumor
  6. Headache with signs of increased pressure?
    -> Brain tumor
  7. Headache with morning vomiting, vomiting not related to headache?
    -> Brain tumor, cerebral sinus thrombosis
  8. Headache with personality change or deterioration of school performance?
    -> Brain tumor
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53
Q

How many patients with migraine also have TTH?

A

83%

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54
Q

How many patients with TTH also have migraine?

A

23%

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55
Q

What is the clinimetric tool called HIT-6?

A

Headache Impact Test 6

  • Measures impact of headache on daily life, at home, job, school, hobbies, social life
  • Score above 50? → High impact on life and doctor should be seen
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56
Q

What is the clinimetric tool called HDI?

A

Headache Disability Index

  • Measures frequency, intensity and impact on quality of life
  • The higher the percentage the bigger the impact and disability
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57
Q

Which common trigger points are present in TTH?

A

M. Masseter

M. Sternoclaidomastoid

M. Splenius

M. Trapezius

Suboccipital region

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58
Q

What are the clinically most useful tests in the assessment of cervical spine and head ache?

A
  • Manual joint palpation
  • CCFT
  • FRT
  • Active ROM
  • Head forward position
  • Trigger point palpation
  • Muscle tests of shoulder girdle
  • Passive physiological intervertebral movements
  • Reproduction and resolution of headache symptoms
  • Screening of thoracic spine
  • Combined movement tests
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59
Q

Spinal manipulation may be effective for which type of headache?

A

Migraine and TTH

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60
Q

Spinal manipulation + exercise program might be effective for which type of headache according to article by Bronfort et al?

A

Cervicogenic headache?

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61
Q

Which structure should be part of mobilising in head ache?

A
  • Cervical spine
  • Upper cervical spine (C0, C1, C2)
  • Cervico-thoracic junction
  • Thoracic spine
  • Stretching muscles

→ FROM UNSPECIFIC TO SPECIFIC

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62
Q

What is the composition of stability training of the cervical spine in headache patients?

A
  • Activating deep neck flexors
  • Strength endurance training for local and global neck muscles
  • General strength training of the neck muscles
  • Build-up from isolated to functional training

→ Improve proprioception, strength and posture (the quicker the deep neck flexors are activated the better)

→ Low-load deep neck flexor training provides pain relief

→ High-load training for strength and endurance

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63
Q

What does low-load deep neck flexor training provide?

A

Pain relief

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64
Q

What are the training parameters for stability training in headache patients?

A

6 weeks

2x per day

5min per session

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65
Q

What are the components of functional training is headache patients?

A

Multimodal intervention that includes postural, manual, visual, relaxation and psychological training
→ way more effective than traditional ultrasound or electro stimulation treatment

Cervico-thoracic stabilisation

Ergonomics

Postural training

Overall strength and fitness

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66
Q

What are good exercises for cervico-thoracic stabilisation during functional training in headache patients?

A

→ Regain dynamic control of cervico-thoracic region
→ Shoulder shrugs with resistance
→ Scapular retractions
→ Serratus punch
→ Tree hugs
→ Upright rows
→ Lateral arm raise
→ Cervical retraction against gravity

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67
Q

What are the treatment specifics for tension type headache?

A
  • Lifestyle advice
  • Avoid provocation
  • Avoid drug overuse
  • NSAIDs and paracetamol for attacks
  • Amitriptyline for serious long-lasting pain
  • Relaxation training
  • Cognitive behavioural therapy

→ Passive mobilisation of cervical and thoracic spine according to McKenzie

→ Training of the deep neck flexors

→ Postural training

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68
Q

What are the parameters of treatment for tension type headache?

A

8 weeks of therapy
1x per week
30 minutes
+ homework exercises

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69
Q

What is the goal of tension type headache treatment?

A
  • Improve ROM
  • Improve cranio-cervical muscle endurance and strength
  • Improve posture
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70
Q

What are the treatment specifics for migraine?

A
  • Explain factors that provoke migraine (triggers)
  • Medication based stepped care programme
  • Combination of:
  • Amitriptyline
  • Aerobic training
  • Relaxation therapy
    → Fewer days of migraine and reduction of pain during attacks
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71
Q

What are the training parameters for migraine therapy?

