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Manual Therapy Exam > The Nervous System > Flashcards

The Nervous System Flashcards

1
Q

A-alpha neural info:

A

Tbc

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2
Q

A-delta neural info:

A

Afferent Temperature and touch

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3
Q

Meissner’s corpuscle

A
  • function: Exact location/texture

- location: Non Hairy

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4
Q

Hair end organ

A
  • function: Continuous touch

- location: Skin

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5
Q

Ruffini’s end-organs

A
  • function: Continuous state deformation

- location: Deep skin & joint capsule

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6
Q

Pacicnian corpuscles

A
  • function: Rapid movement/vibration

- location: Skin and deep fascia

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7
Q

Muscle spindle (annulospinal ending)

A
  • function: Dynamic and static posture changes

- location: Muscle

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8
Q

Muscle spindle (flower spray ending)

A
  • function: static posture changes

- location: Muscle

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9
Q

Golgi tendon organ

A
  • function: tension in muscle unit

- location: tendon

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10
Q

1) Nerve cell components
2) peripheral nerve fiber components
3) peripheral nerve

A

1) cell body, dentrite, axon
2) axon, myelin, ranvier node, nucleus, cytoplasm, neurofibrils
3) epineurium, perineurium, endoneurium, blood vessels, sensory & motor nerve fibers bundles

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11
Q

Describe the area of skin innervated by the follow dermatome:

  • C5
A

Shoulder, the front of the arm, the forearm as far as the base of the thumb

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12
Q

Describe the area of skin innervated by the follow dermatome:

  • C7
A

Back of the arm and forearm to the index finger,middle & ring fingers

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13
Q

Describe the area of skin innervated by the follow dermatome:

  • L3
A

Upper bottomless, inner and front of thigh, as far as the med malleolus

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14
Q

Describe the area of skin innervated by the follow dermatome:

  • L4
A

Ant and med aspect of the leg, the medial side dorsum of the foot, hallux

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15
Q

Describe the area of skin innervated by the follow dermatome:

  • S2
A

Back of the thigh, leg, sole and the plantar aspect of the heel

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16
Q

Describe the area of skin innervated by the follow dermatome:

  • S4
A

Saddle area, anus, perineum,scrotum, penis, inner upper thigh

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17
Q

Describe the area of skin innervated by the follow dermatome:

  • T1
A

Inner side of the forearm as far as the wrist

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18
Q

What embryological segments are the following tissues derived?

A- capsule of the shoulder joint
B- gall bladder
C- supraspinatus
D- Triceps

A

A: C5
B: C4-T7
C: C5
D: C7

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19
Q

What embryological segments are the following tissues derived?

E: AC joint
F: Diaphragm
G: Heart
H: Hip joint capsule

A

E: C4
F: C3-4
G: C8-T4
H: L2-L3

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20
Q

What embryological segments are the following tissues derived?

I: Quadriceps
J: Gastrocnemius
K: L1 vertebrae

A

I: L3-4
J: S1
K: T12-L1

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21
Q

Name two tests for each of the following areas to assess the mobility of the dura mater.

  • Lumbar levels
  • Thoracic levels
A

Lumbar levels:
- SLR, PKB, Slump
Thoracic:
- Slump, scapular approximation, T1 dural stretch

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22
Q

What fingers would be affected by pressure on the C7 nerve root?

A

2,3,4

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23
Q

Classify the following tissues as inert or contractile:

  • Muscle, ligament, tendon, capsule, fascia, bursa, attachments to periosteum, Dura mater, nerve root
A

Connective:
- mm, lig, tendon, attachment to periosteum

Inert:
- capsule, fascia, bursa, dura, nerve

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24
Q

What does the following Hx suggest?

- pain staying in the back as it moves to the leg?

A
  • Discogenic symptoms progressing to radicular (mechanical or inflammatory)
  • referred (embryological) from structures on the lumbar segment (ie. Facet)
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25
Q

What does the following Hx suggest:

Unilateral leg pain on standing for 10 minutes?

A
  • Discogenic protrusion resulting from “creep” of the disc connective tissue impacting on the radical of the nerve on one side.
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26
Q

What does the following Hx suggest?

Unilateral leg pain on walking for 10 minutes:

A
  • Suspect unilateral lateral stenosis of the IVF if relieved quickly with lumbar flexion or side flexion,
  • Be suspicious of intermittent claudication in the lower extremity (femoral artery) pain relieved with rest, to effect noted with lumbar movement, pain returns with walking
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27
Q

What does the following Hx suggest?

Hip pain at the age of 15:

A
  • Slipped femoral epiphysis
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28
Q

What does the following Hx suggest?

Knee pain at age of 15. On exam, full ROM, all resisted tests normal:

A
  • Slipped femoral epiphysis
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29
Q

What does the following Hx suggest?

Hip pain at the age of 5:

A
  • Leg Perthes Disease
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30
Q

What does the following Hx suggest?

Hip weaknees noted early as the child’s normal walking milestone is significantly delayed:

A
  • Suspect neurologically based development or orthopaedic disease. Referral to paediatric specialist is required
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31
Q

What does the following Hx suggest?

