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Physiotutors Orthopaedics > Spine Course Introduction > Flashcards

Spine Course Introduction Flashcards

1
Q

As a PT, your job is to address the “bio” aspect of the biopsychosocial model. Artus et al investigated general prognostic factors for musculoskeletal pain. What are 4 factors that are associated with a negative prognosis & which physiotherapy can affect?

A
  1. widespread pain
  2. a high pain severity
  3. high disability
  4. movement restriction
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2
Q

Give 5 examples of biologic factors in the biopsychosocial model for musculoskeletal pathology.

A
  1. mobility
  2. strength
  3. coordination
  4. anatomy
  5. anatomic adaptations
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3
Q

Give 6 examples of social factors in the biopsychosocial model for musculoskeletal pathology.

A
  1. socioeconomic (class?) status
  2. social support network
  3. family dynamics
  4. cultural beliefs
  5. social isolation / stigma
  6. workplace dynamics
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3
Q

Give 5 examples of negative psychological prognostic factors in the biopsychosocial model for musculoskeletal pathology.

A
  1. depression
  2. pain-related fear
  3. false beliefs
  4. castastrophic thinking
  5. passive coping strategies
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4
Q

How should our assessment of someone’s biopsychosocial factors weigh on our treatment approach

A

If someone shows signs that there are biologic factors that play a significant role (e.g. patellar tendinopathy), the treatment approach will be more tissue-based. If someone shows more dominant psychsocial factors (e.g. central sensitization), then the treatment might be more about generalized movement, coupled with other healthcare professionals.

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5
Q

How do you evaluate social and psychological factors?

A

You have to ask specific questions & use questionnaires.

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6
Q

List two reliable questionnaires that assess for pain-related fear or anxiety about movement.

A
  1. Fear-Avoidance Beliefs Questionnaire (FABQ)
  2. Tampa Scale of Kinesiophobia
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7
Q

Which biopsychosocial domain & factor is assessed with the Tampa Scale of Kinesiophobia?

A

Doman: psychological
Factor: fear, fear-avoidance, beliefs

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8
Q

Give an example of a questionnaire that assesses for clinically relevant depression.

A

Four-Dimensional Symptom Questionnaire (4DSQ)

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9
Q

Which biopsychosocial domain & factor is assessed with the Four-Dimensional Symptom Questionnaire?

A

Domain: psychological
Factor: depression

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10
Q

Give an example of a questionnaire that assesses catastrophic thinking & beliefs about illness.

A

Brief Illness Perception Questionnaire (IPQ-B)

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11
Q

Which biopsychosocial domain & which 2 factors are assessed with the Brief Illness Perception Questionnaire?

A

Domain: psychological
Factors: catastrophic thinking & false beliefs about illness

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12
Q

Give an example of a questionnaire that assesses for a passive coping style (for someone in pain, specifically).

A

Pain Coping Inventory (PCI)

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13
Q

Which biopsychosocial domain & negative prognostic factor is assessed with the Pain Coping Inventory?

A

Domain: Psychological
Factors: passive coping strategies

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14
Q

What are 2 questions that you can ask someone to assess for the presence of social factors that may impact their prognosis?

A
  1. “How do [your symptoms] affect work?”
  2. “How do [your symptoms] affect your ability to spend time with friends and family?”
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15
Q

What acronym can be used to assess for lifestyle factors that have the highest potential to impact someone’s prognosis?

A

SNAPS(S)
1. Smoking
2. Nutrition
3. Alcohol
4. Physical Activity
5. Stress
6. Sleep

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16
Q

When assessing someone’s lifestyle factors, what are 5 questions that you might ask a patient about smoking?

A
  1. “Do you smoke?”
  2. “What do you smoke?”
  3. “How much do you smoke?”
  4. “Do you want to stop?”
  5. “Do you want any help/support?”
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17
Q

When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about nutrition?

