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Boards Prep - MSK > Spine > Flashcards

Spine Flashcards

1
Q

Neck Pain CPG - differential diagnosis

A
  • Level I
  • determine appropriateness of PT and need for referral by performing assessments and utilizing existing imaging studies to determine presence of senior pathology
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2
Q

Neck Pain CPG - risk factors

A
  • strongest/most consistent: female; prior hisotry of neck pain
  • older age, high job demands, smoking history, low sock/work support and prior history of low back pain may also be risk factors
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3
Q

Neck Pain CPG - examination (outcome measures)

A
  • use validated outcome measures (NDI, patient specific functional scale) for neck pain relative to pain, function, and psychosocial matters to establish baseline
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4
Q

Neck Pain CPG - examination (assessment)

A
  • assess physical impairments to establish baselines, monitor changes over time and guide clinical decision making
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5
Q

Neck Pain CPG - examination (assessment) - neck pain with mobility deficits

A
  • include cervical AROM, cervical flexion-rotation test, and thoracic segment mobility
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6
Q

Neck Pain CPG - examination (assessment) - neck pain with headache

A
  • add or include upper cervical mobility testing
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7
Q

Neck Pain CPG - examination (assessment) - neck pain with radiating pain

A
  • add or include neurodynamic testing, Spurlings test, distraction test, and valsalva test
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8
Q

Neck Pain CPG - examination (assessment) - neck pain with movement coordination impairment

A

add or include neck flexor muscle endurance test

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9
Q

Neck Pain CPG - interventions in acute stage

A
  • thoracic manipulation, neck ROM, home ROM exercise, scapulothoracic and UE stretching and strengthening (II)
  • cervical manipulation/mobilization (III)
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10
Q

Neck Pain CPG - interventions in subacute stage

A
  • neck and shoulder girdle endurance (II)
  • thoracic manipulation, cervical mobilization/manipulation (III)
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11
Q

Neck Pain CPG - interventions in chronic stage

A
  • thoracic manipualtion and cervical mobilization/manipulation, NM types of exercises, stretching, strengthening, endurance, aerobic conditioning, dry needling, intermittent traction (II)
  • advice to remain active, endurance exercises for trunk, shoulder and neck that promote active lifestyle and address any cognitive or affective disorders (III)
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12
Q

Neck Pain CPG - interventions for neck pain with movement coordination impairments (including WAD) in acute stage

A
  • advice to remain active, education to return to pre accident activities ASAP, minimize use of a cervical collar, perform postural and mobility exercises to decrease pain and increase ROM, reassurances that recovery will occur within first 2-3 months, multimodal interventions including mobilization, strengthening, endurance, flexibility, postural, aerobic for those patients predicted to have a moderate to slow recovery (II)
  • TENS (III)
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13
Q

Neck Pain CPG - interventions for neck pain with movement coordination impairments (including WAD) in chronic stage

A
  • pt eduction, mobilization, submax exercise program including strengthening, endurance, coordination using principles of CBT, TENS (III)
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14
Q

Neck Pain CPG - interventions for neck pain with headache in acute stage

A
  • supervised active mobility exercises (II)
  • C1-C2 Self SNAG (III)
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15
Q

Neck Pain CPG - interventions for neck pain with headache in subacute stage

A
  • cervical mobilization/manipulation (II)
  • C1-C2 self SNAG (III)
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16
Q

Neck Pain CPG - interventions for neck pain with headache in chronic stage

A
  • clerical or thoracic mobilization/manipulation, shoulder girdle and neck stretching, endurance and strengthening (II)
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17
Q

Neck Pain CPG - interventions for neck pain with radiculopathy in acute stage

A
  • mobilizing and stabilizing exercises
  • low level laser
  • possible short term use of c collar (III)
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18
Q

Neck Pain CPG - interventions for neck pain with radiculopathy in chronic stage

A
  • stretching, strengthening, cervical/thoracic, manipulation/mobilization, education and counseling to participate in activities and movement, mechanical intermittent cervical traction (II)
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19
Q

LBP CPG - differential diagnosis

A
  • consider serious medical conditions or psychosocial factors and refer to an appropriate medical practitioner, if activity limitations or body structure are not consistent with low back pain diagnosis/ classifications or if symptoms are not resolving with interventions (I)
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20
Q

LBP CPG - risk factors

A
  • multifactorial, population specific, and only weakly associated with the development of low back pain; two categories of suspected risk factors are individual and activity related factors (II)
21
Q

LBP CPG - outcome measures

A
  • should use validated self-report questionnaires to establish baseline and on-going status relative to pain, function and disability (I)
22
Q

LBP CPG - diagnostic classifications

A
  • acute, subacute, or chronic
  • if no sxs of serious medical or psychological conditions, should classify based on associated findings (II): mobility impairments in thoracic, lumbar, SI regions, referred or radiating to LE, generalized low back pain
23
Q

