week 2 joint conditions Flashcards
1
Q
axial neck pain is described as…
A
pain felt in the neck that doesn’t radiate
2
Q
common causes of axial neck pain are…
A
degenerative, traumatic, malignant, infections, systemic inflammatory processes, and smoking
3
Q
the most supporting data link to… as the origin of axial neck pain
A
zygoapophyseal joints and cervical discs
4
Q
mechanical lower back pain is described as…
A
a symptom complex
5
Q
common causes of mechanical lower back pain are…
A
repetitive trauma and overuse
6
Q
mechanical lower back pain comes from…
A
spine, discs, or soft tissue
7
Q
when is mechanical lower back pain worse during the day
A
morning
8
Q
does it worsen over the day
A
yes
9
Q
physical exam findings for lower back pain…
A
- reduction in ROM
- tight hamstrings
- muscle spasms
- trigger point tenderness
- inc. or symptoms in flex. or extension
10
Q
What type of pain is associated with posterior cervical pain due to involvement of the posterior elements of the cervical spine?
A
Posterior cervical pain is secondary to involvement of the facet joints.
11
Q
True or False: Facet joints, when involved in posterior cervical pain, cause sclerogenic pain referral at this stage.
A
False. Facets may be fixated or inflamed but do not cause sclerogenic pain referral at this stage.
12
Q
What are some associated symptoms in a patient with posterior cervical pain related to facet joint involvement?
A
The patient may have associated headaches and muscle spasms.
13
Q
True or False: Fixation or inflammation of the cervical facet joints will always cause sclerogenic pain referral.
A
False. At this stage, fixation or inflammation does not cause sclerogenic pain referral.
14
Q
Where is cervical facet pain located?
A
The pain is located over the posterior cervical spine, which can be either uni or bilateral, depending on the involved facets.
15
Q
True or False: cervical facet pain always comes on suddenly after trauma.
A
False. The onset can be insidious after repetitive biomechanical stress or acute after trauma, like whiplash.
16
Q
What postures or actions provoke cervical facet pain?
A
Sustained postures and repetitive cervical extension can provoke the pain.
17
Q
True or False: Lateral bending and flexing the neck away from the involved facet joint can alleviate cervical facet pain
A
true
18
Q
What quality of pain is typically felt in cervical facet pain?
A
The pain is dull and achy at first, becoming sharp with motion.
19
Q
True or False: cervical facet pain issues often radiates to other areas of the body.
A
False. There is no radiation or referral for facet pain.
20
Q
How severe is cervical facet pain?
A
mild to moderate (1-3 or 4-7)
21
Q
When does cervical facet pain typically occur?
A
The pain is intermittent, coming on only when the joint is stressed.
22
Q
What is a hallmark cause of cervical facet pain?
A
Repetitive stress, especially from hyperextension activities
23
Q
True or False: Cervical facet pain involves sclerotomal pain referral.
A
False. Cervical facet pain does not involve sclerotomal pain referral.
24
Q
How does movement affect cervical facet pain?
A
Movement generally makes cervical facet pain better.
25
True or False: Cervical facet pain is often accompanied by neurological symptoms.
False. There are no neurological symptoms associated with cervical facet pain.
26
How does extending the neck affect cervical facet pain?
Symptoms of cervical facet pain are increased with neck extension.
27
True or False: Cervical facet pain does not respond to chiropractic adjustments.
False. Cervical facet pain responds very well to chiropractic adjustments.
28
What may be observed during the inspection of a patient with cervical facet pain?
Anterior head carriage or signs of poor posture, and the patient may appear distressed or guarded depending on the chronicity.
29
true or false: Palpation of the involved area in cervical facet pain will show increased joint play (JP) and no signs of subluxation.
False. Palpation will reveal decreased joint play (JP) and signs of subluxation over the involved areas.
30
What muscle characteristics might be found during palpation in patients with cervical facet pain?
Hypertonicity in local and postural muscles, especially if posture is poor.
31
True or False: Increased heat and edema are not typically found in the area of complaint for cervical facet pain.
False. There may be increased heat and possibly edema in the area of complaint.
32
Are special instruments required for diagnosing cervical facet pain?
No, instrumentation is not typically needed, but chiropractic scans may show signs of subluxation.
33
What would you expect to find during range of motion (ROM) testing in a patient with cervical facet pain
Full ROM, but pain is expected on extension, and if chronic, lateral flexion to the affected side will be painful.
34
best orthopaedic tests for cervical facet pain
- cervical distraction
- cervical foraminal compression
- Jackson's
- max. cervical compresion
- modified spurling's
- shoulder depression
35
what abnormalities are shown in a neurological exam for cervical facet pain
NONE (dermatomes, myotomes, dtrs, cerebellum, cranial nerves)
36
Any extra tests for cervical facet pain?
- None
- if x-rays are taken, postural changes could be expected and degeneration due to age or chronicity of condition
37
chiropractic management for cervical facet pain?
