Spine One - ends with OA/DJD Flashcards
What needs to be assessed if it is a cervical or thoracic complaint?
scapular stabilizers
What needs to be asses if it is a lumbar complaint?
hips
in the upper cervical spine, forward head posture __________ the facets and causes tendency towards facet ___________
compression, hypomobility
With FHP, there can be a possible compression of the _________ which refers pain in headache patterns
greater occipital nerve
in the mid-lower cervical/ upper thoracic, FHP causes the facets to go ______ and ________ and causes a tendency for facet _______
up and forward, hypomobility
FHP causes a ________ in lower cervical lordosis and _________ in C/T junction kyphosis
decrease, increase
upper janda cross syndrome is the same as
FHP
With FHP or UJCS (upper janda cross syndrome), what are the weak/inhibited muscles?
anterior: deep cervical flexors (esp longus coli!!)
posterior: lower trap and serratus ant.
With FHP/UJCS what are the facilitated/tight muscles?
anterior: SCM/pectoralis
posterior: upper trap/levator scap
What happens with the shoulder girdle in UJCS?
- protracted shoulders
- shortening of pecs and other IR (lats, teres major, subscap)
- lengthening of scap retractors (rhomboids, mid/lower traP)
With FHP, the abdominal wall ______
constricts
What are the consequences of abdominal wall constriction with FHP?
- lessens diaphragmatic breathing
- facilitates increased activity of accessory muscles (like serratus, scalenes, SCM)
- elevated 1st rib (thoracic outlet risk)
What muscles are inhibited/weak in lower janda cross sydrome (LJCS)
anterior: abs
posterior: glute min/med/max
What muscles are facilitated/tight/overworked in LJCS
anterior: rec fem/iliopsoas
posterior: thoraco-lumbar extensors
who is posterior pelvic tilt common in?
people who sit/slouch at a desk all day (desk job/video games)
What part of disk weakens with posterior pelvic tilt?
posterior aspect (increases risk for disc bulge)
What are the causes/results of posterior pelvic tilt?
tight hamstrings
forward head posture
who is anterior pelvic tilt common in
weak abs, tight iliopsoas, or overweight
thoracic kyphosis (weakening scapula) can be the cause/result of ________
anterior pelvic tilt
anterior pelvic tilt _________ facet joints in lumbar spine which can lead to _____, ______, and ________.
compress, DJD, DDD, stenosis
What are the overall general causes of spine pain?
- stressful living and working habits
- decline in physical fitness
- stress and poor nutrition
What faulty body mechanics can cause spine pain?
lifting with back flexed
twisting without a pivot
What are 3 things you should ask about with cervical spine pain
- dizziness
- headache
- TMJ pain
What are 2 things you need to ask about with lumbar pain?
- bowl/bladder incontinence
- saddle paresthesia
yellow flags
psychosocial factors (ex. emotional distress, hypervigilance, pain catastrophizing, etc.)
could indicate poor prognosis
What scales do we use to assess yellow flags?
- pain catastrophizing scale (overestimate get effects of pain)
- FABQ, Tampa Scale, Kinesiophobia (elevated fear avoidance beliefs)
Blue flags
- injured workers
- patient’s perception of work and conditions that may impair return-to-work (low job satisfaction)
Black flags
- social and financial issues
- reimbursement incentives to remain disables, secondary gain, litigation
true or false: a single red flag may be predictive of a serious disease
false, must make clinical decision on clusters of findings
what are 5 red flags that may increase the likelihood of cancer
history of cancer
night pain or pain with rest
unexplained weight loss
age >50 or <17
failure to improve over the predicted time interval following treatment
red flags that may suggest diskitis or osteomyelitis
patient is immunosuppressed
a prolonged fever with a temp >100.4
history of IV drug abuse
history of recent UTI, cellulitis, or pneumonia (other infections)
red flags suggesting an undiagnosed vertebral fracture
- prolonged use of corticosteroids
- mild trauma >50
- age >70
- known history of osteoporosis
- recent major trauma at any age (MVA or fall >5ft)
- bruising over the spine following trauma
red flags for an abdominal aortic aneurysm
- pulsating mass in abdomen
- history of atherosclerotic vascular disease (smoking)
- age >60
Why should we not use waddells signs?
almost all chronic pain people have these symptoms
how many questions are on the neck disability index (NDI)
10
what score is the NDI out of? is higher or lower score more disability? what is the MDC? MCID?
out of 50 points
higher is more disability
MDC = 10.2 (20%)
MCID = 10
Difference between NDI and oswestry disability index?