L3 pain with a painful cough

A
  • Acute L3 disc prolapse impacting structures like the nerve root and and the disc
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32
Q

List 4 possibilities of warmth surrounding a joint?

A
  • RA
  • OA
  • Haemarthrosis (bleed into joint space)
  • Infection
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33
Q

What is a capsular pattern?

A

Limitation of passive movements in a specified proportion to each other

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34
Q

What is the capsular pattern of the shoulder

A

ER> abduction, IR

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35
Q

What is the capsular pattern of the ulno-humeral joint?

A

Flexion>extension

36
Q

What nerve root could be involved if elbow flexion is weak?

A
  • C5 + C6
37
Q

What nerve is involved in each case if weak elbow flexion is accompanied by:

  • weak abduction at the shoulder
  • weak extension at the wrist
A
  • weak abduction at the shoulder: C5

- weak extension at the wrist: C6

38
Q

Pressure on which nerve roots would produce the following signs?

  • Weakness of supraspinatus:
  • Weakness of triceps:
  • Weakness of infraspinatus:
  • Weakness of biceps:
A
  • Weakness of supraspinatus: C5
  • Weakness of triceps: C7
  • Weakness of infraspinatus: C5
  • Weakness of biceps: C5-6
39
Q

Pressure on which nerve roots would produce the following signs?

  • Pins and needles in the thumb and index fingers
  • pins and needles in the long, ring and index fingers
  • Absence of triceps reflex
  • Weakness of small muscles of the hand
A
  • Pins and needles in the thumb and index fingers: C6
  • pins and needles in the long, ring and index fingers: C7
  • Absence of triceps reflex: C7
  • weakness of small muscles of the hand: C8
40
Q

Is calcification of the supraspinatus tendon painful?

A

No, not necessarily if there is no inflammation. Calcification does not hurt on its own.

41
Q

Name three types of arthritis at the shoulder joint?

A
  • RA
  • OA
  • traumatic immobilization arthritis
42
Q

Is the disc innervated? If so how much?

A

Yes, peripheral 1/3

43
Q

Can a single disc protrusion cause an L4-L5 palsy?

A

Yes. A L4 lateral protrusion will impact the L4 root. If this has a posterior component it will impact the L5 nerve root as it continues in the central canal on its was to exit L5 IVF

44
Q

Will a nerve trunk/root produce pain if subjected to pressure?

A

Nerve trunks typically will not cause pain. (Tingling/weakness/paresthesia). Surrounding structures may become inflamed around the trunk and therefore cause pain

45
Q

What might be the reason for an X-ray failing to detect Spondylolethesis?

A
  • May be missed if taken in non-weight bearing.

- Look for a step deformity in standing

46
Q

What level does a painful SLR indicated immobility at?

A
  • L4-5
47
Q

What roots can be tested with prone knee bend

A

L2-3

48
Q

List one possibility of?

  • painless weakness of deltoid:
  • weakness of deltoid, bicep, supraspinatus and infra:
  • painless weakness of supraspinatus:
  • painful and weak supraspinatus:
  • painless and weak supraspinatus and infraspinatus
A
  • Axillary nerve palsy
  • C5
  • rupture of supraspinatus
  • 2nd degree strain
  • Suprascapular nerve palsy
49
Q

List one possibility of:

  • painless weak SA:
  • painless weak trap:
  • Painless weak infraspinatus
  • painless weak triceps and wrist flexors
  • painless weak biceps and wrist extensors
A
  • long thoracic nerve palsy
  • Spinal accessory nerve + C4
  • Rupture
  • C7 compression
  • C6 compression
50
Q

Differentiate low and high irritability:

A

High:
- low activity causes high degree of pain

Low:
- high activity causes a low degree of pain

51
Q

Describe what a patient with radicular pain would feel?

A
  • Sharp distinct linear pain. Deep and unrelenting pain following an embryological segment
52
Q

Is radicular pain always direct mechanical pressure?

A

No, because the inflammatory component can irritate the nerve root

53
Q

List 4 clinical possibilities for dizziness

A
  • Vertebral artery pathology: trauma, injury, stenosis, plaque
  • Labyrinthe and vestibular apparatus
  • Upper cervical joint proprioception dysfunction
  • brain/ cerebellar pathology
54
Q

What are the vertebral basilar insufficiency symptoms

A

5D’s

- dizzy, drop attack, dysphasia, dysarthria,diplopia

55
Q

Name 4 cord signs

A
  • Hyperreflexia
  • babinski (extension- up turning toes)
  • wide base gait
  • bowel/ bladder signs
56
Q

What does babinski, Oppenheimer, and Hoffman test suggests

A

The pressence of these reflexes suggests a loss of inhibition from CNS (UMN)

57
Q

What is the Oppenheimer test?

A

Down going toes when the noxious stimulus is applied to the tibial crest

58
Q

What is the Hoffman’s reflex?

