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MS Injuries Midterm
Up until Midterm review of Musculoskeletal Injuries II
| Question | Answer |
|---|---|
| Spinal Cord Injury Signs and Symptoms | bowel and bladder dysfunction bilateral or quadrilateral paresthesia hyperreflexia below lesion level hyporeflexia at lesion level babinski positive test colnus below lesion level |
| Cauda Equina Signs and Symptoms | saddle area anesthesia bowel and bladder dysfunction hyporeflexia or areflexia positive dural signs |
| Objective Examination steps of the Lumbar Spine | Inspection Active ROM Active ROM with overpressure |
| Inspection of Lumbar Spine | anteriorly, posteriorly, laterally |
| Active ROM of the Lumbar Spine | assess the quantity and quality of flexion, extension, side flexion, and rotation |
| Active ROM of the Lumbar Spine with overpressure | assess active ROM and add overpressure to assess end feel |
| End Feel | sensation or feeling physiotherapists detect when a joint is at its end range of motion |
| Types of End Feels (6) | Bone to Bone Spasm Capsular Springy Block Soft Tissue approximation Empty |
| Bone to Bone End Feel | An abrupt halt to two hard surfaces meeting (ex. Elbow extension) |
| Spasm End Feel | Sudden stop or vibrant twang to passive movement |
| Capsular End Feel | When a joint capsule or ligament is stretched to end of range (ex. Onion bag) |
| Springy Block End Feel | Rebound sensation caused by a possible derangement (can be in meniscus) |
| Soft Tissue Approximation End Feel | Joint cannot go further because of another body part hitting against it (ex. Elbow flexion) |
| Empty End Feel | Movement causes pain before reaching the end range (can be a sign of a serious pathology) |
| Squat assessment | quick clearing test for lower extremities, if pain, then peripheral joint needs to be assessed |
| Dermatomes | an area of skin supplied by a single nerve root (sensation) Test for altered nerve conduction by assessing pain, temperature, or light touch over area of skin |
| Myotomes | a muscle or group of muscles that is predominantly supplied by a spinal nerve Test for fatigue or altered nerve conduction by testing the strength and endurance of myotome |
| Only true myotome | Cervical Spine |
| Clonus | Rhythmic or rapid alternating contraction and relaxation of a muscle brought on by sudden passive tendon stretching |
| How is Clonus tested | Tested by rapidly extending the wrist, dorsiflexing the ankle or shearing the patella cranially |
| What does a positive Clonus test indicate | an upper motor neuron lesion |
| Babinski test | The skin of the sole of the foot is slowly stroked along the lateral border of the heel forward |
| What does a positive Babinski test indicate | Positive test occurs with extension of D1 with fanning of other toes Indicates a disorder in the motor pathway of the brain and spinal cord |
| Dura | thick membrane that is the outermost of the three layer (think thick extension cord) |
| Dura Tests | Straight Leg Raising Test Femoral Nerve Stretch |
| Straight Leg Raising Test | assesses the integrity of the dura of the sciatic nerve and its various branches |
| Femoral Nerve Stretch | passively flex the patient’s knee noting the onset of pain or symptoms; commonly used for patient presenting with anterior thigh pain |
| Low back pain Prevalence | 75% or 4/5 people; greatest between the ages of 30-50 years old; equal frequency in men and women |
| Causes of Low Back Pain | mechanical in nature, traumatic, or from an underlying medical condition 85-95% of cases are unknown |
| Cost of Low Back Pain in the US annually | 40,000-50,000 per year |
| Injuries to the Lumbar Spine | Spondylogenic Neurogenic Vascular Viscerogenic Psychogenic |
| Viscerogenic Back Pain | sinister; idiopathic |
| Intervertebral Disc Derangement | damage to the disc occurs following compression, flexion and/or rotation of the spine |
| Clinical Presentation of Intervertebral Disc Derangement | Usually occurs in males in the 3rd or 4th decade Pain often associated with lifting, bending and twisting |
| Objective Assessment Findings for Intervertebral Disc Derangement | Lumbar spine appears flat in flexed position Patient may stand with a lateral shift Flexion and rotation of spine cause pain |