A
  1. “Do you eat well?”
  2. “Do you know your calorie intake?”
  3. “Do you eat fruits and vegetables every day?”
  4. “How much protein do you eat?”
  5. “How much sugar do you eat?”
  6. “Do you want any help/support?”
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18
Q

When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about alcohol?

A
  1. “Do you drink alcohol?”
  2. “How often?”
  3. “How much?”
  4. “Do you know the guidelines?”
  5. “Do you want to stop or drink less?”
  6. “Do you want any help/support?”
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19
Q

When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about physical activity?

A
  1. “Do you exercise?”
  2. “How much?”
  3. “Do you do any strengthening exercise?”
  4. “Do you enjoy exercise?”
  5. “What stops you from exercising?”
  6. “Do you need any help/support?”
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20
Q

When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about stress?

A
  1. “Do you find time to relax?”
  2. “What do you do to relax?”
  3. “Do you feel stress often?”
  4. “What triggers your stress?”
  5. “How do you manage stress? / Do you have strategies to manage stress?”
  6. “Do you want any help/support?”
21
Q

When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about sleep?

A
  1. “Do you sleep well?”
  2. “How many hours do you get?”
  3. “Do you feel refreshed on waking?”
  4. “What stops you from sleeping?”
  5. “What helps you sleep?”
  6. “Do you want any help/support?”
22
Q

What is the nocebo effect?

A

A clinical situation in which a person’s negative expectations of a treatment cause the treatment to be ineffective or have a more negative effect than it otherwise would have.

23
Q

In a notable example of the nocebo effect, Mondaini et al performed a study in which they essentially “gave” men sexual dysfunction. Describe the study and how it demonstrates how beliefs and expectations affect outcomes.

A

120 males with benign prostate hyperplasia were given Finasteride (Propecia), but only half were told that they could experience side effects like erectile dysfunction, reduced libido, and/or problems with ejaculation. ~44% of those who were told about the side effects reported one or more of those symptoms, compared to only ~15% of the control group.

24
Q

In a remarkable study on the placebo/nocebo effect, Aslaksen et al used the application of analgesic cream and a thermode to demonstrate the role of beliefs and expectations on pain. Describe the study and what it shows about both positive and negative expectations.

A

120 people were dividied into 6 groups:
1. Real cream + “This will decrease your pain”
2. Real cream + “This will increase your pain”
3. Fake cream + “This will decrease your pain”
4. Fake cream + “This will increase pain”
5. Just real cream
6. Nothing (Control)

A thermode was used to induce pain on the skin via heat. Group #1 (Real cream + "This will decrease your pain") was showed the greatest decrease in pain, followed by Group #3 (Fake cream + "This will decrease your pain"). This is an example of the placebo effect.    The group that experienced the most pain was Group #2 (Real cream + "This will increase your pain"), which shows that negative expectations can effectively "cancel out" even real physiological effects.
25
Q

The cup analogy is often used to describe how pain can come about from a variety of biopsychosocial stressors. List 6 different ways that people can help to reduce/manage stressors and “drain the cup”.

A
  1. Advice & reassurance
  2. Avoid certain activities/positions
  3. Modify activities
  4. Medication (ex. NSAIDs)
  5. Manual Therapy
  6. Isometric Exercises
26
Q

The cup analogy is often used to describe how pain can come about from a variety of biopsychosocial stressors. List 7 ways for someone in pain to increase resilience and build a bigger “cup”.

A
  1. Ask “How could I be healthier?”
  2. Build positive beliefs
  3. Improve their mood
  4. Improve their coping
  5. Make better food choices
  6. Improve their sleep hygiene
  7. Gradual physical loading / Exercise
27
Q

In orthopaedic medicine, clinical special tests are probably not as useful as we’d hope. According to Cook et al in 2017, what percentage of special tests have a high clinical value?

A

only 4% or so

28
Q

Acording to Physiotutors, only 3 special tests for the cervical spine have a high clinical value. What are they, and what do they test for?