A

Flick of the finger tip of the 3rd finger produces opposition of the thumb and index finger

59
Q

Differentiate between cauda equina and cord signs

A

Remember the pathology is affecting the roots and the category is classified as a LMN pathology and not the UMN (SC).
- Lumbo-sacral root signs (LMN) = hyporeflexia & can be multisegmental (likely bilateral), sensation (light touch) (bilateral and multisegmental) loss in a dermatomal distribution, key muscle loss ( multisegmental and bilateral).

  • Bowel and bladder signs: hypotonic (dribbling). Low tone and no capacity to fill, the sphincter is hypotonic and will not hold back the flow compared to a hypertonic UMN SC lesion bladder which has urgency with sudden evacuation
60
Q

Approximately where does the SC end?

A

T12-L1,2

  • large posterior herniations at L3-L4-L5 will not compress the SC but will impact the cauda equina.
61
Q

List the key muscles for L2-S2

A

ie. “Myotomes”
- L1-2: Hip flexion
- L3: Knee extension
- L4: DF
- L5: great toe extension/ hip abduction
- S1: PF/eversion/ knee flexion
- S2: hip extension/ knee flexion

62
Q

List 3 UMN signs of the lower quadrant

A
  • Plantar response (babinski)
  • Oppenheimer
  • Clonus
63
Q

Name the 3 neural mobility tests for the lower quadrant

A
  • Slump
  • SLR
  • PKB
64
Q

Where do you find the femoral pulse?

A
  • Inferior to the inguinal ligament at the midpoint
65
Q

The iliac crests are usually in line with L ____ interspace?

A

L4-5

66
Q

What can be assessed in the popliteal fossa

A
  • Tibial nerve
  • Popliteal artery
  • Popliteus mm
67
Q

Name 2 tests for the ACL

A
  • Lachman’s

- Anterior drawer

68
Q

Name 6 structures running between the Achilles tendon and the medial malleolus

A

Tom dick and not harry “stiles”

  • Tibialis Posterior
  • Flexor digitorum longus
  • Posterior tibial artery
  • Tibial nerve
  • Flexor Hallucis longus
  • Long saphenous vein
69
Q

List C1-T1 key muscles

A 
C1-2: Short neck flexors
C3-4: shoulder elevation
C5: Shoulder abduction
C6: Elbow flexion, wrist extn
C7: Elbow Extension, wrist flex
C8: thumb extension
T1: intrinsics, 5th abduction
70
Q

List the neural mobility tests of the upper quadrant

A
  • ULTT: radial, ulnar, median X 2
  • slump
  • passive neck flexion
  • Scapular retraction (T1)
71
Q

What must be assessed prior to vertebral artery Ax?

A
  • neurological exam: 5D’s, 3N’s, URTI, headache Q’s
  • AROM
  • ## Craniovertebral stability: Spurlings, sharp purser (AA), ant sheer, distraction,
72
Q

List symptoms of vertebral artery dysfunction

A
  • Diplopia
  • Dysarthria
  • Dysphasia
  • Drop attack
  • Dizziness
  • vertigo
  • Nystagmus
  • Ataxia
  • Peri-oral numbness
  • B&B dysfunction
73
Q

List symptoms of SC lesions

A
  • Hypertonicity
  • Quadrilateral paraesthesia
  • ## Ataxia
74
Q

List one muscle in which a true myotome exists

A
  • Multifidus
  • Rotators
  • Suboccipitals
75
Q

Failure to fuse during the 2nd decade results in which condition found in the upper cervical spine?

A
  • Os odontoidium
76
Q

List 3 congenital anomalies in the upper limb?

A
  • Bifid clavicle
  • cervical fusion
  • Scalene anticus
77
Q

List 3 congenital abnormalities of the lower limb

A
  • Anteversion of the hip > 15 degrees
  • Patella Baha
  • Extra growth of the navicular
78
Q

Name a difference b/w peripheral nerves and nerve roots as it relates to blood supply

A
  • Nerve roots have more limited blood supply

- Nerve roots are more at risk of ischemia

79
Q

speed conduction of a nerve depends on 2 factors

A
  • Diameter of the nerve fiber

- myelination

80
Q

Name 2 mechanoreceptors

A

Look up

81
Q

Where is the proposed location of the “gate controlled theory”

A
  • Substantial Gelatinosa (lamina 5 of dorsal horn)
82
Q

Clue to differentiate Mechanical vs. Inflammatory pain

A

Mechanical pain is: intermittent

- AM stiffness

83
Q

What is root pain / neuropathic pain?

A
  • laminating pain
  • remember compression of an uninsured nerve is paresthesia and not pain
  • intra/peri- neural edema may produce nerve root ischemia, which cause radicular symptoms = lancinating/ shooting pain
84
Q

5 ways that pain can be categorized

A
  • Nociceptive
  • Neuropathic
  • centrally evoked (anxiety)
  • psychological facts
  • social/ environmental factors
85
Q

When listing structures and related pathology…what 7 things should we keep in mind?

A
  • anatomical components
  • how does the structure react when injured (mm vs. Nerve)
  • what might refer to that spot?
  • how do you assess those structures, what are the signs?
  • what is a +ve tests
  • what Hx precipitates such an event
  • age predictors?

Manual Therapy Exam (5 decks)

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