| Treatment for Intervertebral Disc Derangement | Education of movements and positions that decrease pain Postural correction Rest, Ice, Surgery, Brace, Modalities, Spinal extension exercises |
| Postural Syndrome | Overstretching and mechanical deformation of the normal spinal tissue results in postural pain after prolonged static loading |
| Clinical Presentation of Postural Syndrome | Client is usually under 30 Insidious onset Sedentary occupation and lack of physical fitness Intermittent pain that may disappear for several days Pain is eased when stress is removed |
| Objective Findings for Postural Syndrome | Nothing is evident Poor posture Diagnosis is made by the absence of typical signs and their history |
| Treatment for Postural Syndrome | Postural correction in sitting, standing and with functional tasks Education on back care Modification of work station layout Change positions frequency |
| Mechanical Dysfunction Syndrome | adaptive shortening results in the soft tissue and the resultant loss of mobility causes pain |
| Clinical Presentation of Mechanical Dysfunction Syndrome | Client is usually 30+ Early morning stiffness which eases as day progresses Intermittent pain Pain is greatest at the extremes of movement |
| Objective Findings for Mechanical Dysfunction Syndrome | No deformity on observation but may have poor posture Decreased ROM |
| Treatment for Mechanical Dysfunction Syndrome | Postural correction Stretching exercises to regain mobility Joint mobilizations Education on back care |
| Spinal Stenosis | a bony narrowing of the spinal canals either centrally or in the lateral recesses |
| Clinical Presentation of Spinal Stenosis | Vague and intense bilateral leg pain Client is comfortable at rest in a flexed position Walking increases leg symptoms and must stop and flex or sit down |
| Treatment of Spinal Stenosis | Postural correction Mechanical or manual traction Cycling Flexion type exercises Stabilization exercises Surgical decompression |
| Neurogenic Back Pain | nerve is the source of pain in the back |
| Clinical Presentation of Neurogenic Back Pain | Severe, sharp, electric, shock-like, shooting lightning like or lanciating pain Deep burning or cold pain Travelling along the nerve path into the arms, hands, legs or feet |
| Lipoma | Benign tumor; build up of excess fat cells |
| Abdominal Aortic Aneurysm | swelling of the aorta |
| Clinical Presentation of Abdominal Aortic Aneursym | If untreated, leads to expansion or rupture Feels pulsating mass in the abdomen Boring and deep seated pain in the groin or flank Minimal objective findings related to the spine Pain is unaffected by activity Testicular pain often means rupture |
| Signs of Intermittent Claudication | Bilateral leg pain Pain increased with walking Pain decreased by standing still |
| Clinical Presentation of Intermittent Claudication | Affects individuals 40-60 years of age No burning and numbness reported Decreased or absent pulses in the lower extremities Cold, numb, dry, or scaly pain |
| Viscerogenic Back Pain | diseases of the pelvic viscera, kidney, lung, breast and prostate may refer pain in the back |
| Tumor | Blood thirsty, worst pain at night, activity and rest does not alter pain; night pain is prevalent |
| Psychogenic Back Pain | a small percentage of client's present with inconsistencies in their subjective and objective assessment findings. Pain of this nature may be due to central sensitization |
| Clinical Presentation of Psychogenic Back Pain | Original pain spread Mirror pains on the opposite side Often report sudden "stabs" of pain Pain has a mind of its own Cyclical |
| Treatment of Psychogenic Back Pain | Multi modal treatment Counselling Education of hurt vs harm |
| Lordosis | Curve |
| Thoracic Spine Regions | T1-T12 |
| Scoliosis | lateral curvature of the spine |
| Non Structural Scoliosis | No bony deformity Most common Normal spine flexibility Curve disappears with forward flexion |
| Causes of Non-Structural Scoliosis | Postural Hysterical Nerve root irritation Inflammatory Compensatory |
