VII. Done Pathophysiologic And Pathomechanical Components Of The Vertebral Subluxation Complex (VSC)

Question 1

T/F: Vertebral subluxation complex is a bone out of place with nerve compression

Answer 1

Nope, it is viewed as a complex theoretical phenomenon

Question 2

What are extra articular things that may cause joint restriction?

Answer 2

Injury and spasm
Reflex muscle spasm
Soft tissue fibrosis
Stages of injury and repair

Question 3

What is the main difference between Maigne hypothesis and Korr hypothesis?

Answer 3

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.

Question 4

What is the myofascial cycle idea

Answer 4

Once segmental muscles splinting is initiated it may become self perpetuating and, over time, may develop into muscle contracture

Question 5

The inflammatory phase of injury repair last for how long

Answer 5

2-4 days

May persist with re-injury or chronic stress

Question 6

What happens to tissues during the inflammatory phase of injury repair

Answer 6

Increased tissue permeability, so fibroblasts and macrophages and fibrinogen are doing their jobs.

Question 7

What are the signs of a patient being in the inflammatory phase of injury repair?

Answer 7

Redness
Heat
Swelling
Pain
Muscle splinting

Question 8

T/F. Redness, heat, swelling are always evident for deep soft tissues of the back

Answer 8

False.

May not be evident because of thick soft tissue muscles

Question 9

In chart notes, what do you write down when a patient is in the inflammatory phase of injury?

Answer 9

Acute ______itis

Ie. Acute myofasicalitis

Question 10

When there is inflammation, what is the suffix?

Answer 10

“itis”

If not inflammed, then it’s “osis”

Question 11

Goals of therapy when patient is in the inflammatory phase of injury repair

Answer 11

Limit inflammatory exudates
Decrease pain
Decrease muscle spasm
Promote pain-free mobility

Question 12

What therapies may be used when patient is in the inflammatory phase of injury repair?

Answer 12

Immobilization
Mobilization
Gentle manipulation in pain-free direction
Anti-inflammatory agents and analgesics
Ice (=vasoconstriction, decrease swelling)
Electrical modalities
Home stretching/mobilization

Question 13

What is the second phase of an injury?

Answer 13

Repair phase

Question 14

How long does the repair phase last?

Answer 14

6 weeks

Question 15

What is happening in the repair phase of injury repair?

Answer 15

Consolidation, organization and fibrosis (collagen deposition)
Scar formation
Significant tissue vulnerability persists in early stages

Question 16

What are the signs of the repair phase?

Answer 16

Pain
Joint restrictions
Adhesions

Question 17

What diagnostic terms could be used in the repair phase? ie. What would you write in your charts

Answer 17

Sub- or post-acute sprain, strain, etc
Joint dysfunction
Subluxation syndrom

Question 18

What are the goals of therapy when in the repair phase?

Answer 18

Minimize intra-articular adhesions
Promote normal joint motion
Promote normal tissue flexibility
Normalize proprioception

Question 19

What treatments/therapies might you use for someone in the repair phase?

Answer 19

Mobilization
Manipulation
Active motion
Cross-fiber friction
Electrical modalities
Proprioceptive retraining

Question 20

What is the final phase of injury recovery?

Answer 20

Remodeling phase

Question 21

How long can the remodeling phase of injury repair last?

Answer 21

Months to years

Question 22

What are the characteristics of the remodeling phase?

Answer 22

Remodeling of tissue in response to function demands

Limited depend on the degree of injury

Question 23

What are the signs of patients in the remodeling phase?

Answer 23

Altered soft tissue texture/flexibility
Joint restrictions
Pain
Hypermobility/instability

Question 24

Diagnostic terms for remodeling phase?

Answer 24

Chronic sprain, strain, etc
Joint dysfunction
Subluxation syndrome
“Osis”

Question 25

“osis”

Answer 25

Not inflammed Ie tennis elbow is called lateral epicondralisis when inflamed, however when it is NOT inflammed you call it: lateral epicondralosis

Question 26

Goals of therapy for patient in remodeling phase

Answer 26

Reduce pain Promote normal joint mobility Promote proper stress lines for collagen fiber alignment Normalize proprioception

Question 27

What therapies do you use for the remodeling phase?