A

Walking, cycling or cross trainer
3x per week
45 minutes
→ still not statistically relevant

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72
Q

What are the treatment specifics for cluster headache?

A
  • Oxygen inhalation
  • Sumatriptan injection or nose spray
  • Relaxation techniques
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73
Q

What are the treatment specifics for cervicogenic headache?

A
  • Manual therapy + exercise therapy
  • Effects of manual therapy:
  • Stimulates neuro-inhibitory system
  • Activates lateral inhibitory paths of grey matter of midbrain
  • Deep neck flexor training
  • Strength training of the neck
  • Proprioception training
  • Muscle energy techniques → Stretches
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74
Q

What does CANS stand for?

A

Complaints of the arms, neck and shoulders

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75
Q

What is photophobia?

A

Abnormal sensitivity to light

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76
Q

What is phonophobia?

A

Abnormal sensitivity / (fear) of sound

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77
Q

What is typical for CANS?

A
  • Pain and/or other symptoms in the arms, neck and/or shoulders
  • Affected by physical activity
  • Within the context of work, household activities, hobbies, sports or study
  • Repeated movements for long period of time
  • Prolonged static posture in which arm, neck and/or shoulder are involved
  • Imbalance between load and carry-ability
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78
Q

What are risk factors for peripheral nerve injury in the upper extremity?

A
  • Superficial position of nerves
  • Long course through an area at high risk of trauma
  • Narrow path through bony canal
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79
Q

Which type of peripheral nerve injury or entrapment in the upper extremity is most common?

A

Carpal tunnel syndrome

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80
Q

What are the nerves of the brachial plexus?

A

Musculocutaneous nerve
Axillary nerve
Median nerve
Radial nerve
Ulnar nerve

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81
Q

Where does the musculocutaneous nerve originate and what does it innervate?

A
  • Carries fibres from C5, C6, C7
  • Innervates flexor compartment of the arm
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82
Q

Where does the median nerve originate and what does it innervate?

A
  • Carries fibres from C6, C7, C8, T1
  • Innervates flexors of forearm and parts of the hand
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83
Q

Where does the ulnar nerve originate and what does it innervate?

A
  • Carries fibres from C7, C8, T1
  • Innervates intrinsic muscles of the hand
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84
Q

Where does the radial originate and what does it innervate?

A
  • Extension of the posterior cord
  • Carries fibres from C5, C6, C7, C8, T1 (contains all spinal levels)
  • Innervates all extensors of the upper limb
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85
Q

Where does the axillary nerve originate and what does it innervate?

A
  • Carries fibres of C5, C6
  • Innervates muscles around the shoulder
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86
Q

What is neuropraxia?

A
  • Compression of nerve tissue
  • Reversible conduction block
  • Common forms:
  • Radicular syndrome
  • Pseudoradicular syndrome
  • Peripheral nerve entrapment
87
Q

What is axonotmesis?

A
  • Demyalination + axon loss
  • Endoneurium is intact
  • Neuron can grow back
88
Q

What is neurotmesis?

A
  • Demyalination
  • Tear of neuron and endoneurium
  • Impaired healing
89
Q

What are examples of Pseudoradicular Syndrome OR Peripheral Nerve Entrapment?

A
  • Saturday Night Palsy
  • Radial Tunnel Syndrome
  • Cubital Tunnel Syndrome
  • Guyon’s Canal Syndrome
  • Pronator Teres Syndrome
  • Carpal Tunnel Syndrome
90
Q

What type of brachial plexus injury is Erb‘s palsy?

A

Axonotmesis/Neurotmesis

91
Q

What type of brachial plexus injury is Klumpke‘s Paralysis?

A

Axonotmesis/Neurotmesis

92
Q

What type of brachial plexus injury is Paralysie des amoureux?

A

Neuropraxia

93
Q

What type of brachial plexus injury is thoracic outlet syndrome (TOS)?

A

Neuropraxia

94
Q

How many cases of CRS are due to spinal stenosis?

A

70-75% of cases

95
Q

How many cases of CRS are due to disc herniation?

A

20-25%

96
Q

What are other causes of CRS despite spinal stenosis and herniation?

A

Tumors or osteophytes

97
Q

What should be given in a patient to diagnose CRS according to several authors?

