VII. Done Pathophysiologic And Pathomechanical Components Of The Vertebral Subluxation Complex (VSC) Flashcards
T/F: Vertebral subluxation complex is a bone out of place with nerve compression
Nope, it is viewed as a complex theoretical phenomenon
What are extra articular things that may cause joint restriction?
Injury and spasm
Reflex muscle spasm
Soft tissue fibrosis
Stages of injury and repair
What is the main difference between Maigne hypothesis and Korr hypothesis?
Maigne: overstretching
Korr: approximation
Both lead to muscle spasm. But Maigne suggested its because of over-stretching while Korr hypothesised its the approximation of short segmental muscles that leads to spasm.
What is the myofascial cycle idea
Once segmental muscles splinting is initiated it may become self perpetuating and, over time, may develop into muscle contracture
The inflammatory phase of injury repair last for how long
2-4 days
May persist with re-injury or chronic stress
What happens to tissues during the inflammatory phase of injury repair
Increased tissue permeability, so fibroblasts and macrophages and fibrinogen are doing their jobs.
What are the signs of a patient being in the inflammatory phase of injury repair?
Redness Heat Swelling Pain Muscle splinting
T/F. Redness, heat, swelling are always evident for deep soft tissues of the back
False.
May not be evident because of thick soft tissue muscles
In chart notes, what do you write down when a patient is in the inflammatory phase of injury?
Acute ______itis
Ie. Acute myofasicalitis
When there is inflammation, what is the suffix?
“itis”
If not inflammed, then it’s “osis”
Goals of therapy when patient is in the inflammatory phase of injury repair
Limit inflammatory exudates
Decrease pain
Decrease muscle spasm
Promote pain-free mobility
What therapies may be used when patient is in the inflammatory phase of injury repair?
Immobilization
Mobilization
Gentle manipulation in pain-free direction
Anti-inflammatory agents and analgesics
Ice (=vasoconstriction, decrease swelling)
Electrical modalities
Home stretching/mobilization
What is the second phase of an injury?
Repair phase
How long does the repair phase last?
6 weeks
What is happening in the repair phase of injury repair?
Consolidation, organization and fibrosis (collagen deposition)
Scar formation
Significant tissue vulnerability persists in early stages
What are the signs of the repair phase?
Pain
Joint restrictions
Adhesions
What diagnostic terms could be used in the repair phase? ie. What would you write in your charts
Sub- or post-acute sprain, strain, etc
Joint dysfunction
Subluxation syndrom
What are the goals of therapy when in the repair phase?
Minimize intra-articular adhesions
Promote normal joint motion
Promote normal tissue flexibility
Normalize proprioception
What treatments/therapies might you use for someone in the repair phase?
Mobilization Manipulation Active motion Cross-fiber friction Electrical modalities Proprioceptive retraining
What is the final phase of injury recovery?
Remodeling phase
How long can the remodeling phase of injury repair last?
Months to years
What are the characteristics of the remodeling phase?
Remodeling of tissue in response to function demands
Limited depend on the degree of injury
What are the signs of patients in the remodeling phase?
Altered soft tissue texture/flexibility
Joint restrictions
Pain
Hypermobility/instability
Diagnostic terms for remodeling phase?
Chronic sprain, strain, etc
Joint dysfunction
Subluxation syndrome
“Osis”
“osis”
Not inflammed
Ie tennis elbow is called lateral epicondralisis when inflamed, however when it is NOT inflammed you call it: lateral epicondralosis
Goals of therapy for patient in remodeling phase
Reduce pain
Promote normal joint mobility
Promote proper stress lines for collagen fiber alignment
Normalize proprioception
What therapies do you use for the remodeling phase?
Manipulation Mobilization Rehabilitation/exercises Cross-fiber friction Proprioceptive retraining
What is it called when the fibrous cap of the meniscoid (or interpophysary meniscus or capsular infolding) is drawn in between the articular surfaces?
