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nms q & a
nms question/answer
| nms question | nms answer |
|---|---|
| aka Hyperabduction Syndrome | pectoralis minor syndrome |
| in pec minor syndrome, where is the compression of neurovascular bundle? | beneath the pec minor or the coracoid process |
| what is the ortho test for pec minor syndrome? | wright's, hyperabduction test |
| def costoclavicular syndrome | compression of neurovascular bundle betw the clavicle and first rib |
| ortho test for costoclavicular syndrome | costoclavicular test, Roos's test |
| ortho tests for costclavicular syndrome | adson's, roos's, costoclavicular |
| sx of cervical rib | "hands fall asleep", symptom c8-t1 dermatomes, prominence at the base of the neck |
| ortho tests for anterior scalene syndrome | adson's, roos's |
| sx of ant scalene syndrome | anterior head carriage, paresthesia in the ulnar aspect of hand/forearm, raymond's phenomenon |
| anatomic structures involved in thoracic outlet | first rib or cervical ribs, anterior and middle scalene, space betw clavicle and ribs and the pec minor |
| sx of basilar impression | middle age, ext weakness, sensory deficits, cerebellar manifestations, cranial n. manifestations |
| what is basilar impression | settling of skull onto the upper cervical spine, with decreased volume of the posterior cranial fossa |
| cause of spinal infection | specific bacteria-staphylococcus, bacillus, tuberculosis |
| diffuse idiopathic skeletal hyperostosis sx | flowing candle wax calcification along the anterolateral vertebral bodies, maintained disc bodies and spaces, older pt., male, stiffness, dec rom, dysphagia, assoc dm |
| barre lieou syndrome aka | posterior cervical sympathetic syndrome |
| sx of barre lieou | atypical consistent complaints related to sympathetic nervous sytem dysfunction |
| sx of barre lieou | no other ds present, ha, vertigo, dizziness, tinnitus, hoarseness, neck px, dysestheisas of forearms/hands |
| cervical facet syndrome sx | compression test cause local discomfort, crepitus, mm. hypertonicity, antalgia, fixations, rom, palpatory tenderness over the facets, distraction feels good, abn gravitational stress lines |
| cervical myelopathy sx | radicular sx, paresis in arms/legs, altered gait, sensory changes, atrophy, altered reflexes, pathologic reflexes |
| sx of cervical disc syndrome | radiating neck px, antalgia, dec rom, bakody's sign, valsalva, cervical compression causes pain |
| cervical spondylosis sx | adults over 50, stiff in neck after prolonged rest, altered lordosis, crepitus, restricted rom, ha, reduced px with cervical distraction |
| causes of cervical radiculopathy | disc herniation, degenerative disc, osteophyte formation, trauma, stenosis, masses |
| torticollis sx | presentation of deformity and frequently severe px, local px along the cervical pillars or lat mm, stretch test uncomfortable |
| sx of tmj | female, crepitus, cervicogenic ha, tinnitus, vertigo, tooth px |
| anatomy of tmj | meniscus11111, jt capsule1111, ligaments (collateral, sphenomandibular, stylomandibular), mm-supramandibular, masseter, temporalis, medial pterygoid, lateral pteyrgoid, suprahyoid, infrahyoid |
| cluster ha sx | sudden onset, severe night time attack or head px, stabbing/burning/agonizing px, lacrimation, rhinorrhea, nasal stuffiness, ptrosis, flushing, male |
| sinus ha sx | local dull ache/pressure over sinus felt along teeth or frontal periorbital areas, more in morning and leaning forward |
| cluster ha sx | vascular unilateral abrupt, severe night px closely packed groups of px attacks which occur for a few weeks and interspersed with a long remission phase. |
| migraine | sudden, intense recurring attacks of unilateral ha w/ visual and/or gastrointestinal disturbances |
| dx of migraine | progressive throbbing/pounding unilateral ha which stabilizes to a constant ache, adolescent onset w/ prodromal manifestations and signs |
| cervicogenic ha sx | suboccipital and/or a dull temporal ache, produced by sustained contraction of the mm of the head and neck, or segmental dysfunction of the nec |