A
  • Upper extremity shows objective neurological signs
    -> reduced tendon reflexes, muscle weakness, sensory disorders
  • Patient should score positive on provocation and reduction tests
98
Q

What are the different types of TOS?

A

Vascular TOS
-> Arterial or venous

Neurological TOS

True TOS

Symptomatic TOS

99
Q

What are causes of true TOS?

A

Due to congenital abnormalities
- Enlarged transverse process of C7
- Cervical ribs
- Enlarged scalene muscles

100
Q

What are causes of symptomatic TOS?

A
  • Usually intermittent
  • Arises from bad posture
  • Lower anterior chest wall
  • Drooping shoulders
  • Forward flexed neck
101
Q

How many TOS cases are of vascular origin?

A

2%

102
Q

How many cases of TOS are of neurological origin?

A

98%

103
Q

What are typical compression points in TOS?

A

Posterior scalene port

Costoclavicular space

Subcoracoid tunnel

104
Q

What three properties does a nerve need to function properly?

A

Ability to stretch, slide and be compressed

105
Q

What are the 3 components of neurodynamics?

A

Neural structures

Mechanical interface

Innervated structures

106
Q

What’s the mechanical interface in neurodynamics?

A
  • Musculoskeletal system
  • Like a flexible telescope that follows the movements of the nervous system
  • Tendons, muscles, bones, intervertebral discs, ligaments, fascia and blood vessels
107
Q

What are the innervated structures in neurodynamics?

A
  • Excessive stretching of innervated tissue can cause excessive strain on peripheral nerve tissue
  • E.g. muscle stretch of the quadriceps muscle can increase the tension on the femoralis nerve
108
Q

What are the 2 categories of malfunction of the neurodynamic system?

A

Specific non-serious complaints:
- CRS and LRS
- ULTT 1 increases tension on median nerve → high sensitivity to rule out CRS
- SLR is a high- sensitivity test (useful for ruling out) LRS
- Crossed SLR is highly specific (useful for determining the presence) LRS

Non-specific non-serious complaints:
- Neuromechanosensitivity (hypersensitivity of nerve/aspecific disorder) → neurodynamic mobilisation effective

109
Q

What should be the initial hypothesis in a patient with unilateral radiation?

A

Radiation due to neuromechanosensitivity

110
Q

What are the characteristics of patient profile 1 of CANS?

A
  • Impairment of function and/or anatomical features
  • No limitations in activities and participation
111
Q

What are the characteristics of patient profile 2 of CANS?

A
  • Impairment of functions and/or anatomical features
  • Limitations in activities
  • Participation problems
  • Correlation between disorder, activities and participation
    -> understandable and recognizable by both physio and patient
112
Q

What are characteristics of patient profile 3 of CANS?

A
  • Disorders in functions and/or anatomical features
  • limitations in activities
  • Problems in participation
  • According to physio there is discrepancy between present disorder and limitations in activities and participation
  • Inadequate behaviour in dealing with issue by patient may be present
113
Q

What are the main differences between profile 2 and 3 in CANS?

A

Profile 2: Patient has complaints and limitations but tries to maintain level of functioning, activities and participation

Profile 3: Patient has similar complaints but is catastrophising and therefor limits himself/herself in functioning etc.

114
Q

What are prognostic factors in CANS patients?

A
  • Longterm stress
  • Depressive mood
  • Unrealistic beliefs (pain-related fears)
  • Catastrophising
  • Low satisfaction with work situation
  • Decreasing work load on one hand, increasing activity and participation restriction on other hand
115
Q

How is the Adson Test for vascular TOS executed and when is it positive?

A
  • Sensitivity 79% / Specificity 76%
  • Patient sits
  • Rotation and lateral flexion of head to test side
  • Deep inhalation, hold for up to 30 seconds
  • Palpate radial pulse on test side and look for change (modified in 15° shoulder abduction)
  • Positive if pulse declines/disappears OR if patient’s symptoms are provoked
116
Q

How is the Wright Test for vascular TOS executed and when is it positive?

A
  • No knowledge of accuracy
  • Patient sits
  • Passively bring tested arm into 90° of abduction, 90° external rotation
  • Elbow is flexed to max 45°
  • Hold arm in this position and palpate radial pulse for 1 minute
  • Move arm in to hyper adduction and repeat for 1 minute
  • Positive if pulse declines/disappears OR if patient’s symptoms are provoked
117
Q

How is the Roos Test for vascular TOS executed and when is it positive?