| Structural Scoliosis | Scoliotic curve lacks normal flexibility May be progressive Curve does not disappear with forward flexion |
| Causes of Structural Scoliosis | Idiopathic Congenital Neuromuscular Hereditary Tumors |
| Treatment of Structural Scoliosis | Bracing Surgery Exercise Neuromuscular Electrical Stimulation |
| Dowager's Hump | associated with post menopausal osteoporosis |
| Hump back or Gibbus | associated with a wedge fracture of the thoracic spine or with Scheurmann's Disease |
| Diminished Kyphosis | Flattened back secondary to postural imbalance respiratory dysfunction |
| Thoracic Spine Disc Derangement | Extremely rare in the thoracic spine due to the thick posterior longitudinal ligament and ribs |
| Cervical Spine Regions | C1-C7 |
| Lumbar Spine Regions | L1-L5 |
| Clinical Presentation of Thoracic Spine Disc Derangement | Severe aching or burning or shooting pain located in the posterior or anterior aspect of the thorax All movements limited and painful Due to size of spinal canal, spinal cord signs may be present |
| Treatment for Thoracic Spine Disc Derangement | Medical clearance for spinal cord compression (rule out heart attack) Treat same as Lumbar Spine Disc Derangement |
| Vertebral Fractures/Dislocations | Result of hyper flexion injuries Most common at T12-L1 May occur in the anterior, posterior, middle column |
| Rib Fractures | usually traumatic may be caused by a vigorous cough or sneeze or lying on a hard surface |
| Costochondritis | Local inflammation of the costochondral junctions anteriorly |
| Tietze's Syndrome | Multiple levels involved in Costochondritis |
| Clinical Presentation of Costochondritis | Hot or swollen joint on the anterior thorax Can be mistaken for breast cancer |
| Barrel Chest | Sternum project forward and upward with increased anterior to posterior diameter Associated with COPD such as emphysema |
| Pectus Excavatum | AKA funnel chest Sternum pushed posteriorly by the ribs Results in altered inspiratory pattern May be associated with an increased kyphosis |
| Herpes Zoster | AKA shingles An acute viral infection that lives in the sensory nerve bodies (dorsal root ganglion) At times of great stress or illness, it can travel to skin and attach causing sores |
| Treatment for Herpes Zoster | No specific therapy, but post hepatic neuralgia may be treated with TENS on the contralateral side |
| Scheurmann's Disease | osteochondritis of the anterior intervertebral ring epiphyses Caused by anterior wedging and some flattening of the softened vertebrae |
| What does the Hunchback of Notre Dame have | Scheurmann's Disease |
| Scheurmann's Disease Prevalency | Most common in females; onset of 10-16 yrs |
| Treatment For Scheurmann's Disease | The use of postural education Extension exercises Surgery in more severe cases |
| Easing Factors of Mechanical Dysfunction Syndrome | Movement and upon releasing the end range stress |
| Aggravating Factors of Mechanical Dysfunction Syndrome | Extremes of movement Waking/getting up in the morning |
| Easing Factors of Spinal Stenosis | Rest in flexed position |
| Aggravating Factors of Spinal Stenosis | Walking and back extension |
| Intermittent Claudication | pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest |
| Upper Quadrant Scan | scanning examination used to determine if a person's symptoms are of spinal origin or in the periphery |
| Subjective Examination of UQS | Same as LQS |
| Special Questions regarding Safety | Vertebral artery signs Rheumatoid Arthritis Medications Headaches Upper Respiratory Tract Infections |
| Vertebral Artery | Damage to the artery that supplies the brain |
| Vertebral Artery Signs | 5 D's Dizziness Diplopia Drop attacks Dysarthria Dysphagia |
| Slump Test | assesses integrity of the dura of the sciatic nerve |
| Vertebral Artery Test | test used to look for the 5D's |
| Whiplash Associated Disorder | MOI associated with a collision of some sort |
| Clinical Presentation of Whiplash Associated Disorder | Pain in the neck, shoulder and interscapular regions Headache due to intracranial damage, soft tissue injury or fracture Blurred vision Tinnitus Dizziness Numbness in upper extremities |