| episacroiliac ilia lipomas | fatty tissue accumulation over the sacroiliac joints |
| paget's ds | bony resorption and subsequent formation of irregular new bone |
| prevalence of paget's | 3% of population over 40 years |
| Is paget's ds asymptomatic or symptomatic? | asymptomatic |
| sx of osteoporosis | LBP with related minute compression fx and altered mechanical stresses in the area, chronic dull ache taking on sharp stabbing quality with an acute compression fx |
| sx of multiple myloma | malignant tumor of plasma cells, mild, achy and intermittent px aggravated by weight bearing |
| m/c primary malignancy of bone in adult | multiple myeloma |
| most common sites for metastatic ds | axial skeleton and pelvis, spread thru blood stream or direct extension |
| ratio of mets to primary tumors | 25 to 1 |
| neoplasms most frequently assoc with skeletal mets include: | tumors of prostate, breast, lung, kidney, thyroid and colon |
| hx of mets sx | gradual development of px which increases in intensity |
| vertebral osteomyelitis | growth of a bacterial or microbacterium, fungi and/or parasites |
| what contributes to spread of osteomyelitis | venous plexus of baston-valveless venous system |
| m/c bacteria | staphylococcus aureus, e. coli |
| sx of vert osteomyelitis | lbp, hx of recent primary infection, invasive diagnostic procedure |
| osteitis pubi | surgical trauma, labor/delivery and pelvic infections, occurring around pubic symphysis |
| sx of osteitis pubi | px around pubic symph. with radiating px into the thigh-midline px with occasional radiation of px into the thigh |
| Osteitis condensans illi | mild back px, unilateral/bilateral sclerosis of the lower portion of the sacroiliac joint |
| prevalence of osteitis condensans | females more than males, 9 to 1 |
| sx of ost condensans | urinary tract infections, infl. ds, abnormal mech stress, lbp dull and localized to one side |
| DISH | diffuse idiopathic skeletal hyperostosis-over production of bone in spine and extra spinal sites |
| prevalence of dish | males 2 to 1, caucasians |
| sx of dish | spinal stiffness long standing in duration starting in middle age |
| radiographic changes for dish | flowing calcification of 4 contiguous vertebral bodies, preservation of the intervertebral disk height, absence of apophyscal joint ankylosis |
| rheumatoid arthritis sx | lbp with sacroiliac involvement, hand and forearm involvement as well as lower extremity. cervical region m/c |
| enteropathic arthritis | arthritic sx in pts with ulcerative colitis and chron's ds |
| psoriatic arthritis | rare assoc with lbp, 5-7% of pts had psoriasis |
| sx of psoriatc arthritis | distal interphalangeal joint and assoc changes in the nails; spondylits may occur in approx 5% of the pts with psoriatic; skin changes include erythematous raised circumscribed dry scaly lesion over the elbows and knees |
| reiter's syndrome | assoc with triad of urethritis, conjunctivitis and arthritis m/c in males |
| clinical sx of reiter's | triad plus HLA-B27 antigen in 60% of pts., related to venereal infection; young male who develops a urethritis and mild conjunctival reaction followed by lower extremity px syndromes, achy back px frequent and acute, improved with activity |
| conjunctivitis in reiter's | redness and crusting of the lids, bilateral and resolves over a few days, but recurs spontaneously |
| when does reiter's arthritis occur | one to three weeks after the initial infection and involves weight bearing joints of the lower extremity |
| dx of acute reiter's | peripheral arthritis of more than one month, with assoc with urethritis or cervicitis |
| prognosis of reiter's | no definitive cure, self limiting illness lasting up to approx a year-50% of people developing a relapsing pattern of illness with periods of complete remission. |
| ankylosis spondylitis | infl condition involving sft tissues around jts., progresses to axial skeleton |
| does AS have HLA? | yes in 90% |
| Classic AS presentation: | young adult male with intermittent LBP worse in AM. Over yrs px fades replaced with stiffness and immobility of jts |
