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Outpatient Rehabilitation Quiz > W1: MC > Flashcards

W1: MC Flashcards

1
Q

What is a red flag? What must be done immediately?

A

Sign and symptom of serious pathology
(Early detection is essential! Immediate referral!)

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2
Q

What is a yellow flag?

A

Indicators of psychological, social, and environmental factors that may influence the patient’s recovery and prognosis eg anxiety, depression, fear of movement

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3
Q

What is an orange flag?

A

Indicators of serious psychiatric conditions that require immediate attention.

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4
Q

What is a blue flag?

A

Indicators related to the patient’s perceptions of their work and occupational factors

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5
Q

What is a black flag

A

Indicators related to socio-occupational factors and system or contextual obstacles.

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6
Q

General characteristics of a red flag?

A
  • Severe and/or progressive symptoms
  • Non mechanical pain
  • Night pain or pain at rest
  • Systemic symptoms eg fever/weight loss
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7
Q

Provide examples of red flags and their incidence?

A

Cancer (0-5%)
Infection (0.01-1.2% for spinal infection)
Fracture (0.7-10%)
Cauda equina syndrome (0.002-0.4%)

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8
Q

What are the risk factors/signs for cancer?

A

Unexplained weight loss
History of cancer
Age over 50
Pain that is unrelenting and worse at night

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9
Q

What are the risk factors/signs for infection?

A

Fever
Recent bacterial infection
IV drug use
Immune suppression

FRII (Red flags for infection - RI)

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10
Q

What are the risk factors/signs for a fracture?

A

History of trauma or fracture
Osteoporosis
Prolonged corticosteroid use
Presence of contusion or abrasion
Age >50
Severe, localised pain

HOP PAS

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11
Q

What are the risk factors/signs for cauda equina syndrome?

A

Severe low back pain
Saddle anesthesia
Bladder or bowel dysfunction
Bilteral leg pain and weakness
Neurological deficits eg loss of sensation in the perineal area or reduced reflexes in the legs

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12
Q

True or false is a single characteristic alone sufficient to diagnose a serious condition

A

False - generally multiple red flags will indicate a serious condition eg severe back pain accompanied by fever and a recent bacterial infection might strongly suggest an infection

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13
Q

Downie 2013 - Diagnostic accuracy of red flags in a fracture. What are the red flags and their percentages in relation to diagnostic accuracy?

A

Older age: 2-7% in primary care
Prolonged corticosteroid use: 33%
Severe trauma: 11%
Presence of contusion or abrasion: 62%

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14
Q

Downie 2013 - Diagnostic accuracy of red flags in a malignancy. What are the red flags and their percentages in relation to diagnostic accuracy?

A

History: 7%
Older age: below 3%
Unexplained weight loss: below 3%
Failure to improve symptoms (1 month) below 3%

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15
Q

Article: Most red flags for malignancy in low back pain guidelines lack empirical support: A systematic review

  • A “…… ….. …..” and “….. …… …..” are the only red flags with empirical evidence of acceptable high diagnostic accuracy.
A

A “history of malignancy” and “strong clinical suspicion” are the only red flags with empirical evidence of acceptable high diagnostic accuracy.

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16
Q

Article: Red flags to screen for vertebral fracture in patients presenting with low-back pain (Review)

True or False: The available evidence does not support the use of many red flags to specifically screen for vertebral fracture in patients presenting for LBP.

A

True

  • Most red flags have poor diagnostic accuracy as indicated by imprecise estimates of likelihood ratios.
  • When combinations of red flags were used the performance appeared to improve.
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17
Q

Structure of the intervertebral disc - two key features?

A

Annulus fibrosus (outside) & Nucelus pulposus (inside)

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18
Q

Annulus fibrosus:
- Description
- Composition
- Function

A
  • Description: The outer layer of the intervertebral disc
  • Composition: Made up of tough, fibrous ring of collagen
  • Function: provides strength and flexibility, allowing for movement and weight-bearing
19
Q

Nucleus pulposus
- Description
- Composition
- Function

A
  • Description: the inner core of the intervertebral disc
  • Composition: gelatinous material rich in water and proteoglycans
  • Function: acts as a shock absorber, distributing pressure evenly across the disc
20
Q

Each vertebra has how many facet joints? What movement do they allow?

A

Two: one pair facing upwards (superior) and one pair facing downwards (inferior)

Allows bending, twisting & extension movements

21
Q

Thoracic pain
- Accounts for ~…% of all spinal pain cases
- …..% of chest pains are caused by MSK disorders
- more common in ….., ….. and …..
- Risk factors include:

A
  • 15-20%
  • 10-50%
  • Middle age & older as well as children/adolescents
  • Sedentary lifestyle, limited neck ROM, previous cervicothoracic pain, emotional factors, underlying medical condition eg osteoporosis/scoliosis and poor posture
22
Q

Muscle strain: signs and symptoms

A
  • Localised pain and tenderness in the thoracic muscles.
  • Stiffness and limited range of motion.
  • Pain exacerbated by movement or touch (always function-related).
  • Imaging usually not required unless trauma is suspected.
23
Q

Facet joint dysfunction signs and symptoms (degeneration or injury to the facet joints)

A
  • Localised pain often described as aching or sharp.
  • Pain worsened by twisting or bending movements.
  • Possible referred pain to the shoulder or abdomen.
24
Q

Herniated thoracic disc signs and symptoms. Briefly describe what it is?