A
  • Arms abducted to 90°
  • Elbows flexed to 90°
  • Squeeze hands for 3 minutes
  • Positive if patient experiences heaviness, ischemic pain, weakness or numbness and tingling of the hands
118
Q

How is the Eden Test for vascular TOS executed and when is it positive?

A
  • No knowledge of accuracy
  • Can be used if other tests can’t be conducted due to limited ROM in shoulders or arms
  • Patient sits straight in “military” position, chest out and shoulders back
  • Patient can also inhale and hold to improve effect
  • Physio extends shoulders
  • Palpate radial pulse for up to 1 minute on both sides
  • Positive if pulse declines/disappears OR if patient’s symptoms are provoked
119
Q

How is the Phalen Test for carpal tunnel syndrome executed and when is it positive?

A
  • Sensitivity of 85% / Specificity 89%
  • Compression of median nerve is tested
  • Flex wrists maximally and hold dorsal sides together
  • Hold for 1 minute
  • Positive if tingling in thumb, index finger, middle finger and lateral half of ring finger → Carpal Tunnel Syndrome
120
Q

How is the Median nerve compression test executed and when is it positive?

A
  • Patient sits with resting arm
  • Palpate carpal region and compress
  • Positive if carpal tunnel symptoms are provoked
121
Q

What are the therapy variables for neurodynamic treatment?

A
  • Intensity
  • Duration
  • Gradation
  • Slider vs tensioners
    → Sliders hardly lead to an increased tension in the nerve, but do lead to displacement with regard to the mechanical interface
  • Openers vs closers
    → Opening and closing techniques consist of movements of the joint, muscle and fascia
    → Aim is to exert a mechanical influence on the nerve structure
    → Opener will (temporarily) reduce the compression on the nerve
    → Closer will (temporarily) increase the compression on the nerve
122
Q

What are the most appropriate neurodynamic techniques to reduce pain and calm the nerve irritation?

A

Openers and sliders (and the combination of the two)

123
Q

Why first flossing then stretching in neurodynamic treatment?

A

to make sure there is no obstruction present!!

124
Q

What are the main recommendations for neurodynamic treatment?

A
  • Be gentle and get patient moving
  • Treat primary problem that is affecting the nerve (e.g. disc etc.)
  • If nerve is primary problem -> treat nerve!
  • If irritable consider sliding! Work away from painful segment!
  • If less irritable consider tensioning! Work towards painful segment!
  • Reps, sets, durations based on treatment goals and patient
  • External soft tissue Mobilisation as adjunct
125
Q

What should you ask the patient during neurodynamic assessment or treatment?

A

How does it feel?

  • Position?
  • Type of stretch?
  • Blockage or obstruction?
126
Q

How fast should neurodynamics be executed?

A
  • Make sure patient is able to control movement
  • Patient feels what’s going on
  • 1-2 sec per direction maybe?
  • CONTROLLED
127
Q

What is the triage of diagnostics in low back pain?

A
  • Non-specific low back pain (95% of cases)
  • Specific non-serious low back pain (approx. 5% of cases) → like nerve root irritation/sciatica
  • Specific serious low back pain (approx. 1% of cases) → like spinal cord injury, tumour, fracture
128
Q

What is the incidence and prevalence of LSR?

A

Incidence 12/1000 patients

Prevalence 36/1000 patients

129
Q

What are risk factors for LSR?

A
  • Tall statue
  • Heavy physical work
  • Mental stress
  • Prolonged smoking
  • Frequent and prolonged driving
  • Genetics
130
Q

What are common characteristics of radicular leg pain?

A
  • Radiating pain into one leg
  • Dermatomal pattern
  • Sharp pain
  • Clear localization
  • Postural influence
  • Increase with coughing and sneezing
  • Leg pain > back pain
  • Muscle weakness, sensory loss and parasthesis
131
Q

What are common characteristics of a herniated nucleus purposes?

A
  • Subacute onset
  • Recovery usually < 12 weeks
  • Pain:
    → Sharp
    → Burning
  • Physical examination:
    → Diminished strength and sensation
    → Positive radicular provocation tests
132
Q

What is the typical age range for a bulging disc?