Answer 27

``` Manipulation Mobilization Rehabilitation/exercises Cross-fiber friction Proprioceptive retraining ```

Question 28

What is it called when the fibrous cap of the meniscoid (or interpophysary meniscus or capsular infolding) is drawn in between the articular surfaces?

Answer 28

Meniscoid entrapment

Question 29

What is the theory about interapophysary meniscus (capsular infolding)?

Answer 29

It’s drawn in between the articular surfaces and trapped by them

Question 30

If interapophysary meniscus (capsular infolding) is prolonged and left untreated, the articular cartilage may

Answer 30

Reshape around the meniscoid, encarcerating it within the joint

Question 31

Meniscoid entrapment vs extrapment

Answer 31

Entrapment is inside, extrapment is outside. The adjustment is the same

Question 32

Fissuring of the annulus and migration of nuclear fragments into posterior fissures

Answer 32

Interdiscal block

Question 33

Structural degenerative alteration in osseous articular structures

Answer 33

Osteoarthrosis (DJD — degenerative joint disease)

Question 34

What is the joint called when there is increased segmental mobility and normal coupling patterns that is stable under normal loading?

Answer 34

Join hypermobility

Question 35

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.)

Answer 35

Clinical joint instability

Question 36

T/F there is evidence that subluxation can result in nerve root or spinal cord compression

Answer 36

False

Question 37

Motion segment subluxations narrowing the IVF leading to altered vascular dynamics within the IVF and nerve root ischemia and dysfunction is called

Answer 37

Indirect compression

Question 38

The reflex hypothesis that persistent altered proprioceptive and/or nociceptive input leading to sensitization of neuron pools is called what

Answer 38

CNS reflexes

Question 39

Mechanical joint derangement or joint immobilization inducing segmental tissue damage and liberation of inflammatory agents is what

Answer 39

The theory of the dysfunction induced inflammatory reaction

Question 40

Tearing or stretching of the muscle leading to | protective splinting and joint dysfunction

Answer 40

Injury and spasm

Question 41

Mechanical or inflammatory stimulation of articular | structures leading to reflex segmental muscle splinting

Answer 41

Reflex muscle spasm

Question 42

Injury or immobilization leading to fibrosis and | decreased flexibility in articular soft tissues

Answer 42

Soft tissue fibrosis

Question 43

What is an inter articulate adhesion?

Answer 43

Fibrotic invasion and adhesions between articular surfaces

Question 44

The hypothesis that the motion segment subluxation narrows the IVF leading to direct compression of the nerve root and therefor its function

Answer 44

Direct bony compression (this is a debated hypothesis)

Question 45

What is the theory of a subluxation complicated with associated joint pathologies?

Answer 45

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

Question 46

What is the theory of a uncomplicated subluxation?

Answer 46

the nerve root is anatomically not vulnerable to compression

Question 47

The reflex hypothesis that Altered spinal mechanics leading to direct irritation of sympathetic chain

Answer 47

Mechanical irritation of sympathetic ganglion

Question 48

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

Answer 48

Mechanical irritation of parasympathetics

Question 49

Clinical signs of neurologic dysfunction

Answer 49

(1) Pain (2) Altered temperature regulation (3) Muscle splinting (4) Analgesia (5) Hypesthesia (6) Paresthesias (7) Hyperesthesia (8) Altered somatic and/or visceral function

Question 50

What are the pathological divisions of the vertebral subluxation complex (VSC)?

Answer 50

Mechanical Neurobiologic Inflammatory vascular

Question 51

What is another term for vertebral subluxation complex?

Answer 51

Joint dysfunction

Question 52

Manipulations that _____ the joint surfaces may liberate the entrapped meniscoid?

Answer 52

Distract

Question 53

What motion would create right gapping?

Answer 53

Left lateral flexion and right rotation

Question 54

What motion would create left gapping?

Answer 54

Right lateral flexion and left rotation

Question 55

Manipulations that ____ the joint surfaces may encourage the extraped meniscoid to resented the joint cavity.

Answer 55

distract

Question 56

Giles concluded that the nerve root was anatomically vulnerable because he made measurements in what zone?

Answer 56

Interpedicular zone

Question 57

Crelin concluded that the nerve root is anatomically not vulnerable because he made measurements where?

Answer 57

At the lateral borders of the IVF

Question 58

What is an uncomplicated subluxation?

Answer 58

Subluxation with no associated pathologies

Question 59

What is a complicated subluxation?

Answer 59

A subluxation with associated joint pathologies, making the nerve root more prone to compression