Clin Path II > Disc Herniation > Flashcards

Disc Herniation Flashcards

(19 cards)

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1
Q

What are 2 clues for which nerve root is affected? Which is most predictive?

A

Deficits, paresthesia (more predictive than pain distribution)

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2
Q

What is the order of deficits for C8 radiculopathy based on +LRs? (Don’t need to know +LR#’s)

A
  • Sensory loss to little finger (41.2)
  • diminished triceps reflex (28.3) (C7 or C8)
  • weak finger flexion (3.8)
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3
Q

What are the pure patches that support disc herniation in order of +LRs? (Don’t need to memorize +LR#’s)

A
  • C8 on pinky (41.8)
  • C6 on thumb (8.5)
  • C7 is poor
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4
Q

Which big 5 ortho tests for disc herniation are sensitive? Which are specific?

A

Specific

  • max cervical compression
  • cervical distraction
  • valsalva
  • shoulder abduction

Sensitive
- ULTT- median

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5
Q

What are test that close or open the IVF? What are tests that tension the nerve? How does each affect the arm sx?

A

Close/open

  • AROM: extension, ipsi-rotation/lateral flexion (increase arm sx)
  • AROM: flexion, contra-rotation/lat flex (decrease arm sx)
  • cervical compression (increase arm sx)
  • cervical distraction (decrease arm sx)

Tension

  • ULTT (increase arm sx)
  • shoulder abduction test/ Bakody’s sign (decrease arm sx)
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6
Q

What are the peak ages for C/S disc herniation

A

40-60 with peak age 50-54

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7
Q

What are the indications for radiographs?

A
  • moderate to high load trauma(r/o fractures and structural instability)
  • red flags for disease
  • cord signs/symptoms (then MRI)
  • radicular signs/symptoms
  • nonresponsive case (perhaps after 1 month or more of filed care)
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8
Q

Indications for MRI?

A
  • Lowest = signs/symptoms of radiculitis
  • Moderate= only if there are deficits
  • Highest = only if there is suspicion of myelopathy, progressive (motor) deficit, non-responsive to conservative care, pre-surgical exam, severe motor weakness on the first visit
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9
Q

Treatment for cervical disc herniation? How is each performed?

A

Day 1

  • McKenzie (retraction, extension, other directions with/without overpressure for 10 repetitions)
  • C/S traction
  • adjustment

After a couple Weeks
- neuromobilization

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10
Q

What is the prognosis for conservative care of C/S disc herniations?

A
  • 55% improvement in 2-4 ish weeks, 69% in 1 month, 86% in 3 months
  • acutes responded better and faster, but more chronic cases also responded
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11
Q

What is the ddx of pain/paresthesia into medial hand?

A
  • lower brachial plexus (TOS, tumor, stretch trauma)
  • ulnar nerve entrapment
  • MFTP’s (lats, serratus, pecs)
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12
Q

What are the 5 clues from the physical for disc herniation?

A
  • arm symptoms may be improved by repetitive/ sustained end range movements (into chin retraction, extension, or some other direction)
  • may have flexion load sensitivity
  • may have a positive valsalva
  • may be aggravated by cervical compression
  • may be relieved by cervical distraction
  • tenderness more midline than over facets
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13
Q

how might you alter motion palpation for a suspected cervical disc case?

A
  • with long axis distraction distraction

-

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14
Q

Which muscles with MFTP project pain to the medial arm? What is the hand position to remember this?

A
  • Thumb’s on pec major and minor
  • palm on serratus anterior
  • pinky finger on lat dorsi
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15
Q

Which muscles with MFTP project pain to the lateral arm? What is the hand position to remember this?

A
  • thumb on scalenes
  • palm on supraspinatus
  • fingers on infraspinatus
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16
Q

What are the C6 radiculopathy signs in order of +LR’s? (Do not need to know +LR#’s)

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A
  • decreased biceps or brachio-radialis reflex (14.2)
  • sensory loss over thumb (8.5)
  • weak wrist extension (2.3)
17
Q

What are the 5 clues from the physical for disc herniation?

Study These Flashcards
A
  • arm symptoms may be improved by repetitive/ sustained end range movements (into chin retraction, extension, or some other direction)
  • may have flexion load sensitivity
  • may have a positive valsalva
  • may be aggravated by cervical compression
  • may be relieved by cervical distraction
  • tenderness more midline than over facets
18
Q

What are the signs of C7 radiculopathy in order or +LRs? (Do not need to know +LR#’s)

Study These Flashcards
A

Decreased triceps reflex (28.3) (C7 or C8)

  • weak elbow extension (4)
  • sensory loos of middle finger (2.3)
19
Q

What are additional tests for C6 and C7?

Study These Flashcards
A
  • Pronator test

- finger extensors

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