Christina Spring 26 > MSK 2B > Flashcards

MSK 2B Flashcards

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1
Q

neck and UE pain is common at what age?

A

middle

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2
Q

___ spine has HIGH potential for serious injury

A

C-spine

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3
Q

cervical spine needs to be examined w/ caution b/c exam ____

A

may be harmful

*esp w/ hx of trauma

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4
Q

in addition to subjective hx and physical exam, ___ studies may be required to exclude fx or instability

A

imaging studies

*esp w/ hx of trauma

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5
Q

need to clear non MSK dysfunction early for what

A

CNS or PNS deficits
neurovascular compromise

*REFER OUT

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6
Q

after subjective hx and system review what do you do next?

A

special tests and scanning examination for vertebral artery, transverse ligament, and alar ligament

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7
Q

how does vertebral artery, transverse artery, alar ligament become lax

A

need MOI, some exceptions is DS or arthritis

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8
Q

if Pt presents with craniovertbral dysfunction what do you do?

A

urgent care: if fine and drove
ER: if progressing SOB, etc

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9
Q

Pt has no sign of cranovertebral dysfunction what do you do next?

A

access AROM of cervical spine

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10
Q

after accessing AROM of cervical spine and note pt doesnt have enough range what do you do?

A

mobilize it!

access for hypomobility

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11
Q

after accessing AROM of cervical spine and note pt doesnt have normal or too much motion?

A

stabilize!

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12
Q

Pt hx questions?

A

Age
occupation
hand dominance
recreational activites

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13
Q

Pt hx

MOI

A

trauma/specific event

insidious onset

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14
Q

what is one of the first question to ask in subjective?

A

MOI!!!!!!!!!

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15
Q

if ask and no MOI what do you do?

A

can move forward with exam

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16
Q

neurologic symptoms present

A

paraesthesias
dizziness
tinnitus
visual disturbances
loss of consciousness

5D, 3Ns

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17
Q

what is PHQ2

A

over the past 2 weeks how often have you had little interest in doing things?

over the past 2 weeks, how often have you felt down,depressed, hopeless?

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18
Q

OSPRO-YF

A

assesses 3 specific domains of psychosocial distress

-negative mood
-fear avoidance
-negative affect/coping

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19
Q

important to DDx Neck Pain

A

mobility deficits
movement coordination impairments
headaches
radiating pain
serious injury/pathology

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20
Q

sequence your exam in such a manner to allow for?

A

Pt safety
efficient data collection
effective clinical decision making

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21
Q

spine responds better to______ based classification and treatments

A

impairment

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22
Q

what are the 4 buckets

A

mobility deficits + neck pain
movement coordination impairments + neck pain
headaches + neck pain
radiating pain + neck pain

