Week 3 Panopto Flashcards
Three characteristics of Angina
exercise
relieved by rest
chest pain
Can unstable angina occur without activity?
Yes
It can even occur when asleep
Atypical cardiac pain
Pain that is not associated with chest but may have other symptoms
What percent of MI in men and women go unrecognized?
Men - 26%; Women - 34%
Half had no symptoms and half had atypical presentation
What populations are more likely to have an atypical cardiac presentation?
Older patients, non-smokers, no previous history of angina
These patients had a mortality rate of 50% vs 18% in typical presentations
Presentations of MI in the elderly
1/3 have a classic presentation
1/3 present primarily with confusion and restlessness
1/3 combination of dyspnea, palpitations, and sweating
Intervention strategy
Ask for meds Call 911 Chew a 325 mb aspirin Monitor vitals Give O2 or CPR Alert PCP
Big 5 orthopedic tests
Cervical compression Cervical distraction Shoulder abduction Valsalva ULTT - Median nerve
Clinical deep referred pain in cases may present as
Pain present in an extremity but neuro tests are all largely negative
5 clues for nerve pain
pain distal to the joint, stabby, dermatomal, greater than neck Dermatomal paresthesia SMR changes Big 5 orthos Change in Sx with spinal loading
Possible pathoanatomical diagnosis for non-traumatic neck pain with no neuro findings
Facet syndrome (start)
Disc derangement (start)
Sprain
Strain
Cervical distraction should not increased pain in what Dx?
Disc derangement
Three common biomechanical Dx to look for
Joint dysfunction
Myofascial pain syndrome
Myospasm
What information should not be provided for a biomechanical diagnosis of cervical joint dysfunction?
Do not give level or listing
Do not give restriction
What are complicatiors?
Pre-existing non-painful findings
Key exam findings for facet syndrome
Tenderness over facet (palp)
Palpable local spasm (palp)
Joint restriction
Extension or compression may reproduce or worsen local pain
More than one of these
Pertinent negatives for facet syndrome
Radicular syndrome
Neuro deficits
Distal arm sx that are reproduced with orthopedic tests or tension tests
Treatment for facet syndrome
Manipulation
Activity/behavior modification (avoid extension)
STM on tight muscles
Isotonic for neck muscles
Clues for C8 radiculopathy
Weak finger flexors
Paresthesia to the pinkie
Three Most common causes of cervical radiculopathy
Osteophytes spurs
Soft disc herniations
Spinal Canal stenosis
B List for cervical radiculopathy (5)
Tumor infection NR adhesions Trauma to NR Structural Instability (trauma, inflammatory arthritis, degeneration)
TINTS
Clues that a disc may be injured
Flexion sensitivity pattern Positive Valsalva Aggravated by cervical compression Relieved by cervical distraction Midline tenderness (not facets)
Most common age for cervical disc herniations
40-60 years old
Most dependable clues for identifying a specific NR
Deficits and paresthesia
C8 radiculopathy LRs
Sensory loss of little finger (41.2)
Diminished triceps reflex (28.3)
Weak finger flexion (3.8)
Pure patches for C6, 7, 8
C6 - Thumb, LR 8.5
C7 - Poor LR
C8 - 41.8
Which of the Big 5 Orthos are more specific to NR/disc problems than sensitive?
Maximum cervical compression and lateral compression
Cervical distraction
Shoulder abduction
Valsalva
Which of the big 5 orthos are more sensitive for NR/disc problems than specific?
ULTT - median
What are the three best LRs for NR/disc in the big 5 orthos
LR +4.4 - Cervical distraction
LR +3.5 - Maximum cervical distraction
LR +3.5 - Valsalva
5 broad indications for taking a radiograph
Moderate to high load trauma Red flags for disease Cord signs/symptoms Radicular signs/symptoms Nonresponsive cases
Indications for MRI
LOW - signs/sx of radiculitis (medical necessity)
MED - only if there are deficits (doesn’t meet standard of care)
HIGH - only if there is suspicion of myelopathy, progressive [motor] deficit, non-response to care, presurgical exam (standard of care) - severe motor weakness on the first visit
Motions to perform with McKenzie protocol
Protrusion and retraction
Seated retraction with extension
mb any other direction
How long should you wait to start neuromobilization?
Usually a couple of weeks
Is McKenzie an immediate care approach?
Yes
Prognosis for conservative care of cervical disc herniations
Good for improvement in a few weeks
If not improved for 3 months refer for surgical consultation
Causes of pain paresthesia into the hand
Disc/NR
Lower brachial plexus injury
Ulnar nerve entrapment
MFTPs (lats, serratus, pecs)
Language for plexus, nerve, NR injuries
- plexitis
- neuritis
- neuropathy
What device can be used to associate MFTPs and hand symptoms using the armpit?
Thumb on pecs
Palm on SA
little fingers on latissimus dorsi
What device can be used to associate MFTPs and hand symptoms using the neck
Thumb on scalenes
Palm on supraspinatus
Fingers on infraspinatus
LR ratio for C6 radiculopathy
LR +14.2 - decreased biceps or brachioradialis reflex
LR +8.5 - sensory loss over the thumb
LR +2.3 - weak wrist extension