A

20-50 years

133
Q

What is the pathology in a bulging disc?

A

Damage to NP causes distortion of AF

  • causes pressure on surrounding structures
  • AF stays intact
134
Q

What are typical signs and symptoms of a bulging disc?

A

Weakness

Pain

Tingling

Numbness

135
Q

How are symptoms with a bulging disc provoked?

A

When sitting or bending

136
Q

What is the typical age group for a protrusion?

A

35-50 years

137
Q

What is the pathology in a protrusion?

A

Fissures in surrounding AF due to degeneration or trauma

NP pushes from the insight -> causes pressure on surrounding structures

138
Q

What are typical signs and symptoms of a protrusion?

A

Local pain lumbar spine

More pain in the morning

Provocation with sitting and bending

No or minimal leg pain

139
Q

What are risk factors for a protrusion?

A

Smoking

High BMI

Age

Gender

Occupation

History of trauma

Genetics

140
Q

What is the main age group for a Prolaps?

A

30-50 years

141
Q

What is the injury mechanism in a Prolaps?

A

AF is ruptured and NP squeezes out and puts pressure on structures

142
Q

What are typical signs and symptoms of a prolaps?

A

Severe low back pain

Pain in the leg

Gradual increase of symptoms over weeks

Key muscle weakness

143
Q

What are some risk factors for a Prolaps?

A

Male

Obesity

Smoking

144
Q

What is the typical age range for lumbar spinal stenosis?

A

60 years or older

145
Q

What type of pain is typical in lumbar stenosis?

A

Burning

Dull

With heavy and tired feeling

146
Q

What provokes or reduces symptoms in lumbar spinal stenosis?

A
  • Provocation: Lumbar extension (Standing/Walking)
  • Reduction: Sitting and forward bending → opening/widening the spinal canal
147
Q

What are typical signs and symptoms in lumbar stenosis?

A

Radicular pain in both legs

Tingling

Numbness

Weakness of legs

Problems with bowel or bladder?

Intermittent claudication in the calves

148
Q

What is the typical age for piriformis syndrome? And which gender is more affected?

A

30-40 years

Female

149
Q

What is the cause of piriformis syndrome

A

Tightening or swelling of piriformis due to injury, spasm or muscle imbalance (e.g. weak glutes)

Weak piriformis which is overused

Tightness due to inactivity and sedentary lifestyle

Sacroiliac and/or hip joint may be irritated

150
Q

What are typical signs and symptoms of piriformis syndrome?

A

Pain in the buttock

Pain when walking uphill

Tingling

Numbness

Shooting pain

151
Q

What is a common cause for cauda equina syndrome?

A

Massive herniation in lumbar spine

152
Q

What are typical symptoms of cauda equina syndrome?

A

Saddle anaesthesia

Uni or bilateral motor deficits

Severe pain

Sexual dysfunction

Bowel or bladder dysfunction

153
Q

What is saddle anaesthesia?

A

Sensory disturbance or loss of anal, genital and buttocks region

154
Q

How is the Slump Test executed, what does it test for and when is it positive?

A
  • Maximally stretching neural structures of vertebral canal and foramen
  • Provoke shooting, burning pain and neurological symptoms in the lower limbs
  • Positive test can indicate herniation or nerve root entrapment
  • Patient sitting at end of table
  • Patient puts hands behind back and flexes lumbar and thoracic spine (slump)
  • Head is kept in neutral position
  • Push on patients shoulder girdle with one arm, ask patient to flex head look for provocation
  • Apply pressure on neck and head and ask patient to extend knee on affected side
  • Passively dorsiflex foot with other arm

→ Stretching sensations are NOT indicators for a positive test

155
Q

How is the Prone Knee Bend Test executed, what does it test for and when is it positive?

A
  • Also called Reverse Lasegue Sign
  • Patient lies prone
  • Maximally flex knee passively
  • Hold position for 45-60sec and look for reproduction of complaints
  • If unable to flex knee past 90°, flex knee maximally and add passive hip extension
  • Positive if unilateral neurological pain in lumbar area, buttock or posterior thigh → possible L2 - L4 nerve root lesion
  • Watch for pelvic tilt → could cause back pain → false positive
156
Q

How is the SLR Test executed, what does it test for and when is it positive?

