Week 5 Study Qs Flashcards
What are the 5 components of the Neuropathic Screening Tool when applied to neck and arm
symptoms? What findings would support a cervical radicular syndrome?
- Pain (DISTRIBUTION can be dermatomal, peripheral nerve, general. QUALITY: sharp, stabbing, electric. ARM>NECK P. POSITIONS aggravate arm sx.)
- Paresthesia (numbness, dead, heavy, itchy, cold, pins and needles
- SMRs abnormalities
- Big 5 cervical orthopedic tests change arm Sx (cervical compression, distraction, ULTT-Median N, hyperabduction, valsalva)
- Spinal loading: any load on spine reproduces arm Sx immediately e.g. AROM, Soto hall (supine, pt place hand on sternum, doc stab. Thoracic spine through sternum and flex neck = brudzinski’s sign or Lhermitte’s sign), shoulder depression
What are the 5 components of the Neuropathic Screening Tool when applied to low back and
leg symptoms? What findings would support a lumbar radicular syndrome?
Pain (DISTRIBUTION, QUALITY, LEG>BACK P, POSTURES aggravate leg Sx, AGGRAVATED by hot, col, light pressure)
Paresthesia: numb, tingling, heavy, cold, pins and needles
SMRs
Nerve tension tests: SLR, bowstring, femoral nerve stretch test
Spinal loading: any lumbar spine loading create immediate leg P e.g. AROM in flexion, valsalva, kemps
Do any of the components above include pain centralization with repetitive/sustained end range
spinal and loading? Why or why not?
Yes. Directional preference is often found in the PE by performing repetitive/sustained loading (#5). This is to identify motions that improve symptoms, and result in increase of global ROM
What two ancillary tests can actually confirm that the nerves/nerve roots are damaged and not
functioning properly?
1- Nerve conduction study
2- Needle electromyelography (EMG)
What is the key distinguishing feature separating a radiculopathy from a radiculitis?
Radiculopathy = deficits
What are 4-5 key features about the pain in a neuropathic pain syndrome?
Distribution (dermatomal? peripheral n? general?)
Quality
Limb P>Spine P
Limb P affected by loading/spine position
Aggravated by hot/cold/light pressure
What are the various pathoanatomical causes of radicular syndromes?
Herniated disc
Spinal stenosis
Spurring in IVF (MC in cervical, LC lumbar)
SOL
NR adhesions
Instability (structural)
Fx
Infection
Traction injury/compression injury (cervical only)
Spondylolisthesis (lumbar spine, if unstable)
What is the effect of a radicular pain syndrome relative to prognosis?
Affect on prognosis varies based on cause (Dx), but generally a more serious case often with slower response to conservative Tx. Prognosis is worse if there are complicating features such as ligamentous instability or stenosis.
What are the (4) key features of a myofascial pain syndrome?
1-Palpable nodule
2-W/i taut band of muscle
3-Reproduces CC P
4-May reproduce referred P pattern
What are some of the other supporting clues for a myofascial pain syndrome?
Twitch sign
Short, tight mm
Advanced testing procedures: thermography
What does the presence of muscle fasciculations suggest?
LMN lesion
Fibrillation suggest UMN lesion
Do patients suspected of having a lumbar disc herniation require an MRI if they present with
loss of sensation or absent deep tendon reflexes?
Not necessarily. There are 3 reasons to MRI a lumbar disc herniation patient, and reflexes aren’t one of those. Progressive motor loss or significant motor loss grade 3 or worse are 2 reasons to MRI a lumbar disc herniation patient.
What circumstances should trigger an MRI in
suspected lumbar disc herniation patients? (3)
- CES
- Progressive motor loss under care
- Sig motor loss grade 3 or worse
In what specific ways can a mechanism of injury analysis help the chiropractor?
You get a list of DDX that could be wrong
And you learn how to manage the patients case
Analysis of the mechanism of injury occurs in two steps. What are they?
- Decide the broad category of injury
2. Decide what were the magnitude and direction of forces involved
What are the 5 broad categories of injury mechanisms? Which are the most common?
- Repetitive stress (end range) **MC
- Postural (sustained end-range)
- Single traumatic event
- Sudden unguarded movement
- Normal activity, unstable spine
What are the factors that lead to repetitive stress syndromes? How does this type of mechanism directly affect your management plan?
Job “repetitive stress syndrome”
Sports related “overuse syndrome”
Tx often requires changing work environment (getting a better chair) or patients behavior (correcting lifting strategy) and finding and correcting weak link (inhibited glut max, poor endurance in low back extensors)
What are two types of factors that lead to sustained postural injuries?
Extrinsic loads e.g. based on static postures required by work or recreation
Intrinsic loads e.g. over weight patient may become hyperlordotic to balance the abdominal load, placing sustained pressure onto the facets
How can a sudden unguarded movement or an even a normal activity of daily living lead to an
injury?
Simple action done rapidly or partly off balance results in a moment of incoordination at the level of the deep stab muscles of the spine.
Based on mechanical loading, low back injuries are divided into what two broad categories?
TORSION or COMPRESSION injuries
Based on vectors, compression injuries are divided into what 3 types?
Neutral
Hyperflexion
Hyperextension
What are some ways your patient might sustain a compression injury with a neutral spine?
Fall on heels / butt
Your patient becomes airborne while flying over a mogul while riding a snowmobile and lands
hard on the seat resulting in low back pain.
- What are the top two diagnoses to rule out?
- What would be one of the least likely pathoanatomical diagnosis to consider?
(In other words, list the 3 most likely in order from most to least likely)
1- End plate or compression Fx
2- Ligament sprain due to shear load
3- Posterior disc herniation
What three diagnoses would be at the top of your DDX in a patient who gets low back pain from trying to improperly lift a heavy object off the ground?
1- Disc injury
2- Compression Fx
3- Sprain of posterior ligaments (traumatic)
Second: joint injury, joint dysfunction, MFTPs, etc.
