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Tch 6508 midterms

QuestionAnswer
what is the proportion of the nucleus to the entire disc in the c-spine vs lspine? nucleus is smaller in proportion to the entire disc in the cspine than in the lspine
in ___years the mucoid tissue of nucleus is replaced with ___ which arises from ____ of the ____ in TEEN years the mucoid tissue of the nucleus is rplaced with FIRBOCARTILAGE arising from the HYALINE CARTILAGE of the VERTEBRAL END PLATE
by age 40 the nucleus is ___ & ___ and composed of what? with little or no what? by age 40 the nucleus is dry and ligamentous, and composed of fibrocartilage, islands of hylanine cartialge, and tendon-like materials, with little or no proteoglycans
What may cause radicular-like sx in the cspine? after loss of disc ht, unicnate processes approximate & result in degen which can form osteophytes which project into the disc space or ivf
What do uncinate processes limit and guide? they limit pure lat flexion they are guides to couple lat flexion with rotation
from c3-c7, what is the coupling? lat flex and ipsi rotation
true synovial joints are richly innervated with what./ nociceptive nerve fibers
what has been the main source of pain in pts with chronic neck pain? the facet joints
what is the causal theory of acute torticollis? from a meniscoid entrapments, together with acute mm spasm
What is the best way to adjust acute torticollis and why? adjsuting into the direction of fixation bc it may gap the joint and release the meniscoid without jamming the joint.
disc protrusion is with nuc pulpsos penetrating ____, but ____ disc protrusion with nuc pulposus penetrating asymmetrically thru annular fibers, but confined within the annular margin
with disc extrusion, nuc,. pulposus goes? goes beyond the annular margin
radiculopathy is not the same as what? as pain radiating into the extremities
what is radiculopathy defined as? presence of sensory, motor, or reflex abnormalities in the affected nerve root
what is myelopathy? spinal cord dysfunction
what complications are typically seen with myelopathies? finger numbness, clumsiness, difficulty walking due to spasticity and loss of position sense
in more severe cases of myelopathy what may occur? bowel and bladder control dysfunction
upon examination what do pts with myelopathy present with? long-tract signs such as hyperreflexos and clonus
what can cause myelopathy? severe stenosis of spinal canal due to bony encroachment
When a patient presents with signs and symptoms of significant and/or progressive myelopathy what must happen? urgent surgical decompression of the spinal cord or nerve roots may be indicated.
A chronic degenerative condition of the cervical spine that can affect the vertebral bodies, the IVD, the facet joints, longitudinal ligaments, and/or ligamentum flavum cervical spondylosis
Degenerative arthritis (osteoarthritis) of the vertebrae and related tissues Spondylosis def
Inflammation of vertebrae (ex.-spinal tuberculos Spondylitis def
Breaking down of a vertebral structure (ex. pars interarticularis). Spondylolysis
Forward slippage of a vertebra due to a spondylolysis. Spondylolisthesis
clay shovelers fx mechanism? and type of fx hyperflexion injury, usually oblique or vertical
Cervical Hyperflexion Compression Fracture with dislocation can lead to? Can damage the spinal cord at that level, and lead to paralysis or death
C0 articulations (condyles) are ___? convex
C1 superior facets are _____? concave
Both articular surfaces between C1-C2 are ____allowing for considerable mobility in rotation convex
what are the mms of the suboccipital triangle obliques capitis inferior obliques capitis superior rectus capitis posterior major
what is the princple movt of c0/c1? ext and flex
During flexion occipital condyles move _____, and c0/c1 ___ the occipital condyles glide postreior and superior and c0/c1 separate
c0/c1 axial rotation and lat flexion is @ end range @ _____ degrees to each side 4-8 degrees
c0/c1 rottation is couple with? with small amount of OPPOSITE side lat flexion
Lat flex of c0/c1 is associated with ___ (___ direction of LF) and ____ (___ direction of LF) lat flex of c0/c1 is associated with roll (same direction as LF) and slide (opp direction LF)
what is the primary movt of c1/c2? rotation 40 degrees to each side
rotation @ c1/c2 accounts for ___% of all cerv rotation 50
@ c1/c2 flex/ext occurs as a ___ movement due to ____facet surfaces, and is associated with forward and backward translation of __mm in adult occurs as a rocker movement due to bioconvex facet surfaces, associated with forward and backward trasnlation of 2mm in adult
C1/C2 lat flexion is __ degrees each side and is coupled with ___ to the same side 5 degrees each side and is coupled with translation to the same side
AS occiput bilat. extension malposition bilat. flexion restriction
PS occiput bilat flex malpos biltat extension restriction
AS-RS occiput ext malpositon, left lat flex malposition flex restriction, right lat flex restriction
AS-RS-RP ext malpositon, left lat flex malposition, right rotation malposition flex restriction, right lat flex restriction, left rotation restriction
AS-RS-RA ext malpositon, left lat flex malpositon, left rotation malposition flex restriction, right lat flex restriction, right rot restriction
PS-LS flex malposition, right lat flex malposition ext restriction, left lat flex restriction
PS-LS-LP flex malpositon, rt lat flex malposition, left rotation malposition extension restriction, left lat flex restriction, right rotation restriction
PS-LS-LA flex malposition, right lat flex malposition, rt rot malposition ext restriction, right lat flex restriction, left rot restriction
static model for C1/C2 is used in? HIO or Toggle Recoil technique, HVLA thrusting done on an “unloaded” joint in side posture
static c1/c2 listings always start with __ for ? A for atlas
ASR left lat. flexion malp. right lat. flex. restriction
ASL right lat. flex. malp. left lat. flex. restriction
ASRP left lat. flex. malp. right rotation malp right lateral flexion rest. left rotation restriction
ASLA right lat. flex. malp. right rotation malp. left lat. flexion restriction left rotation restriction
define dissetion partial tearing of the inner artery wall (the intima).
