SMT-1 Manual, pgs 72-78 Flashcards
According to Zito et al 2006 were all hypomobile cervical joints painful?
No, not all hypomobile cervical joints were painful
According to Zito et al 2006 were all painful cervical joints hypomobile?
Yes, all painful joints on PPIVM testing were hypomobile
What group in Zito 2006 had increased muscle tightness?
Cervicogenic headache group
What group in Zito 2006 demonstrated poorer performance at 26, 28, and 30 mmHG in the CCFT?
Cervicogenic headache group
In Zito 2006 how did the authors discriminate CGH from other headaches? How successful were they?
C1-C2 painful and hypomobile on PPIVM was able to discriminate CGH group from migraine and control subjects with 80% sensitivity
According to Boddeck 2005, is the origin of a headache able to be distinguished?
No because trigeminal muscles can
Zito 2006 found CGH to have a neural component when U/LE NTPT testing was added. What other author found this to be true?
Jull 2001 found 10% of 200 CGH’s to have neural component
According to Hall & Robinson 2004 comparing CGH to asymptomatic patients, which group had decreased flexion rotation on testing?
CGH group 24/28 patients, with primary motion segment of C1-C2. 4/28 CGH patients had primary motion segment of C2-C3. No asymptomatic patients had positive flexion-rotation test
In Hall & Robinson 2004 were active ROM in cardinal planes different between CGH and asymptomatic groups?
NO - meaning the adjacent levels compensate
What were the average AROM movements in flexion rotation between groups reported in Hall & Robinson 2004?
44 degree in asymptomatic patients and 28 degrees in CGH group
What did the Pearson’s correlation test indicate in Hall & Robinson 2004?
The greater the restriction in flexion-rotation test then the more severe the headache would be in terms of frequency, duration, and intensity
What cervical segment was most symptomatic in Hall & Robinson 2004?
C1-C2 motion segment was the most frequent symptomatic cervical motion segment in CGH
The results regarding primary affected motion segment in CGH stated in Hall & Robinson 2004 are in agreement with reports from what author?
Jull et al 1997
The results regarding primary affected motion segment in CGH stated in Hall & Robinson 2004 are in contrast with reports from what author?
Bogduk 2005 who implicated C2-3
According to Schwartz 1998 what is the most common type of headache?
Tension type headache
According to Rasmussen 1991, what is the lifetime gender prevalence for TTH in the general population?
69% of men and 88% of women
According to the IHS, what is the definition of chronic TTH?
Headache at least 15 days a month for at least 6 months
According to systematic review by Lenssinck et al 2004 is there sufficient evidence to support or refute SMT for TTH?
NO - insufficient evidence to support or refute
Von Piekartz et al 2006 found what neurodynamic component in children with CGH?
36 degree of neck flexion during long sitting slump test for CGH patients, versus 85 degree for migraines, and 101 degree for control group
What authors stated that 10% of CGH have a neural component?
Michael Shacklock (2005) and Gwendolen Jull (2002)
Can you reproduce the headache by sensitizing the neural system?
Yes, look for change in symptoms with distal tensioning in the slump test. Or try upper cervical flexion and then UE abduction to 90degree as in NTPT I or III
What are the most valid and reliable outcome measures for CGH patients?
1) Neck Disability Index ( Vernon & Moir, 1991)
2) Frequency, intensity, and duration records kept daily or weekly by patient
3)Flexion-Rotation Test (Ogince et al 2007 = valid)
20 degree is mean FRT for CGH, 32 degree is cut off for positive FRT in CGH pop. 91% sen and 90% sp
4) Craniocervical flexion test with PBU 20-30mmHG
5) Neck flexion endurance test (reliability established, no validity as of yet)
What are the key factors in differential diagnosis for CGH and migraines?
CGH, migraine, and TTH symptoms often overlap. Occipital, cervical, facial, shoulder, and periorbital pain can occur in CGH and migraine.
Consider CGH component if migraine medications provide only partial relief.
Describe the results of the 4 case reports on CGH performed by Xiaobin 2005?
All patients had positive Tinel’s sign over occipital nerve
Occipital neuralgia is likely a subcategory of CGH
After nerve block patients had gradual return of symptoms in 10 days, 2 weeks, 40 days and 2 months
What two types of clinicians did Laslett 2003 and 2005 use to diagnosis SI joint dysfunction?