A
  • Sensitivity 91%; Specificity 26%
  • Assess unaffected leg first
  • Passively flex hip while keeping knee fully extended
  • 35°-70° → Tension in sciatic nerve roots over intervertebral discs
  • Above 70° → Mostly joint pain
  • IF pain in neurological pain zone:
  • Move out of pain zone
  • Then dorsiflex ankle passively → Bragard’s Sign
  • Or ask patient to maximally flex head → Neri’s Sign
  • Pain still there → damage to dura mater or spinal cord pathology (e.g. herniation
157
Q

How is the Crossed SLR Test executed, what does it test for and when is it positive?

A
  • Sensitivity 28%; Specificity 90%
  • To confirm LRS (especially large axillary protrusions)
  • Patient in supine lying position
  • Passively flex patients uninvolved leg at the hip to about 60-70° with knee extended
  • Positive if shooting pain in affected leg
158
Q

How is the cluster of cook to include/exclude lumbar spinal stenosis executed?

A
  • Bilateral symptoms?
  • Leg pain more than back pain?
  • Pain during walking/standing?
  • Pain relief upon sitting?
  • Age > 48 years?
  • 0/5 positive? → 96% sensitivity (that condition isn’t present)
  • 4/5 positive? → probability is 76% and imaging should be initiated
159
Q

Which spinal levels are most commonly effected in bulging or herniation?

A

L4/L5

L5/S1

160
Q

Reflex testing is highly sensitive or highly specific?

A

Highly specific?

161
Q

What is the 5 grade scale for reflex testing?

A

0 → no response → always abnormal

1+ → slight but definitely present response (may or may not be normal)

2+ → brisk response (usually normal)

3+ → very brisk response (may or may not be normal)

4+ → clonus → always abnormal

162
Q

What can be tested in the assessment for piriformis syndrome?

A
  • Strength tests hip extensors
  • Strength tests hip abductors
  • Strength tests hip external rotators
  • Functional Testing of pelvis and hip control
  • Muscle length test piriformis
  • Strength test piriformis
163
Q

How is the cluster of wainner conducted, what does it test for and how is sensitivity and specificity distributed?

A
  1. Test -> ULTT1 (good to rule out cervical radiculopathy due to high sensitivity)
    Sensitivity 97%, specificity 22%
  2. Test -> Cervical rotation
    Sensitivity 89%, specificity 49%
  3. Test -> Traction Distraction Test
    Sensitivity 44%, Specificity 90%
  4. Test -> Spurlings Test A
    Sensitivity 50%, Specificity 86%

3/4 positive -> likelihood ratio of 6.1%
4/4 positive -> likelihood ratio of 30.3%

164
Q

Which structures does the Adson Test for TOS assess?

A

Tests for compression of subclavian artery by cervical rib or tight anterior and middle scalene muscles

165
Q

Which structures does the Wright Test for TOS assess?

A

Compression of axillary interval (space behind pecs minor) due to tightness

166
Q

Which structures does the Roos Test affect in testing for TOS?

A

Compresses all three compartments of TOS
→ Scalene triangle
→ Costoclavicular space
→ Retropectoralis minor space

167
Q

Which structures does the Eden Test for TOS compress?

A

Compresses the costoclavicular segment

168
Q

What postural advice could you give for proper spinal alignment?

A
  • Neutral pelvic position
  • Have patient feel their pelvic bones as they move into forwards or backward tilt
  • Show symphysis and sternum position for reference
169
Q

What are the main characteristics for treatment of lumbosacral radicular syndrome?

A
  • Simple to treat
  • Patient can fully recover from this

Active coping style is very important
→ Let client move
→ As much axial compression as possible

Exercising
→ Walking exercises
→ Coordination exercises
→ Dual tasking

Daily (homework) exerises

Adress coping style!! Make moving interesting and challenging for patient!!

170
Q

What is phase 1 of treatment in lumbosacral radicular syndrome?

A
  • SI joint mobilisation
  • Stretching dorsal side of pelvis → glute max and hamstrings
  • Treat it locally
  • Education on pain
171
Q

What is phase 2 of treatment in lumbosacral radicular syndrome?