what can a dissection cause? expanding hematoma or thrombus in the vessel wall of the vertebral artery.
What can a hematoma do? The hematoma may seal off The hematoma may expand to completely occlude The hematoma may disrupt blood flow and form emboli
what may a subadvential dissection do? may rupture through the adventitia, resulting in subarachnoid hemorrhage
what ct disorders put ppl @ a risk for vba? Vascular-Type Ehlers-Danlos syndrome (EDS type IV) Marfan’s Syndrome Osteogenesis Imperfecta Type I
what are two other risks for vbas? Possible Infectious Cause (Recent URI) Elevated Homocystine Levels
Mech of VBA: ____stress, with lack of association of ___ stress therefore it is a _____ trivial stress, with a lack of significant stress, therefore it is a multifactoral etiology
inheritable disorder characterized by weakened linings of the walls of blood vessels and the intestine. ehlers danlos type IV
EDS tpye IV is assoicated with minimal what? minimal skin and joint hyperextensibility, but is associated with a notable tendency toward easy bruising.
what can lead to death in EDS IV? Spontaneous rupture of arteries and bowel can lead
describe the skin in eds IV? and where is it most apparent? The skin is usually thin and translucent with veins being seen through the skin. This is most apparent over the chest and abdomen.
Joint hypermobility is usually limited to the ? in eds IV digits
what rupture can happen in eds Iv? Tendon and muscle rupture can occur
facial features of EDS IV? including large eyes, thin nose, lobeless ears, short stature and thin scalp hair. Also evident is a decrease in subcutaneous tissue, particularly in the face and extremities.
minor trauma in eds iv can lead to? extensive briusing
how is eds IV inherited? autosomnal dominant or recessive
Generalized disorder of connective tissue with skeletal, ocular and cardiovascular manifestations marfans
marfans fingers? long, thin and hyperextensible fingers
OI face? triangular
OI has tendency towards? spinal curvature
what happens in OI in 20s-30s possible hearing loss
OI and collagen? strcture normal, but decreased
what else is a possible risk of vbas? infectious trigger, some resp tract infections in 1 case study was a risk factors
have vbas increased or decreased over the yrs? increased
vba strokes usually present as ____ injuries such as? brainstem, such as severe naseau and vomiting, vis problems and vertigo
what syndrome can strokes of posterior circulation result in and what are sx? Wallenberg’s syndrome, where there is loss of pain and temperature of the face on the ipsilateral side of the lesion, and of the body on the contralateral side.
what is the worst case of vba locked in syndrome, aka the corpse with living eyes
Every reliable published study estimating the incidence of stroke from cervical manipulation agrees that the risk is? < 1-3 incidents per million treatments, and about one incident per 100,000 patients who are being treated with a course of care of cervical CMT
a potenital warning sign is the sudden onset of what? pain in the side of neck, head, occipitals, esp if different than any pain had before, and absence of musculoskel pain source
with dizziness what can be done to potentially see if you should adjust the pt or not if neck rotation and extension aggravate the dizziness, maybe a vasc problem, or if any other red flags are present, but there is no definitive test
when in doubt to adjust a pt with dizziness what can be done? treat the neck with other non-manipulative conservative methods such as soft tissue massage, physiological therapeutics, or non-force chiropractic techniques
defintion of malpractice An act or continuing conduct of a professional which does not meet the standard of professional competence and results in provable damages to his/her client or patient.
malpractice is a tort, what does tort mean? a legal claim between two or more individuals
malpractice is not a ____ act not a criminal act, tried under criminal law
criminal law def beyond a resonable doubt
civil law def A preponderance of evidence
To have a successful malpractice claim, the patient (plaintiff) must prove the following were present at the time of an injury?? and if any mssing? 1. Doctor-Patient relationship 2. Duty 3. Dereliction of Duty 4. Direct Causation 5. Damage If any one of these elements is absent, the doctor (defendant) will prevail in litigation
doc-pt refers to the fact that what arrangement has been made bw doc and pt? a contractual arrangement
elements needed to form a contract 1. both parties are competent 2. offer made by one of parties 3.ACCEPTANCE by other 4.MEETINGS OF THE MINDS of the 2 parties 5. each party must pay CONSIDERATION, something of VALUE is exchanged ( not always $)
Created by: margaretrhager