| What else is affected by AS? | body systems-heart, eyes (iritis), px in insertion pts |
| Main diagnostic criteria for AS? | young male with LBP and stiffness of 3 months or more |
| anatomical leg length and equality causes: | asymmetrical growth of tibia or femur, previous fx, immobilized during growing yrs |
| Functional leg length inequality cause: | pes planus/cavus, knee jt anomalies, SI jt, pronation/sup of ankle, mm. imbalance, spinal dysfunction |
| Gait cycle | Stance phase, swing phase |
| stance phase | foot is in contact with the ground and bearing weight |
| swing phase | portion of the foot is in a non-weight bearing position and moving |
| Four points of a single step | heel strike, mid stance, push off, mid swing |
| reasons for problem on heel strike | heel spurs, dysfunction, L5 (innvervator for toe extensor), tib anterior |
| Problems with push off | 5th metatarsal, transverse arch, 1st metatarsal & sesamoid bones |
| mid-stance problems | cuboid (lat foot px), navicular (pronation), arch (plantar fascia) |
| Morton's neuroma: | most common betw. 3rd & 4th toes, N. runs betw. them, tissue around N. becomes inflammed & compresses N. (term. br. of medial plantar n.) |
| Morton's syndrome: | px response around 2nd metatarsal |
| normal heel strike pattern | head/trunk vertical, pelvis slight ant rot., r. knee extended, r. foot approximately at r. angle to leg |
| lumbar sprain/strain | nonradiating LBP associated with mechanical stress to LS spine |
| paraspinal compartment syndrome | inc intra muscular pressure, result of unyielding fascia which does not allow for expansion of mm that are being used |
| sx of paraspinal compartment syndrome | px after exercise, consistent, ROM restricted |
| Degenerative Joint Ds sx | slowly developing jt px, stiffness, deformity and limitation of motion...AM stiffness |
| Clinical hx of DJD | totally asymptomatic to mild discomfort to stenosis, AM stiffness of short duration, dec ROM particularly ext, SP tenderness, px in butt thigh or leg |
| Disc degen sx | Ongoing ache that's worse with mechanical stresses, relieved by rest and heat. Prolonged rest results in stiffness, hypertonicity of paraspinals, reduced disk space, degen. spurs |
| Post facet syndrome sx | ongoing back px, common, trauma to facet jts., faulty posture with inc angulation of LS junction and lumbar lordosis, LBP radiates into groin, hip, butt, leg seldom below knee |
| Baastrups ds | px over SP as result of SP approximation assoc with DJD |
| Baastrups sx | vague, ongoing, MIDLINE spinal px with SP tenderness |
| Spinal stenosis | reduction in size of central spinal canal results in neurologic compression, assoc with bulging ligamentum flava and spurs off post vertebral body |
| spinal stenosis sx | local px syndrome, dull achy px worse with exertion and relieved by rest, lower extremity manifestations, recurrent episodes of back and leg px brought on by exertion and relieved by postural modifications |
| Cauda Equina syndrome | compression of n. roots of lumbar spine, rare but severe |
| sx of cauda equina | severe bilateral sciatica following trauma, LBP, bilateral motor weakness of lower ext., bilateral sciatica, saddle anesthesia and paraplegia and bowel/bladder incontinence SURGICAL EMERGENCY |
| Sciatica causes | diabetes, alcoholism, pernicious anemia, B12 deficiency, heavy metal toxicity |
| conditions with sciatica | IVD syndrome, spondylolisthesis, SI subluxation/sprain, DDD, lateral spinal canal stenosis, vertebral fx, neoplasms or SOL |
| sx of sciatica | ongoing buttock and leg complaints |
| Femoral neuritis | femoral n. or its n. roots are irritated leading to radicular px in the distribution of the roots or the femoral n. |
| sx of femoral neuritis | ant thigh px which may extend down to the knee |
| spondyloslisthesis | vb has slipped forward |
| common sx of spondylolisthesis | LBP, dull, relieved by rest, extends across SI jts |
| What method of grading is used for spondylo. | Meyerdings |
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pcelvfrdm
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