A
  • Strengthen local stabilizers
  • Adress weight loss strategies
172
Q

What is phase 3 of treatment in lumbosacral radicular syndrome?

A
  • Weight loss strategies
  • Maintenance of exercises
  • Surgery?
173
Q

What are things to focus on in treatment of lumbar herniation?

A
  • Make sure there is no motor failure in lower limb
  • If there is motor failure → Patient has to GP and neurologist!!
  • If no motor failure → Treatable
  • Increasing load capacity of global and local stabilizers of low back
  • Walking is very important (aerobic conditioning)
  • Gradual build-up
  • Discuss psychosocial factors (relax, anxiety etc…)
  • Passive lifestyle is often the cause therefor inform and guide
174
Q

When should you use McKenzie mobilizations?

A

Lumbar herniation treatment

175
Q

What advice should you give a patient with lumbar herniation?

A
  • Return to normal daily life is possible
  • Compliance and daily activity is key
  • At least 2l of water per day to get disc volume back to normal
176
Q

What are key aspects in the treatment of a prolapse?

A
  • Centralize the pain as starting point of treatment
  • Neurodynamics
  • McKenzie mobilisations
  • Stretching and strengthening
  • Active coping style
177
Q

What are characteristics of the treatment of lumbar stenosis?

A
  • Goal is not full recovery → not possible
  • Goal is to gain more mobility in hip, thoracic spine, lumbothoracic area
    → Compensation for stiffness in lumbar spine (flexion and extension limitation)
  • Stretches and mobilizations of these areas
    → e.g. iliopsoas stretch

Article:
- No clinical significance in surgical or non-surgical approach
- Level of functioning and decompression was either similarly successful or unsuccessful in both groups

178
Q

What is done during phase 1 of lumbar stenosis treatment?

A

Phase 1 (6 weeks):

  • Bedrest (if necessary)
  • Education
  • Corset
  • Flexion based exercises
  • Walking, jogging
  • Hydrotherapy
  • Stretching of lumbar spine
179
Q

What is done for treatment during phase 2 of lumbar stenosis therapy?

A

Phase 2 (6 weeks):

  • Aerobic exercises
  • Hydrotherapy
  • Core stability exercises
  • Manual therapy
180
Q

What is done in phase 3 of lumbar stenosis therapy?

A

Phase 3 (6 weeks):

  • Specific strength training
  • Increase aerobic capacity
  • Increase flexibility
181
Q

What are characteristics of peripheral nerve entrapment therapy like piriformis syndrome?

A
  • Local treatment
  • Stretching of dorsal side of hip
    → Glute max
    → Piriformis
    → Hamstrings
  • Mobilisation of SI joint
  • Life style advice:
    → Active lifestyle and movement is key
182
Q

What does phase 1 of piriformis syndrome treatment look like?

A

1st phase (0-4 weeks):

  • Non-weight bearing exercises
  • 3x 15 reps
  • Isolated muscle recruitment
  • Bilateral bridging
  • Side-lying clams to target hip abductors
183
Q

What does phase 2 of piriformis syndrome treatment look like?

A

2nd phase (4-9 weeks):

  • Weight bearing strengthening
  • 3x15 reps
  • Double-leg movement to single-leg movements
  • Side steps
  • Squats
  • Single leg sit to stand/ stand to sit
  • Step up/ step down
184
Q

What does phase 3 of piriformis syndrome treatment look like?

A

3rd phase (9-14 weeks):

  • Functional training
  • 3x 15 reps
  • Lunges
  • Double-leg vertical jumps
  • Double leg jump / single-leg landing
  • Lateral jumps
185
Q

Which spinal segments are mainly effected in cervical radiculopathy?

A

C5-C6
C6-C7

186
Q

What is the key muscle for spinal level S2?

A

Glute max

187
Q

What are the key muscles for spinal level S1?

A

Triceps surae

Peroneal muscles

188
Q

What are key muscles for spinal level L5?

A

Glute medius

Extensor hallucis longus

Extensor digitorum brevis

189
Q

What are key muscles for spinal level L4?

A

Tibialis anterior

190
Q

What are key muscles for spinal level L3?

A

Quads

191
Q

What are key muscles for spinal level L2?

A

Iliopsoas

Adductors

Rec fem

Vastus medialis

192
Q

What are key muscles for spinal level Th2-Th12?