Radiologist & Physical Therapist
What were the inclusion criteria in the Laslett studies?
Buttock pain +/- other pain
What were the exclusion criteria in the Laslett studies?
midline or symmetrical pain
In the Laslett studies, how did the radiologist diagnosis SI joint dysfunction?
Positive reference standard (gold), using fluoroscopically guided injection, led to provocation of familiar pain followed by 80% pain relief with anaesthetic block
In the Laslett studies, how did the PT diagnosis SI joint dysfunction?
Positive physical examination was multi-test regimen of pain provocation tests that produced familiar pain.
What was the percentage of positive tests for SI joint dysfunction identified by radiologists in the Laslett studies?
33%
What was the percentage of positive tests for SI joint dysfunction identified by physical therapists’ in the Laslett studies?
31 to 50%
- According to Bogduk 2005, is the origin of a HA able to be distinguished? (pg. 57 SMT-2)
- No, because the trigeminal nucleus can be evoked from the upper cervical stimulation as a stimulus from frontal, periorbital, facial, occipital, temporal regions.
- According to Bronfert et al 2005, what tx was found to be effective for CGH?
- SMT and low intensity endurance training
- Bronfort et al 2005, is SMT effective for migraine?
- May be effective, has a similar effect to amytriptyline, but less effective for TTH’s.
Jull et al 2002 (pg. 59 SMT-2):
248. What did Jull et al 2002 study for CGH?
- What was used as an outcome measure?
- What were the results?
- Did combined tx improve outcomes?
- What % had decreases in HAs?
- What % had 100% resolution?
- How did med intake change @ 12 months?
- Who performed the best on the CCFT at 6 weeks and 12 months?
- RCT of 10 week tx with 8-12 tx sessions, no longer than 30 minutes
- HA frequency/intensity/duration, pain provocation with MT, CCFT test
- Three groups: MT alone, Ex alone, MT+Ex. Found with all groups a significant decrease in HA frequency and intensity, Northwick compared to control at 6 weeks, 3, 6 and 12 months.
- No better than individual for duration, but MT+EX was better than Ex for duration.
- 76% gained a 50% or better decrease in HA frequency in the 3 tx groups.
- 35%
- decreased 93-100% in all 3 intervention groups, increase 33% in control (medication only) group.
- Any tx that involved EX, p
- According to Hides et al 1996, did MT improve DNF test despite pain relief?
- No
- Does improving the CCFT change pain or disability?
- No
- 62 of 91 subjects in Niere and Robinson 1997 had improved HAs by what %?
- How many had some improvement?
- How many reported a deterioration of HA?
- How many reported no change?
- p values for Niere and Robinson 1997 following SMT: HA frequency? Duration? Intensity?
- What may be the most valuable indicator of tx effect rather than intensity or duration?
- 50%
- 70 out of 91
- 15
- 6
- HA frequency: p=0.000, Duration: p=0.025, Intensity: p=0.000
- frequency
- According the Haas et al 2004, how frequent should you tx CGH? (pg. 61 SMT-2)
- 9-12 txs over 3 weeks did better than 3 tx’s over 3 weeks.
- What % in Jull et al 2002 did not improve HA with SMT and/or Ex?
- 24%
- Did Jull and Stanton 2005 find age, high intensity and chronicity to be suggestive of poor outcome?
- No
- What did Niere et al 1998 find as a predictor of GOOD outcome for SMT and CGH?
- Frequency of HA
- According to Zito et al 2006, when comparing CGH, migraine with aura and non-HA controls who had decreased AROM?
- The CGH group for flexion and extension.
- What group in Zito et all 2006 had pain provocating with PPIVM’s?
- CGH C0-C3 p
- What did Niere et al 1998 find as predictor of BAD outcome for SMT and CGH?
- Affective and Autonomic pain descriptors
- Is maxillary/mandibular pain usually involved according to Bogduk 2005?
- Not as common as frontal and periorbital secondary to weak branch innervation into trigeminal nucleus from opthalmic branch.
- What other regions can be involved in HAs according to Bogduk 2005?
- Nasal, oral, teeth, TMJ, paranasal sinuses, dura mater of anterior/poserior cranial fossa.
- According to Bogduk 2005 what other cranial nerves may be involved in HAs?
- Facial VII, Glossopharyngeal IX, Vagus X
