W7 Flashcards
What is referred pain?
Pain perceived in a region topographically displaced from the region of the source of the pain
Convergence projection mechanism of referred pain
Occurs when afferent neurons form different parts of the body converge at a common neuron. Pain may be experienced in any of these other parts of the body innervated by the other neurons.
What are the timeframes for classification of spinal disorders?
Acute: <6 weeks
Subacute: 6-12 weeks
Chronic: >12 weeks
What are the three main things to consider when assessing spinal pain?
- Red flag disorders
- Specific spinal pain
- Non-specific spinal pain
What are some red flag disorders of spinal pain?
- Cancer
- Inflammatory disorders
- Infections
- Fractures
- Visceral pathology
What constitutes as specific spinal pain?
Pain occurring from clear spinal pathology, where imaging correlates with presentation
- Disc pathology
- Radiculopathy
- Facet Jt pathology
- Stenosis
- Spondylosis
- Spondylolisthesis
What constitutes as non-specific spinal pain?
Pain with no clear patho-anatomical diagnoses. Base assessment on elimination of specific pathology and red flag disorders. May have nociplastic involvement.
What are some features of non-specific spinal pain with non-mechanical/nociplastic symptoms?
- Lack of clear and consistent anatomical source
- Constant pain
- Spontaneous pain with no clear aggs
- Disproportionate pain
- Potential psycho-social/lifestyle contributing factors
What are some features of non-specific spinal pain with mechanical symptoms?
- Clear and consistent anatomical focus
- Proportionate mechanical behavior
- Potential maladaptive beliefs and behaviors as contributing factors
What are the goals of a physical examination of the spine?
- Identify relevant impairments
- Identify source of symptoms
- Identify main pain type
- Identify contributing factors
- Identify main problems
- Confirm or refute hypothesis
When to complete segmental neurological assessment
- Pins and needles
- Numbness
- Weakness
- Pain distribution or nature consistent with neural compromise
What is the likely pathobiology in spinal pain?
- Inflammation
- Acute trauma
- Post surgery
- Ligament damage
- Muscle damage
- Nerve damage
What are the components of muscle system assessment in the spine?
- Length
- Strength
- Endurance
- Control
- Timing
What are the components of the manual examination in the spine?
- PAIVMs
- PPIVMs
- AROM (add overpressure if no pain)
- Neurosegmental examinations
- Neurodynamics
- Special tests
What are the indications for imaging of spinal pain?
- Significant trauma
- Elderly
- Red flags
- Recurrent/persistent problems
- When findings will likely change or influence management
Where to palpate for Multifidus
Most medial muscle of spine (just lateral to SPs)
What other bony landmark indicates L5
Height at posterior iliac crest
Where to palpate quadratus lumborum
From iliac crest towards L1 TP
What other bony landmark indicates T3
Spine of scapula
What other bony landmark indicates T7
Inferior border of scapula
Procedure for PAIVM of central PA L5-S1 vertebra
On SPs, using C-grip, apply pressure with pisiform
Procedure for PAIVM of unilateral L1-L5 facet joints
Sightly medial to erector spinae, push it out of the way with thumbs, apply PA with thumbs
Procedure for PAIVM of central PA T3-T7 vertbera
Use thumbs on SPs
Procedure for PAIVM of unilateral T3-T7 facet joints
1 finger width away from SP, move erector spinae out of way, apply PA force with thumbs