A
  1. Canadian C-Spine Rule (for cervical fx)
  2. NEXUS Criteria (for cervical fx)
  3. Cervical Flexion Rotation Test (for upper cervical hypomobility)
29
Q

According to Physiotutors, only 2 special tests for the thoracic spine have a high clinical value. What are they, and what do they test for?

A
  1. Supine Sign (for osteoporotic vertebral fx)
  2. Closed Fist Percussion Test (for osteoporotic vertebral fx)
30
Q

According to Physiotutors, only 12 special tests for the lower extremity have a high clinical value. What are they, and what do they test for?

A
  1. Patellar Pubic Percussion Test (for occult hip fx)
  2. Single-Leg Stance Test (for gluteal tendinopathy)
  3. Ottawa Knee Rules (for knee fx)
  4. Lachman Test (for ACL rupture)
  5. Lateral Pivot-Shift Test (for ACL tear and/or Anterolateral Rotary Instability)
  6. Posterior Drawer Test (for PCL tear)
  7. Posterior Sag Sign (for PCL tear)
  8. Quadriceps Active / “Active Drawer” Test (for ACL tear)
  9. Anterior Drawer Test (for ACL tear)
  10. ACL Return-to-Play Hop Test Cluster
  11. Ottawa Ankle Rules (for ankle fx)
  12. Thompson Test (for achilles rupture/tear)
31
Q

According to Physiotutors, only 3 special tests for the upper extremity have a high clinical value. What are they, and what do they test for?

A
  1. Shoulder Apprehension Test (for anterior shoulder instability)
  2. Jerk Test (for posteroinferior glenohumeral labral tear)
  3. Hook Test (for biceps tendon rupture)
32
Q

According to Physiotutors, only 2 special tests for vestibular dysfunction have a high clinical value. What are they, and what do they test for?

A
  1. Dix-Hallpike Test (for BPPV)
  2. Supine Head Roll Test (for lateral BPPV)
33
Q

What are 5 reasons why we have so few orthopaedic special tests that can be considered highly valuable?

A
  1. They’re just not specific enough to stress only one structure.
  2. A lot of tests haven’t been sufficiently evaluated for reliability/accuracy.
  3. A lot of the reliability/accuracy studies that we do have contain a high risk of bias
  4. Sometimes, the ‘gold standard’ that researchers use is insufficient to validate the test
  5. A lot of studies are done retrospectively.
34
Q

What are the 3 main steps in making a clinical diagnosis of an orthopaedic condition?

A
  1. Know the epidemiology
  2. Ask specific questions about signs/symptoms
  3. Use special tests to rule in/out hypothesis
35
Q

How is epidemiology useful in establishing an orthopaedic diagnosis? Give two examples.

A

Knowing which conditions appear more or less frequently in a given population can help to guide the likelihood of a condition being present.
(patellar tendinopathy occurs almost exclusively in young jumping males & gluteal tendinopathy is almost always seen in older sedentary females)

36
Q

A patient comes into the clinic with complaints of knee pain. What are 5 signs/symptoms from a history-taking that might increase your suspicion that they’ve torn their ACL?

A
  1. They heard a “popping” sound
  2. The knee swelled up immediately (within 1 hour)
  3. Hemarthrosis (redness/warmth)
  4. After a pivoting movement
  5. During soccer or basketball
37
Q

According to Sackett et al in 2000, orthopaedic special tests usually don’t add much value under which 2 conditions?

A
  1. You are almost positive (80%+) that a condition is present
  2. You are pretty certain that a condition is not present (-20% chance)
38
Q

Self-diagnosis (especially via orthopaedic special tests) by people who aren’t medically trained tends not to work out. Why?

A

Diagnosing an orthopaedic condition should be preceded by reference to epidemiology as well as signs and symptoms. Even the best special tests give you little to no real information unless you have a thorough clinical reasoning process behind them.

39
Q

Initially, manual therapy was thought to be effective by finding & correcting biomechanical dysfunctions. List 4 such theoretical effects.