Meniscoid entrapment
What is the theory about interapophysary meniscus (capsular infolding)?
It’s drawn in between the articular surfaces and trapped by them
If interapophysary meniscus (capsular infolding) is prolonged and left untreated, the articular cartilage may
Reshape around the meniscoid, encarcerating it within the joint
Meniscoid entrapment vs extrapment
Entrapment is inside, extrapment is outside.
The adjustment is the same
Fissuring of the annulus and migration of nuclear fragments into posterior fissures
Interdiscal block
Structural degenerative alteration in osseous articular structures
Osteoarthrosis (DJD — degenerative joint disease)
What is the joint called when there is increased segmental mobility and normal coupling patterns that is stable under normal loading?
Join hypermobility
What is the joint called when there is increased segmental mobility resulting from degenerative changes or acute trauma to articular soft tissues? (Abnormal patterns of movements and coupling.)
Clinical joint instability
T/F there is evidence that subluxation can result in nerve root or spinal cord compression
False
Motion segment subluxations narrowing the IVF leading to altered vascular dynamics within the IVF and nerve root ischemia and dysfunction is called
Indirect compression
The reflex hypothesis that persistent altered proprioceptive and/or nociceptive input leading to sensitization of neuron pools is called what
CNS reflexes
Mechanical joint derangement or joint immobilization inducing segmental tissue damage and liberation of inflammatory agents is what
The theory of the dysfunction induced inflammatory reaction
Tearing or stretching of the muscle leading to
protective splinting and joint dysfunction
Injury and spasm
Mechanical or inflammatory stimulation of articular
structures leading to reflex segmental muscle splinting
Reflex muscle spasm
Injury or immobilization leading to fibrosis and
decreased flexibility in articular soft tissues
Soft tissue fibrosis
What is an inter articulate adhesion?
Fibrotic invasion and adhesions between articular surfaces
The hypothesis that the motion segment subluxation narrows the IVF leading to direct
compression of the nerve root and therefor its function
Direct bony compression (this is a debated hypothesis)
What is the theory of a subluxation complicated with associated joint pathologies?
The nerve root is more prone to compression in this situation
(i) Disc herniation
(ii) Degenerative joint and disc disease
(iii) Joint injury with capsular swelling
What is the theory of a uncomplicated subluxation?
the nerve root is anatomically not vulnerable to compression
The reflex hypothesis that Altered spinal mechanics leading to direct irritation of sympathetic chain
Mechanical irritation of sympathetic ganglion
The reflex hypothesis that Altered spinal mechanics, especially cervical or pelvic, leading to traction and tethering of cranial nerves as they exit through dura or skull foramina
Mechanical irritation of parasympathetics
Clinical signs of neurologic dysfunction
(1) Pain (2) Altered temperature regulation (3) Muscle splinting (4) Analgesia (5) Hypesthesia (6) Paresthesias (7) Hyperesthesia (8) Altered somatic and/or visceral function
What are the pathological divisions of the vertebral subluxation complex (VSC)?
Mechanical
Neurobiologic
Inflammatory vascular
What is another term for vertebral subluxation complex?
Joint dysfunction
Manipulations that _____ the joint surfaces may liberate the entrapped meniscoid?
Distract
What motion would create right gapping?
Left lateral flexion and right rotation
What motion would create left gapping?
Right lateral flexion and left rotation
Manipulations that ____ the joint surfaces may encourage the extraped meniscoid to resented the joint cavity.
distract
Giles concluded that the nerve root was anatomically vulnerable because he made measurements in what zone?
Interpedicular zone
Crelin concluded that the nerve root is anatomically not vulnerable because he made measurements where?
At the lateral borders of the IVF
What is an uncomplicated subluxation?
Subluxation with no associated pathologies
What is a complicated subluxation?
A subluxation with associated joint pathologies, making the nerve root more prone to compression
