Stenosis - Exam 2 Flashcards
stenosis is typically found in what aged individuals?
older individuals
> 65 years old
What are the 2 causes/pathogenesis of stenosis
compression from outside in - narrowing of spinal canal (unilateral)
compression from inside out - fibrotic nerves won’t expand due to inflammation
if nervous system is involved, drainage takes longer because
no lymphatic vessels in PNS or CNS –> once inflammed, the inflammatory phase is longer
when the spinal canal is narrowed, what would someone feel early? what would that turn into?
radicular symptoms - lightning strike feeling
turns into radiculopathy (persistent numbness/tingling)
what would a patient tell you if they have lateral stenosis?
tingling on unilateral UE
gripping type P!
increased pain with: (extension)
- sitting, looking up, turning to one side
decreased pain with: (flexion - opening foramen)
- looking down, standing/walking, in AM
what would the PT find in a scan with lateral stenosis?
-Observation?
-ROM?
-Neuro (+ or -) for ?
-Stress test?
observation - FHP
ROM:
—FLX/Contralat SB and ROT “decrease” spinal/UE P!
—-EXT/Ipsilat SB and ROT “increase” spinal/UE P! (provocation depends on acuity)
Neuro: (+) for radiculopathy
Stress Test: likely (+) with compression, relief in distraction. Possible + PA w/ prolonged hold because it’s most likely a persistent condition
what would the PT find in a biomechanical exam with lateral stenosis?
accessory motion?
MMT?
Special tests?
accessory motion: joint hypomobility (foramen size decreased)
MMT: local muscles inhibited
special tests: + spurlings, CPR (3/4 + findings - radiculopathy), possible excessive shearing w/ stability test
what are central stenosis S&S?
why would they not be present in SB or rot?
cord S&S because disc goes into spinal cord
cord isn’t moving so paresthesias happen when the vertebrae hit the cord - don’t close the foramen
true or false. intermittent traction can be beneficial, but not when used in isolation
true
is someone with radiculopathy likely to have good outcomes at 2 years?
yes
what are the variables for CPR?
< 54 year old
non dominant UE affected
looking down does not worsen symptoms
> 30 flexion
what would you prescribe for someone with radiculopathy?
intermittent mechanical traction
no STM
multi-modal with manual therapy and local muscle training
thoracic thrust manipulation
what MET would you prescribe for someone with lateral stenosis? why?
aerobic activity –> increased circulation
local muscle stabilization
if lateral stenosis patient is not getting better and/or getting worse after ~2 weeks in PT, what would you do?
refer out
possible radiculopathy surgery
what is the comparison between radiculopathy and long term PT in relation to improvement?
long term PT can produce same outcomes as radiculopathy surgery just not as fast
–> 2 years PT vs 1 year