A
  • Radicular pain radiating around the chest or abdomen is common.
  • Numbness, tingling, or weakness in the affected dermatomes if radiating pain.
  • Severe cases may involve myelopathy.
  • MRI to confirm disc herniation and assess nerve compression. But unlikely to change treatment options.

What is it: a serious but treatable spinal condition in which the soft center of a thoracic intervertebral disc (the nucleus pulposus) pushes through a tear in the tough outer layer of the disc (the annulus fibrosus) - this can compress the nerve or spinal cord.

25
Q

Osteoporosis and vertebral fracture
- Due to?
- Signs & symptoms?

A

Due to:
* Age-related bone density loss.
* Prolonged corticosteroid use.

Signs and symptoms:
* Sudden onset of severe pain. Worsen with activities and improve with rest.
* Localised tenderness and possible deformity. Pain upon palpation of the affected vertebrae.
* Height loss, reduced ROM and kyphotic posture.
* X-rays to identify fractures.
* DEXA scan to assess bone density.

26
Q

Thoracic outlet syndrome
- What is it?
- Signs and symptoms

A

What is it?
* Compression of neurovascular structures in the thoracic outlet.
* Congenital anomalies, trauma, or repetitive activities.

Signs and symptoms
* Pain, numbness, and tingling in the arm and hand.
* Weakness and swelling in the affected limb.
* Symptoms worsen with overhead activities.
* Positive Adson’s test.

27
Q

Referred pain from visceral organs (not to be missed!)
- Signs and symptoms

A

Signs and Symptoms:
* Pain radiating to the thoracic spine.
* Associated systemic symptoms (e.g., fever, shortness of breath).
* Pain may vary with meals or respiratory movements.
* Require appropriate diagnosis.

28
Q

Thoracic pain conditions (summary of onset)
- Muscle strain
- Facet joint dysfunction
- Herniated thoracic disc
- Osteoporosis and fractures
- Thoracic outlet syndrome

A
  • Muscle strain: sudden, often after specific activity or injury
  • Facet joint dysfunction: gradual or sudden, often associated with repetitive movements or poor posture
  • Herniated thoracic disc: gradual or sudden often after a specific movement or trauma
  • Osteoporosis and fractures: sudden often after minor trauma or spontaneous in severe osteoporosis
  • Thoracic outlet syndrome: gradual worsens with repetitive overhead activities
29
Q

Thoracic pain conditions (summary of signs and symptoms)

A
  • Muscle strain: localised pain and tenderness with no movement, no neurological deficits
  • Facet joint dysfunction: localised sharp or aching pain in the facet joints, worsened by twisting or bending, no neurological deficits
  • Herniated thoracic disc: radicular pain around chest or abdomen, numbness, tingling, weakness, confirmed by MRI
  • Osteoporosis and fracture: pain that worsens with activities and upon palpation of the affected vertebrae. Limited ROM, and improve with rest
  • Thoracic outlet syndrome; pain, numbness, tingling in arm and hand, worsened by overhead activities, positive Adson’s test
30
Q

Thoracic pain outcome measures

A
  • NRS or VAS
  • Patient specific functional scale
  • Roland-morris disability questionnaire or Oswestry Disability index
  • Quality of life
31
Q

Active movements of the thoracic spine: forward flexion –> degrees?

A

20 to 45

32
Q

Active movements of the thoracic spine: Extension –> degrees?

A

25 to 45

33
Q

Active movements of the thoracic spine: Side flexion –> degrees?

A

20 to 40

34
Q

Active movements of the thoracic spine: Rotation –> degrees?

A

35 to 50

35
Q

Active movements of the thoracic spine: Costovertebral expansion –> degrees?

A

3 to 7.5cm

36
Q

Active movements of the thoracic spine: Rib motion

A

Pump handle: during inspiration the upper ribs move up & outward to increase anterior-posterior diamater of the chest chavity (increase expansion)

Bucket handle: during inspiration the lower ribs move up and out to the side to increase lateral diameter of the chest cavity

Caliper

37
Q

Article: Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review

There is a moderate level of evidence of … ……. difference in thoracic kyphosis between groups with and without shoulder pain.

A

No significant

38
Q

Muscle strain: AROM & PROM response

A

AROM: Pain with movements that contract the affected muscle eg lifting, pushing, bending, reaching

PROM: pain with passive movements that stretch the affected muscle eg passive bending, reaching

39
Q

Facet joint dysfunction: AROM & PROM response

A

AROM: pain with movements that load or stress the facet joints (eg extension, rotation, lateral flexion)

PROM: pain with passive movements that stress the facet joints especially with overpressure (extension & rotation)

40
Q

Facet joint dysfunction: MMT & PAM response

A

MMT: pain may not be as pronounced during isolated muscle strength tests unless they involve significant spinal extension or rotation

PAM: pain is typically elicited during PAMs that stress the facet joint such as joint play tests involving extension and rotation

41
Q

Muscle strain: MMT & PAM response

A

MMT: Pain is typically felt during muscle strength tests that contract the affected muscle such as resisted movements (eg lifting, pushing)

PAM: pain is usually not elicited during PAMs unless the movement indirectly stretches or compresses the affected muscle

42
Q

Article: Clinical reasoning framework for thoracic spine exercise prescription sport: A systematic review and narrative synthesis

Four main types of exercises?

A

Mobility
Strength
Work capacity
Motor control

43
Q

Findings for manual therapy

A

Not a long term solution
Useful for pain relief and mobility
No difference in effectiveness between thrust or non-thrust manipulation

Outpatient Rehabilitation Quiz (13 decks)

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