A

Internal and external intercostal muscles

193
Q

What are key muscles for spinal level C8?

A

Adductor pollicis

Abductor digiti minimi

Extensor pollicis

Flexor and extensor carpi ulnaris

194
Q

What are key muscles for spinal level C7?

A

Long head of triceps

Flexor carpi radialis

Opponens pollicis

195
Q

What are key muscles for spinal level C6?

A

Biceps

Extensor carpi radialis

196
Q

What are key muscles for spinal level C5?

A

Delts

Supraspinatus

197
Q

What are key muscles for spinal level C4?

A

Diaphragm

Traps

Rhomboids

198
Q

What are key muscles for spinal level C3?

A

Traps descendens

Levator scapulae

199
Q

What are key muscles for spinal level C2?

A

Obliques capitis superior

Rectus capitis posterior minor and major

Sternocleidomastoid

200
Q

What are key muscles for spinal level C1?

A

Rectus capitis anterior and lateralis

201
Q

Which spinal level is tested with the biceps tendon reflex and what is the mnemonic?

A

C5 - C6
Pick up sticks!

202
Q

Which spinal level is tested with the brachioradialis reflex?

A

C5 - C6

203
Q

Which spinal level is tested with the triceps tendon reflex and what is the mnemonic?

A

C7 - C8
Lay them straight!

204
Q

Which spinal level is tested with the patella tendon reflex and what is the mnemonic?

A

L3 - L4
Kick the floor!

205
Q

Which spinal level is tested with the hamstrings reflex?

A

L5, S1-S2

206
Q

Which spinal level is tested with the Achilles tendon reflex?

A

S1 - S2
Buckle my shoe!

207
Q

What are typical symptoms of radial tunnel syndrome?

A
  • Nagging pain that can cause fatigue
  • Pain and tenderness outside of elbow stretching down to forearm
  • Usually 4cm distal to lateral epicondyle
  • Muscle weakness in wrist can be present
  • Often provocation by elbow extension, lifting things, forearm rotation, wrist flexion
  • All symptoms very similar to lateral epicondylalgia
208
Q

What are common symptoms of cubital tunnel syndrome?

A
  • Numbness and tingling in the hand or ring and little finger, especially when the elbow is bent
  • Numbness and tingling at night
  • Hand pain
  • Weak grip and clumsiness due to muscle weakness in the affected arm and hand
  • Aching pain on the inside of the elbow

-> Symptoms very similar to golfer‘s elbow

209
Q

What are common symptoms of carpal tunnel syndrome?

A
  • Numbness, tingling, burning, and pain — primarily in the thumb and index, middle, and ring fingers
  • Pain may wake up people at night
  • Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning your clothes
  • Dropping things — due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
210
Q

What are the Canadian C Spine Rules?

A

Screening tool for the cervical spine to check if imaging is necessary

  1. Any high risk factor which mandates radiography?
    - Age ≥ 65?
    - Dangerous mechanism?
    - Paresthesias of extremities?
    -> 1 of them yes -> imaging!
    -> all negative -> continue to 2.
  2. Any low risk factor which allows safe assessment of ROM?
    - Simple rear end motor vehicle collision?
    - Sitting position in ER?
    - Ambulatory at all times?
    - Delayed onset of neck pain?
    - Absence of midline c-spine tenderness?
    -> 1 of them no -> imaging!
    -> all positive -> continue to 3.
  3. Able to actively rotate head side to side (45°)?
    -> If unable -> imaging!
    -> If able -> continue assessment
211
Q

What are dangerous mechanisms according to the Canadian c-spine rule?

A
  • Fall from elevation ≥ 3 feet or 5 stairs
  • Axial load to head (e.g. diving)
  • High speed collision ≥ 100km/h, roll-over, ejection
  • Motorized recreational vehicles
  • Bicycle struck or collision
212
Q

What is NOT a simple rear end collision according to the Canadian c-spine rules?

A
  • Pushed into oncoming traffic
  • Hit by bus or large truck
  • Roll over
  • Hit by high speed vehicle
213
Q

What is meant by delayed onset of neck pain according to the Canadian c-spine rules?

A

Not immediate onset of neck pain

Physiotherapy 2.3 (9 decks)

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