- adjustments but be wary of certain positions that make the patient uncomfortable (e.g extension)
- educate patient on poor posture
- refer for erognomic assessment
- physio/massage for muscle work
38
prognosis for cervical facet pain
- condition improves in 2 weeks after care
- if unresponsive then consider new DDX
39
What percentage of the axial load is carried by the lumbar facet joints in a normal, intact disc?
Lumbar facet joints carry 20-25% of the axial load with a normal, intact disc.
40
True or False: Lumbar facet pain is primarily caused by a traumatic injury, not repetitive overuse.
False. Lumbar facet pain is usually secondary to repetitive overuse and microtrauma.
41
What types of injuries or conditions can lead to lumbar facet pain?
can follow a spinal strain, torsional mechanisms of injury, or degeneration due to conditions like DDD (degenerative disc disease) or aging of the skeletal system.
42
True or False: The prevalence of facetogenic pain decreases with age.
False. The prevalence of facetogenic pain tends to increase with age.
43
what innervates the facet
medial branch of the post. rami of the spinal nerve at the same level and the level above
44
Where is the pain located in lumbar facet pain?
The pain is localized over the irritated facets, which can be on one side or both.
45
True or False: The onset of lumbar facet pain is always gradual and non-traumatic.
False. Lumbar facet pain can have a sudden onset from hyperextension (acute traumatic) or occur after cumulative hyperextension stress (chronic).
46
What movement provokes lumbar facet pain?
Extension of the spine provokes lumbar facet pain.
47
True or False: Movement and exercise do not alleviate lumbar facet pain.
False. Movement and exercise can help alleviate lumbar facet pain.
48
What type of pain quality is commonly felt in lumbar facet pain?
The pain is sharp and pinpoint, localized over the involved facet.
49
True or False: Lumbar facet pain usually radiates to other areas of the body
true. buttock, post thigh and past the knee
50
How severe is lumbar facet pain?
The severity of lumbar facet pain varies depending on the patient's pain perception
51
When does lumbar facet pain tend to feel better?
The pain often feels better when the patient is active, depending on the activity.
52
What might be observed during the inspection of a patient with lumbar facet pain?
The patient may be guarded if pain levels are high and may have an anterior pelvic tilt with posterior weight-bearing.
53
What muscles may be tight if there is an anterior pelvic tilt in lumbar facet pain?
Tight erector spinae and hip flexors.
54
What are common palpation findings over the involved area in lumbar facet pain?
Heat, edema, and bogginess.
55
What is typically found during lumbar spine joint play assessment in lumbar facet pain?
decreased joint play
56
True or False: Percussion and instrumentation are very effective tools for diagnosing lumbar facet pain.
A: False. They are not hugely helpful.
57
How does range of motion typically respond in individuals with lumbar facet pain?
ROM may be within normal ranges, but pain will be induced or exacerbated in extension and relieved with flexion.
58
what are the best orthopaedic tests for lumbar facet pain
* Standing Kemp’s +ve for local pain over actively inflamed facets
* Seated Kemp’s –ve but incidental pain at the level of facets involved
* Stork’s +ve for local pain or inability to perform
59
What is the typical sensory finding in a neurological exam for lumbar facet pain?
Normal sensory findings.
60
How are the myotomes graded in a neurological exam for lumbar facet pain?
Graded 5/5
61
What is the typical grade for deep tendon reflexes (DTR) in a neurological exam?
Graded 2+.
62
How is the cerebellum typically assessed in a neurological exam?
Normal cerebellum function
63
What is the usual finding for cranial nerves (CN’s) in a neurological exam for lumbar facet pain?
Normal cranial nerves.
64
What may an X-ray reveal in terms of the sacral base angle in lumbar facet pain?
An increased sacral base angle and posterior weight-bearing.
65
What conditions might X-rays show in the lumbar spine related to facet pain?
Facet arthrosis or degenerative disc disease.
66
What is the primary chiropractic intervention for lumbar facet pain?
Adjust! Any technique is fine.
67
How many chiropractic adjustments should it typically take to resolve lumbar facet pain?
3-5 adjustments.
68
What should be avoided during chiropractic adjustments for lumbar facet pain?
Hyperextension in the set-up
69
What activity should the patient avoid to prevent aggravating lumbar facet pain?
Hyperextension activities.
70
What type of exercises should be included in the chiropractic management for lumbar facet pain?
Pelvic tilt exercises
71
What dietary approach can help manage lumbar facet pain?
An anti-inflammatory diet/supplements
72
What is important to maintain in daily activities to support lumbar facet pain recovery?
Proper posture and exercise warm-down
73
What is the typical prognosis for lumbar facet pain?
The condition should improve within 2 weeks.
74
What type of pain is characteristic of cervical facet syndrome?
Posterior cervical pain secondary to involvement of the posterior elements of the cervical spine (facet joints).
75
What happens to the facet joints in cervical facet syndrome?
The facets become fixated and inflamed.
76
What additional symptoms might be associated with cervical facet syndrome?
Headaches and muscle spasm.
77
Which cervical levels are often involved in cervical facet syndrome?
Often C2/C3 and C5/C6.