| Horner's Syndrome | sinking in of the eyeball, drooping of the upper eyelid constriction of the pupil, lack of sweat production, and facial flushing of the skin |
| Grade 1 Whiplash | negative UQS complains of pain, stiffness and tenderness only |
| Grade 2 Whiplash | complains of pain and MS signs decreased ROM point tenderness |
| Grade 3 Whiplash | complains of pain and neurological signs decreased or absent deep tendon reflexes, weakness and sensory deficits |
| Grade 4 Whiplash | complains of pain and a fracture or dislocation is present |
| Acute Torticollis | sudden onset of neck pain and stiffness upon awakening caused by a sudden rotation of the cervical spine occurs at C2-C3 |
| Grisel's Syndrome | When a torticollis occurs in children, often a respiratory tract infection may produce laxity of the transverse ligament resulting in a subluxaton of the atlas and producing same symptoms |
| Cervical Spine Disc Derangement | common at C7, C6, C5 less common than lumbar spine due to the fibrous nature of the disc |
| Cervical Spine Spinal Stenosis | Stenosis due to disc prolapse is very uncommon but is more commonly caused by degeneration of the uncovertebral joint |
| Clinical Presentation of Cervical Spine Spinal Stenosis | segmental paresthesia age greater than 45 years compression and extension aggravates symptoms traction relieves symptoms |
| C1 | Neck flexion |
| C2 | Neck extension |
| C3 | Neck side flexion |
| C4 | Shoulder elevation |
| C5 | Shoulder abduction |
| C6 | Elbow flexion and wrist extension |
| C7 | Elbow extension and wrist flexion |
| C8 | Thumb extension |
| T1 | Finger abduction and adduction |
| L1-L2 | Hip flexion |
| L3 | Knee extension |
| L4 | Ankle dorsiflexion |
| L5 | Extension of D1 |
| S1 | Ankle eversion |
| S2 | Knee flexion |
| Widely used analgesic in the world | Aspirin |
| Analgesics and Antipyretics | Most common are acetaminophen and acetylsalicylic acid (Tylenol and Aspirin) |
| Acetaminophen | Inhibits the synthesis of prostaglandins in the CNS but does not inhibit their synthesis in the peripheral tissues |
| Acetaminophen | Acts as an analgesic and reduces fever but has no anti-inflammatory or anti platelet properties Overdose can lead to liver damage or death Will not cause blood to coagulate or reduce swelling |
| Acetylsalicylic Acid | Acts as a analgesic, antipyretic, anti inflammatory and has anti platelet properties |
| Acetylsalicylic Acid | common side effects include GI bleeding, nausea, vomiting and gastric ulcers Should not be used by asthmatics or athletes in contact sports |
| Reyes Syndrome | A severe disorder in going children flowing an acute illness, usually influenza varicella zoster infection |
| Reyes Syndrome | Characterized by recurrent vomiting beginning within a week after the onset of the condition Cahill either recovers rapidly or lapse int coma with a intracranial hypertension that may lead to death |
| NSAIDS | Aspirin like drugs that reduce inflammation, pain, & fever Lack the gastrointestinal and hemorrhagic effects produced by Aspirin Distributed both over the counter and prescription medication (ex.Advil) |
| NSAIDS | NSAIDS should be taken with food, milk, or water to reduce the risk of these medications Examples include Athrotec, Advil, Ibuprofen, or Motrin |
| NSAIDS | Therapeutic effects occur by the inhibition of the activity of prostaglandins Common side effects include gastrointestinal irritation, cardiovascular complications, renal impairment, hypersensitive reactions, or toxicity |
| Corticosteroids | Decreases swelling, warmth, redness, and pain Therapeutic effects occur by blocking the body’s natural response to inflammation by inhibiting the synthesis of chemical mediators such as prostaglandins, leukotrienes, and histamines |
| Corticosteroids | Common side effects include itching, burning, dry skin, fluid retention, increase or decrease in appetite, dizziness, restlessness, facial or body hair growth, gastrointestinal irritation, menstrual irregularities, optic pain, and decreased immunity |
| Corticosteroids | Administered orally, via nasal inhalation, via intra-articular or subcutaneous injection, intravenously, or topically |
Created by:
Caitlyn De La Cruz
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