A
  1. spinal malalignment
  2. subluxations
  3. faulty positions
  4. scar tissue or adhesions that need to be broken up
40
Q

Though there is no evidence that manual therapy causes any lasting biomechanical change in the tissue that it’s targeting, what are 3 effects of manual therapy that we can be confident in?

A
  1. it decreases pain intensity
  2. it improves range of motion due to less stiffness or tightness
  3. it generally improves function
41
Q

Bialosky et al proposed several theories on the mechanism of manual therapy. Their model features not one but 5 mechanisms. List them.

A
  1. Mechanical stimulus & biomechanical effects
  2. Neurophysiological mechanism
  3. Peripheral mechanism
  4. Spinal mechanism
  5. Supraspinal mechanism
42
Q

Bialosky et al proposed a 5-mechanism model of manual therapy. Describe 2 important points that they make about the mechanism of mechanical stimulus / biomechanical effects.

A
  • biomechanical effects like decreased stiffness/tightness may be possible, but they are transient and don’t create any lasting structural changes
  • clinicians aren’t able to reliably determine the specific area that needs manual therapy
43
Q

Bialosky et al proposed a 5-mechanism model of manual therapy. Describe 4 effects of manual therapy that they site as neurophysiological mechanisms.

A
  1. hypoalgesic responses
  2. increased sympathetic nervous system activity
  3. lessening in temporal summation
  4. mediation by the periaqueductal gray and changes in the dorsal horn
44
Q

The periaqueductal gray is cited by Bialosky et al as an area of the brain affected by manual therapy. What are 3 of its functions?

A

the periaqueductal gray plays an important role in
1. automatic responses (autonomic function)
2. motivated behavior
3. behavioral (learned) responses to threatening stimuli

45
Q

Bialosky et al proposed a 5-mechanism model of manual therapy. Describe generally what the peripheral mechanism entails, especially as it pertains to musculoskeletal tissue injury.

A
  • we know that injury to musculoskeletal tissue can (and usually does) result in inflammation & the expression of inflammatory mediators
  • manual therapy targeted at or near that tissue seems to affect chemicals in the interstitial tissue as well as in the blood
46
Q

Bialosky et al proposed a 5-mechanism model of manual therapy. The peripheral mechanisms describe inflammatory responses which initiate the healing process and influence pain processing. Give 5 examples of peripheral effects of manual therapy.

A

manual therapy seems to…
1. reduce local blood flow to the tissue
2. decrease the level of serum cytokines
3. change blood levels of beta-endorphins (decr stress, pain, and increase reward)
4. change blood levels of seratonin
5. change blood levels of endogenous cannabinoids

47
Q

What are beta-endorphins? List 3 functions that beta-endorphins have in the body.

A
  • Beta-endorphins are a type of hormone that the brain (mostly the pituitary) produces in response to pain, stress, and exercise. (it’s one of 3 types, which also include alpha- and gamma-endorphins)
    1. They bind to opioid receptors on nerve cells & stop them from releasing pain-promoting tachykinins like substance P
    2. They reduce stress by binding to opioid receptors in the brain and block nociceptive neurons
    3. They are part of natural reward circuits that produce feelings of well-being, pleasure, and happiness
48
Q

Bialosky et al proposed a 5-mechanism model of manual therapy. Describe the spinal mechanisms that result in neuromuscular changes after manual therapy. List 4 of these changes.

A
  • Spinal mechanisms of manual therapy rely on gate-control theory of pain
  • If the ascending input is strong enough, nociceptive signals are inhibited and the dorsal horn neurons are less active
  • neuromuscular responses include…
    1. hypoalgesia (decreased pain)
    2. afferent discharge
    3. motor neuron pool activity
    4. changes in muscle activity
49
Q

Bialosky et al proposed a 5-mechanism model of manual therapy. Supraspinal mechanisms involve phenomena such as expectations and other psychosocial factors. Give 3 examples of supraspinal effects of manual therapy treatment.

A
  1. supraspinal descending inhibition
  2. changes in the brain’s opioid system
  3. increases in dopamine production

Physiotutors Orthopaedics (3 decks)

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