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23
Q

Hx of recent trauma w/i last ___ weeks demands cautious approach

A

6 weeks

*take vital signs

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24
Q

canadian C spine rules

A

determine whether radiography is necessary prior to initating PT treatment

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25
prescence of ___ flags can increase complexity of symptoms and decrease pt outcomes
yellow
26
canadian c spine rules not applicable when
Non-trauma cases Glasgow coma scale <15 Unstable vital signs Age <16 Acute paralysis Known vertebral disease Previous c-spine surgery Pregnant
27
The canadian c spine rule is for alert GCS ___ and stable trauma patient where cervical spine injury is a concern
15
28
any high risk factor which mandates radiography includes
age of 65 years or older dangerous mechanism paresthesias in extremities
29
what is considered a dangerous mechanism for canadian c spine rules?
30
any low risk factors which allows safe assessment of ROM include?
simple rearend MVC sitting position in ED ambulatory at any time delayed onset of neck pain absence of midline c spine tenderness
31
a simple rearend MVC excludes
32
delayed
33
what is the third question for canadian c spine rule?
able to actively rotate head 45 degrees R or L? able --> no radiograph
34
cervical conditions that must be ruled out
Ligamentous instability (alar/transverse ligs) Myelopathy (any type of SC compression) Malignancy Spinal fx’s Vascular pathologies (ie. VBI) REFER OUT!!!
35
Cervical myelopathy most likely to occur at _____ level as the spinal cord is the largest and the spinal canal is the smallest here.
C5-6
36
Structure-Based (Cyriax)
intervention based on treating pathologic structure (connective tissue healing model)
37
Impairment/Treatment-Based (McKenzie and Maitland)
Intervention based solely on response to tissue loading and symptom response
38
what is the ultimate goal?
self management by the pt
39
forward head/postural syndrome deficits associated with FHP cervical hyperlordosis
TMJ overcloses Posterior compression CV hyperextension OA flexion HYPOmobile AA rotation HYPOmobile OA extension HYPERmobile CV instability Mid-cervical hyperextension
40
forward head/postural syndrome deficits associated with FHP shoulder protraction
GH instability AC instability
41
forward head/postural syndrome deficits associated with FHP CT hyperkyphosis
T-spine extension HYPOmobile Shoulder complex HYPOmobile RC tendinopathy
42
in FHP Lower cervical ____ with upper ___
lower cervical flexion with capital/upper extension b/c of biconcave articulation
43
mechanical neck pain is more joint or postural pain?
joint
44
Diagnostic label when neck pain is NOT caused by/related to:
Trauma (ie. MVA) Cervical radiculopathy Non-MSK cause
45
~_____ of population experiences mechanical neck pain symptoms during lifespan
20-50% Incidence ↑’s w/ age Most prevalent during 4th and 5th decades of life
46
mechanical neck pain can transition from acute to ___ neck pain
chronic if symptoms are severe and debilitating enough no specific MOI responsible for symptoms here
47
cervical disc pathology
acute disc herniation disc degeneration cervical radiculopathy
48
acute disc herniation Uncommon Most commonly seen
Uncommon <30 y/o Most commonly seen ~50 y/o
49
Disc degeneration
Occurs predictably w/ end plate damage followed by disruptive △’s in disc resulting in ↓’d height Disc has limited ability to self-repair 2/2 restricted blood supply
50
Neurologic deficits correspond w/ disc level in ____ of pts
~80% note: wherever disc symptoms of, and with nerve symptoms typically same level
51
Cervical radiculopathy
Compression of spinal nerve root by space occupying lesion (ie. disc herniation, tumor)
52
what does cervical radiculopathy result in
nerve root inflammation, impingement or both
53
cervical radiculopathy commonly seen following:
hyperextension injuries, especially when combined w/ rotation and SB
54
Pts often in middle age get cervical radic but ____
clinical presentation extremely variable
55
C2-C3 disc hernations are
rare
56
C5 spinal nerve root compressions -->
posterior neck/medial scapular border pain
57
Difficulty breathing w/ physical activity may indicate diaphragm involvement _____
(C3-5)
58
C5 spinal nerve root compression →
numbness on superior aspects of shoulders
59
C6 involvement →
radiating pain from neck to lateral aspect of upper arm, forearm and hand
60
C7 involvement →
radiating pain from posterior neck to scapula, posterior upper arm, forearm and hand
61
what is the most common site for cervical radic
C7
62
C8 involvement →
radiating pain from neck to medial aspect of upper arm, forearm and hand
63
In middle age and older pts … symptoms often d/t _____ △’s and _______ vs disc herniation
degenerative osteophyte formation
64
Important to differentiate b/t ____ and peripheral nerve entrapment w/ UE symptoms
spinal nerve root compression
65
cervical spondylosis
Chronic degenerative condition affected content of spinal canal -Spinal cord and spinal nerve roots
66
Related to bony △’s are in the ____ and can cause: Cervical myelopathy → Foraminal stenosis →
spinal cord compression/injury radiculopathy
67
IVD and facet joints affected by degenerative △’s (ie. OA)
Osteophyte formation Hypertrophy of ligamentous structures Result in chronic inflammatory response
68
is cervical myelopathy UMN or LMN
UMN -see gait abnormatlites b/c SC can affect everything down low
69
facet joint dysfunction presents with
Pts typically present w/ unilateral neck pain Reports a ‘crick in their neck’ or that they ‘slept wrong’
70
facet joint dysfunction due to
Occurs 2/2 small piece of synovial membrane getting caught in z-joint (aka facet joint) note: imaging unremarkable
71
cleland CPR for facet joint dysfunction
Symptoms <30 days No symptoms distal to shoulder Looking up does not aggravate symptoms FABQ physical activity score <12 Diminished upper t-spine kyphosis Cervical extension ROM <30º
72
CPR score for cleland
>3 (+) tests out of 6 indicate successful outcome w/ t-spine HVLAT in 86% of pts
73
cervical spine instability
‘inability of spine, under physiological load, to limit patterns of displacement so as NOT TO DAMAGE or irritate spinal cord, nerve roots or surrounding structures’ cant control motion you have *hypermobility
74
cervical spine instability due to
trauma, surgery, systemic disease or degenerative △’s
75
what is the gold standard for diagnosing mild c spine instability
none note: there is for serious like alar or transverse ligaments
76
S&S associated with mild c spine instability
Hx of major trauma Reports of catching, locking, giving way Unpredictability of symptoms* Subjective reports of neck weakness (ie. head feels heavy) Altered ROM Neck pain w/ or w/o muscle spasms Reports of HAs
77
how to treat facet joint dysfunction
closing and opening restrictions MT
78
whiplalsh associated disorder (WAD)
Injury that occurs w/ rapid deceleration or acceleration mechanism
79
common mechanism for WAD
MVAs Sport-related injuries (ie. concussions) Pulls and thrusts on arms Falls, landing on trunk or shoulder
80
WAD damages what?
Damage to soft tissue structures, facet joints and/or CNS and PNS result in motor control deficits and pain Neck pain can occur w/ and w/o HA's and related symptoms Symptoms vary significantly (ie. w/ and w/o neuro presentations)
81
headaches types
Migraine Tension Cluster Cervicogenic
82
migraine
half of head pain
83
tension
tight band around forehead
84
cluster
behind eyeball
85
cervicogenic
rams horn pattern comes around ear and behind eye! C0-C3
86
neck pain classification. categories - buckets
Neck Pain w/ Mobility Deficits Neck Pain w/ Movement Coordination Impairments (WAD) Neck Pain w/ HAs Neck Pain w/ Radiating Pain
Christina Spring 26
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