MDC for oswestry is 5 points
oswestry for low back pain and NDI for neck pain
xrays are used to identify (in general)
arthritis, fractures, and dislocations
How many views of the spine do we need?
3, at minimus 2
What does an AP view of the spine show?
vertical shape
osteophytes
disk space
scoliosis
rib symmetry
What does an oblique view of the spine show?
- neural foramen and fascia
- osteophytes
- stenosis
What does a lateral view of the spine show?
- integrity of ALL
- lordosis/kyphosis
- collapsing or wedging (compression fracture)
- osteophytes
- forward shift of C1 on C2 (may indicate instability)
pathologies common in the whole spine
muscle strain
capsular restrictions
spondylosis
stenosis
radiculopathy
What accompanies most spine pathologies
muscle guarding
an acute muscle strain will have ________-
- a MOI
- s/s will ease with rest
- pain referred over several spinal levels
- uncommon as true/only cause of pain
normal stress to normal tissue
no immediate increase in pain
abnormal stress to normal tissue…
may produce pain without causing damage
becomes abnormal when sustained and causes damage to tissues
normal stress applied to abnormal tissue
will produce pain
abnormal stress applied to abnormal tissue
will increase pain
trigger point
palpable nodule in the taut bands of the skeletal muscle fascia
jump sign
behavioral response to pressure on a trigger point
local twitch response
visible or palpable contraction of muscle and skin
referred pain
pain perceived at a location other than the site of the painful stimulus
does not follow myotomes, dermatomes, or nerve roots
true or false: capsular restrictions are associated with most pathologies
true and they’re usually chronic
What causes capsular restrictions
poor posture, past trauma, repeated inflammation
what are some subjective findings with capsular restriction
limited mobility
pain only at end range of motion
no reduction of pain with rest
no weakness
no numbness or tingling
objective findings with capsular restriction
- limited AROM/PROM that open facets during flexion
- during flexion, may deviate to same side
- cervical - limited contralateral SB and ROT
= lumbar = limited contralateral SB and ipsilateral rot - hypomobility with passive accessory
what are 4 names for spondylosis
arthritis
osteoarthritis
DDD
DJD
What does AO and DJD most commonly affect?
facet joints and discs at any level
def of DDD
- thickening of subchondral bone/capsule
- increased ca deposites
- joint surface erosion and or irregularities (spurs)
DDD def
- hardening of NP
- leads to decreased disc height and decreased annular strength
- vertebral approximation
with OA/DID you have _____ blood suppl
decreased
what 2 things increase the risk of OA/DJD
- loss of movement (movement causes synovial fluid to provide nutrients)
- hypermobility (puts more wear and tear on joints)
T/F OA DJD only occurs in older people
F, can occur at any age and is typically a chronic condition
What age is peak back health
25
Is OA/DJD reversible?
yes, if it is early dysfunction with minor involvement of discs/facets
intermittent instability with OA DJD
- laxity of joint capsule and ligament
- annular loss of proteoglycans (decreased flexibility of disc/more stiff)
- permanent instability and bony changes with time
final stabilization with OA DJD
- fibrosis of joint and capsule
- joints become hypermobile to compensate
- stiff and may not really be painful
- stenosis may occur
cumulative injury cycle
tissue trauma
inflammation
muscle spasm
adhesions (stiffness)
altered neuromuscular control (trouble activating)
muscle imbalance
back to beginning of cycle
subjective findings with OA/DJD
- stiffness (esp in morning)
- pain (in morning, with too much movement or at end ranges)
- mobility/activity decreases with pain
objective findings with OA/DJD
- both hypo and hypermobility
- pain with sitting (disk -DDD)
- pain with standing and walking (facet/DJD)
- radiographs (symptomatic versus asymptomatic)
