SMT Neuro Flashcards
What symptoms would help you determine a patient is experiencing an “Entrapped Facet Joint Inclusion” AKA trapped meniscoid
Unilateral neck/back pain with/without hx of mechanical trauma or positioning strain
Paraspinal tonus, IL capsular pattern; positive joint compression tests
Resisted lateral flexion is more painful on the CL side
Neuro features: nociceptive joint pain, reflex muscle splinting, myofascial pain spots
What kind of joint dysfunction does the McKenzie protocol aim to address?
Internal disc derangement (mechanical derangement of disc leading to joint dysfunction - associated with aging, DDD, trauma)
S&S of internal disc derangement
Muscle tenderness, spasm, reflex muscle tonus, mechanical dysfunction, nociceptive pain
True or false: the clnical pattern for annular disc bulge without radiculopathy is aggravated by valsalva maneuver
True
In radiculopathies, which usually is affected first: the motor or sensory portion? Why?
motor - has larger axons
Which 4 tests are best for evaluating a nerve root lesion?
Light touch sensation with von frey hair monofilament
Sharp/dull testing
Joint position test
Two-point discrimination
The sensory fiber overlap between nerve roots is greater with (touch/pain) fibres
Pain - this is why you should test pain (sharp/full) when evaluating for nerve lesions. Less overlap = deficits will come through sooner. Light touch testing will not reveal early radiculopathy.
What are 6 neurological features of fibrotic tissue shortening?
- Lateral entrapment (positional/nocturnal)
- Lumbar lateral recess compression
- Nociceptive pain with overuse
- Muscle imbalance with reflex inhibition
- Muscular co-contraction
- Mechanical joint dysfunction/irritation
What is thought to be the neurological cause of upper/lower cross syndrome?
Reflex activity of musculature and/or facilitation of inhibited muscle activity
Nociceptive function around motor units changes the kinematics and muscle contraction patrerns which triggers behavioural modifications, feeding into postural distortions and malalignments
Irving Korr proposed that joint dysfunction was sustained after nociceptive input from joint receptors was gone through which part of the neural circuit?
Hyperactivity of the interneuron
Still recieves nociceptive input from many other receptors (ie skin receptors)
What is the convergence theory?
Says that afferent sensory functions from visceral and somatic sources converge onto the same neural unit. Acitvation of other areas innervated by the same neural unit can affect other tissues.
How does Howard Vernon describe central sensitization?
Progressive overflow of nociceptive funcitons at the motor unit leads to progressive changes/stresses
Causes buckling and inflammation, leading to central sensitization
What structures make up the posterior, lateral, and anterior borders of the thoracic outlet?
Posterior: first thoracic vertebrae
Lateral: 1st rib
Anterior: clavicle, SC jt, manubrium of the sternum
What are the 3 areas where constriction can occur in the thoracic outlet?
- Interscalene triangle
- Subclavicular space
- Pec minor
What makes up the base and sides of the interscalene triangle? What are its contents?
Base: first rib
Sides: anterior and middle scalene muscles
Contents: inferior trunk of plexus, subclavian artery
Roughly ____% of patients have neurogenic TOS, while ___% have venous TOS, and ___% have arterial
95%; 2-3%; ~1%
Name 6 MOI for TOS
Trauma Repetitive injuries (i.e. sports) Anatomical defects Pregnancy Postural faults (forward head carriage) Overuse (abnormal pressure on shoulders due to heavy backpack, canoe, construction material)
What are 4 anatomical anomalies which can cause TOS?
Cervical rib
Prolonged TVP
Muscular Abnormalities (eg. sickle-shaped middle scalene)
Fibrous CT
What are 2 causes of arterial TOS?
Cervical rib
Excessively long TVP of C7
Causes arterial compression with arm movement
What are the 2 points of impingement for venous TOS? Which soft tissue structures commonly contribute?
Rib & clavicle
Subclavious muscle, costoclavicular ligaments
Compare the S&S of neurogenic and vascular TOS
Neurogenic:
- painless atrophy of muscles of hands (weakened grip strength)
- numbness/tingling in fingers
- pain in neck, shoulder, hand
Vascular:
- cyanosis of hands during activities (sometimes at rest)
- arm pain due to claudication and edema
- blood clot in veins or arteries in upper areas of arm due to atherosclerosis
- pallor in one or more of fingers and entire hand
- cold fingers/hands/neck
- arm/neck weakness
- throbbing lump near collarbone
Name 5 complications of TOS
Frozen shoulder CTS Paget-Schroetter syndrome Cerebrovascular arterial insufficienct Loss of vision due to vertebral artery compression
Which orthopedic test can diagnose anterior scalene syndrome?
Adson’s (loss of radial pulse in arm by rotating head to IL side with extended neck following deep inspiration)
How can you test for costoclavicular syndrome?
Costoclavicular maneuver: find radial pulse then have patient abduct, externally rotate, and extend arm to 45degrees. Apply downward traction to arm and turn neck away from affected side.
What did Wason & Pizzari find was the biggest flaw with classic TOS provocation tests?
Low specificity - up to 90% of healthy patients had pulso obliteration
True or false: if Adson’s test is negative, TOS can be ruled out
False - low sensitivity
How do you perform Wright’s test?
Patient’s shoulder abducted and externally rotated to 90deg, examiner takes pulse
Patient hyperabducts arm and examiner re-assesses pulse
Positive = change in pulse or symptom reproduction
Which ortho test can be done to assess for pec minor syndrome?
Allen’s:
Hyperabduction of patient’s shoulder with elbow flexed 90deg
Patient rotates head CL to affected side
What is the difference between traction test and Halstead maneuver?
In both, patient is seated and arm is distracted distally while examiner checks for changes in pulse or symptoms
In Halstead, perform traction test but have patient extend neck as well
What is Paget-Schroetter syndrome?
Axillary-subclavian vein thrombosis resulting from repetitive strenuous upper extremity activity
AKA effort thrombosis