LBP CPG - diagnostic classifications for chronic back pain

A
  • PTs may use mechanical diagnosis and therapy, prognostic risk stratification or pathoanatomic based classification to reduce pain and disability (II)
24
Q

LBP CPG- education for acute low back pain

A
  • PTs may use active education strategies (biopsychosocial contributors to pain, self management techniques such has remaining active, pacing, and protection)
  • may also incorporate counseling on favorable natural history of active low back pain
    (II)
25
Q

LBP CPG - education for chronic LBP

A
  • deliver pain neuroscience education alongside exercise or manual therapy (I)
  • use active treatments (yoga, stretching, Pilates, strength) instead of stand alone educational interventions (I)
  • use standard education (II)
26
Q

LBP CPG- acute LBP interventions

A
  • use thrust or nonthrust joint mobilization to reduce pain and disability in pts with acute LBP (I)
  • use massage or soft tissue mobilization for short term pain relief (II)
27
Q

LBP CPG chronic interventions - exercise

A
  • use trunk muscle strengthening and endurance, multimodal exercise, specific trunk muscle activation exercise, aerobic exercise, aquatic exercise, or general exercise (I)
  • provide movement control exercise or trunk mobility (II)
28
Q

LBP CPG chronic interventions - manual therapy

A
  • use thrust or nonthrust joint mobs to reduce pain and disability (I)
  • use soft tissue mobilization or massage in conjunction with other treatments to reduce pain and disability in short term (II)
29
Q

LBP CPG - chronic LBP with leg pain interventions - exercise

A

use training interventions, including specific trunk activation and movement control (II)

30
Q

LBP CPG - chronic LBP with leg pain interventions - manual therapy

A
  • use thrust or nonthrust joint mobs to reduce pain and disability (II)
  • use neural mobilization in conjunction with other treatments for short term improvement in pain and disability (II)
31
Q

LBP CPG - chronic LBP with movement control impairments

A
  • use specific trunk muscle activation and movement control exercise (I)
32
Q

LBP CPG - chronic LBP in older adults

A
  • use general exercise training to reduce pain and disability (I)
33
Q

etiology of spinal or intervertebral stenosis-

A

congenital narrow spinal cancel or intervertebral foramen, coupled with hypertrophy of the spinal lamina and ligament flavum or facets, as the restful of age related degenerative processes or disease

34
Q

clinical exam for spinal stenosis

A

bicycle (van Geldren’s test) test helps identify the condition and differentiate it from intermittent claudication

35
Q

tractions for spinal stenosis

A
  • clerical spine positioned at 15 degrees flexion to provide the optimum intervertebral foramina opening
36
Q

What is internal disc disruption

A
  • internal structure of disc annulus is disrupted however external structures remain normal
  • most common in lunar region
37
Q

symptoms of internal disc disruption

A
  • content deep, achy pain and increased pain with movmenet
  • no neurological findings although patient may have referred pain in LE
38
Q

diagnostic testing for internal disc disruption

A
  • regular CT or pyelogram will not demonstrate any abnormal findings
  • can be diagnosed by CT disco gram or an MRI
39
Q

PT goals, outcomes, interventions

A
  • correct biomechanical faults caused by joint restrictions
    * spinal manipulation may be contraindicated*
  • education
40
Q

what is a good intervention for posterolateral disc bulge/herniation

A
  • positional gapping for 10 miutnes
  • Side lying on contralat side with pillow under trunk
  • flex both hip and knees
  • rotate trunk ipsilaterally
41
Q

what causes facet entrapment (acute locked back)

A

abnormal movement of fibroadipose meniscoidal in facet during extension (from flexion)
- menisci does not properly reenter joint cavity and bunches up, becoming a space occupying lesion, which distends capsule and causes pain

42
Q

what is the most comfortable position for facet entrapment

A

flexion

43
Q

review Canadian C spine rules

A

pg 119

44
Q

early sxs of WAD

A

headaches, neck pain, limited flexibility, reversal of lower cervical lordosis and decrease in upper cervical kyphosis, vertigo, change in vision and hearing, irritability to noise and light, dysethesias of face and bilateral UE, nausea, difficulty swallowing and emotional lability

45
Q

late sxs of WAD

A

chronic head and neck pain, limitation in flexibility, TMJ dysfunction, limited tolerance to ADLs disequilibrium, anxiety, depression

46
Q

clinical findings of WAD

A

postural changes, excessive muscle guarding with soft tissue fibrosis, segmental hyper mobility, and gradual development of restricted segmental motion (cranial and caudal to the injury)

47
Q

interventions for WAD

A
  • manipulation is general indicated
  • correction of muscle imbalances
  • correction of joint restrictions
  • progression to functional training
  • education of harmful positions
  • posture re-ed
  • traction
48
Q
A

Boards Prep - MSK (29 decks)

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