78
What type of pain referral is seen in cervical facet syndrome?
Sclerotomal pain referral
79
What other professional referral may be needed for cervical facet syndrome?
Refer out for an ergonomic assessment.
80
What is the expected prognosis for cervical facet syndrome?
The condition should improve within 2 weeks.
81
What are common risk factors for lumbar facet syndrome?
* Repetitive lifting and bending
* High impact activities
* Hyperlordosis
* History of degeneration
* Sedentary lifestyle
82
What muscle findings might be observed during palpation in lumbar facet syndrome?
Tight erector spinae and hip flexors if there is an anterior pelvic tilt, and other hypertonic muscles surrounding the involved facets
83
What may X-rays reveal regarding the sacral base angle in lumbar facet syndrome?
An increased sacral base angle and posterior weight-bearing
84
What conditions might X-rays show in the lumbar spine related to lumbar facet syndrome?
Facet arthrosis and degenerative disc disease.
85
Where is the pain typically located in SI Joint Syndrome?
Pain is over the posterior aspect of one SI joint and into the buttock. The non-painful SI joint may be locked.
86
What is the typical onset of SI Joint Syndrome?
It usually occurs after lifting something and straightening up from a stooped posture.
87
What activity may provoke SI Joint Syndrome?
Over-adjusting can provoke pain in SI Joint Syndrome
88
What positions tend to relieve pain in SI Joint Syndrome?
Sitting or lying down can be palliative for SI Joint Syndrome pain.
89
How would you describe the quality of pain in SI Joint Syndrome?
The pain is typically a dull ache, but it can also be sharp, stabbing, or knife-like if the SI joint is sprained
90
Where can the pain radiate in SI Joint Syndrome?
It can cause burning pain into the groin, hip, posterior thigh, or even the calf. Numbness or tingling, if present, will be non-dermatomal
91
How severe can the muscle spasms be in SI Joint Syndrome?
Muscle spasm associated with the hypermobile side can be severe
92
How does the timing of muscle spasms present in SI Joint Syndrome?
Muscle spasms can be constant due to the body's perceived hypermobility and the desire to stabilize the joint.
93
What might be seen during inspection of SI Joint Syndrome?
Foot flare due to piriformis spasm, distress from pain, and altered gait due to pain or tight hamstrings.
94
What findings are typically observed during palpation of SI Joint Syndrome?
One SI joint is locked, and the opposite joint is acutely tender and hypermobile. Piriformis tightness on the painful side, along with heat, edema, hypertonicity, and tenderness over surrounding muscles. Signs of subluxation may also be present
95
Is instrumentation needed for SI Joint Syndrome?
No, instrumentation is not needed.
96
How does range of motion (ROM) present in SI Joint Syndrome?
ROM is reduced in any direction that stretches the involved SI joint, including flexion, extension, lateral flexion (LF) away, and rotation away from the painful side.
97
Which orthopedic tests may be positive in SI Joint Syndrome?
- Nachlas, Belt, Goldthwait’s, Fabere’s: Positive for pain at the hypermobile SI joint.
- Hibb’s: Positive for pelvic pain and possibly hip pain.
- Pace and Freiberg: May be positive on the side of piriformis involvement.
98
What is an important rule regarding adjustments in SI Joint Syndrome?
Don't repeat adjustments on a moving joint!
99
What should be checked in the kinetic chain when managing SI Joint Syndrome?
Check the hip
100
Prognosis for lumbar facet syndrome
Most patients respond extremely well to conservative care,
particularly through adjustments
101
What type of disorder is Ehlers-Danlos Syndrome?
Ehlers-Danlos Syndrome is a hereditary collagen disorder
102
What are the key characteristics of Ehlers-Danlos Syndrome?
Hypermobility, dermal hyperelasticity, and widespread tissue fragility.
103
What are the most common types of Ehlers-Danlos Syndrome?
Hypermobile, classic, and vascular types
104
What are the most common symptoms of Ehlers-Danlos Syndrome?
Hypermobile joints, abnormal scar formation and wound healing, fragile vessels, and velvety, hyperextensible skin.
105
Which physical conditions are commonly associated with Ehlers-Danlos Syndrome?
Kyphoscoliosis (25%), thoracic deformity (20%), and pes planus (90%)
106
How is Ehlers-Danlos Syndrome diagnosed?
Diagnosis is clinical and confirmed by genetic testing.
107
radiograph findings
* Small soft tissue calcifications
* Hemarthrosis (especially knees)
* Recurrent dislocation
* Khyphoscoliosis
* Spondylolisthesis
* Arachnodactyly
* Premature degenerative disease
108
What should be considered when performing joint play and motion palpation for a patient with Ehlers-Danlos Syndrome?
Be aware of hypermobility and skin slack when taking tissue pulls
109
What type of chiropractic technique is more suitable for patients with excessive joint mobility and skin fragility?
A low force technique is more suitable
110
What additional consideration should be kept in mind when managing patients with Ehlers-Danlos Syndrome?
Be aware of gastrointestinal (GI) discomfort.
