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Dr. Loia TCH8 1

Dr. Loia's 7th tri technique class midterm 1

What is included in a treatment plan? Frequency, duration of initial phase, assessment, technique, modalities, braces and supports, outcome assessment tools, home instruction
What is treatment frequency based upon? The severity of the patient’s condition and the patient’s need for care
What factors affect the frequency and duration of care? Non-compliance of the patient; severity of the kitchen; age of the patient; length of disability; comorbidity
What are relative contraindications to chiropractic care? Articular hypermobility and uncertain joint stability; severe demineralization of bone; benign bone tumors; bleeding disorders and anticoagulant therapy; radiculopathy w/ progressive neuro signs
What are the phases of care? Relief care; therapeutic; rehabilitative; supportive; palliative; maintenance
What is the 3rd most common condition chiropractors treat after neck and low back pain? Headaches; patients will take OTC’s for HA before seeing a physician/chiropractor
What are diagnostic alarms when evaluating headaches? Begins over age 50; sudden onset; accelerating pattern; new onset in a pt w/ HIV or CA; HA w/ systemic illness; focal neuro S/S of disease; papilloedema
What happens w/ nociceptors in a HA? Stimulated by stress, muscular tension, dilated blood vessels, other HA triggers; nociceptors send message to the nerve cells in the brain signaling that part of body hurts
Why doesn’t stimulation or destruction of the brain produce pain? Bones of the skull and tissues of the brain itself do not hurt b/c they don’t have pain-sensitive nerve fibers
What are the 4 categories of primary headaches? 1. Migraine; 2. Tension-type HA (muscular contraction) MC; 3. Cluster HA (<1%); 4. Miscellaneous
What is the second most frequent type of primary HA and how are they referred to? Migraines; referred to as a neurovascular HA b/c it is most likely caused by an interaction b/w blood vessel and nerve abnormalities
Describe frequency of migraine HAs. Migraine accounts for 64% of all females and 43% of all males w/ severe HA
What is the pathophysiology of migraines? Associated w/ fluctuations in cerebral perfusion; areas of hypo-perfusion preceding the onset of a HA followed by a period of reactive hyper-perfusion and eventual normalization of flow
Males and females have different frequencies of migraines according to age, what are they? <10 y/o males have higher frequency but after puberty migraines are more common in females 3:1
What is the general rule for migraines? Typically unilateral and throbbing but can be bilateral and felt anywhere around the head and neck
What is a prodrome? Forewarning of a migraine that can occur hours to days before onset; tend to be consistent for each person
What can be included in prodromes? Neuro symptoms; lethargy; mental and mood changes; polyuria; meningismus; anorexia; constipation or diarrhea
What are the criteria for migraine w/o aura? Must have at least 5 attacks w/: HA lasting 4-72 hours; HA has 2 of unilateral, pulsating, inhibits activities, bothered by physical activity; nausea or photophobia; not related to secondary HA or if present not related to current complaint
What are motor Sx of migraine HAs? Hemiparesis, partial paralysis of one side of the body caused by corticobulbar tract lesions; aphasia, impairment of language
What is the relationship b/w tension and migraine headaches? Tension HA can lead to a migraine and migraine can lead to tension HA
What are the types of migraines (3)? Migraine w/o aura, migraine w/ aura, retinal migraine
What is an aura? Scintillating scotomas: MC migraine aura; an absent arc or band of vision w/ shimmering zigzag border and often combined w/ visual hallucinations that can take many shapes
What is a diagnosis of a migraine based on? Exclusion; R/O other etiologies using lab and/or radiographs, consider visual field testing w/ visual phenomena, have a heightened sense of concern in pts w/ solely unilateral HA that remain on the same side (should change)
What is the research w/ migraines and chiropractic? Not a lot of evidence based research demonstrating the efficacy of chiropractic manipulation in the Tx of migraine and cluster HA
What is the MC primary HA? Tension HA; 75% of HA sufferers; typically a steady ache rather than throbbing and on both sides of the head
Describe Sx of tension HA. No aura; dull achy and non pulsatile; feeling of tightness or hatband-like; mild to moderate in severity; usually bilateral; occipital location less frequent than frontal or temporal regions; may have neck or TMJ pain
What is the cause of cluster HA? Evidence now suggests cause is the hypothalamus
What are features of cluster HA? Rocking back and forth or pacing in the dark; tears streaming from one eye; face contorted in pain
Who is affected more w/ cluster HA? Men 6:1; Usually b/w ages 20-50 but can begin early <10 or late >70; women may get attacks after 50, not correlated w/ menses but tend to stop during pregnancy
What are characteristics of bouts of cluster HA? clustered in cycles that usually last 4-8 weeks; pain-free remission in 90%; bouts may be as short as a few days or as long as 4 months; later the onset the greater chance of it becoming chronic
What is the relationship b/w cluster HA and sleep? Awakened from sleep by pain in ~50% of cases, usually w/in 2 hours of falling asleep; nocturnal attacks associated w/ REM sleep ½ the time in episodic form but rarely in chronic form
What are the types of pain w/ cluster, migraine and tension HAs? Cluster: pain in and around one eye; tension: pain is like a band squeezing the head; migraine: pain, nausea and visual changes are typical of classic form
What are causes of secondary HAs? HA attributable to head and/or neck trauma; HA attributable to cranial or cervical vascular disorders; disorders of the face and neck, eyes, ears, nose, sinuses, etc (cervicogenic)
What are some types of HAs attributable to head and/or neck trauma? acute post traumatic HA; chronic post traumatic HA; acute HA attributable to whiplash; chronic HA attributable to whiplash; traumatic intracranial hematoma; other head or neck trauma
What is the difference b/w acute and chronic post-traumatic HA? Acute resolves w/in 8 weeks after the injury and chronic lasts longer than 8 weeks
What defines significant head trauma? Loss of consciousness, post-traumatic amnesia lasting more than 10 minutes or abnormal results in neuro exam, skull xray, neuroimaging, evoked potential, csf exam, vestibular fxn testing or neuropsychological testing
What defines a mild brain injury? traumatically induced physiologic disruption of brain fxn, indicated by loss of consciousness, a period of post-traumatic amnesia, an alteration of mental functioning following headache trauma, presence of focal, transient neurologic deficits
What are the 3 categories of the Glasgow coma scale? Best verbal response, best eye response, best motor response
How is the Glasgow coma scale interpreted? Comas classified as: severe w/ GCS <8, moderate w/ GCS 9-12, minor GCS >13; individual elements and the score are important
What are types of vascular HAs? stroke, TIA; non-traumatic intra-cranial hemorrhage; unruptured vascular malformation; HA attributable to arteritis; carotid or vertebral artery pain; cerebral venous thrombosis
What are HAs attributed to cranial or cervical vascular disorder? saccular aneurysms, AVMs, subarachnoid hemorrhage, carotid or vertebral artery dissections, vasculitis, subdural and epidural hematomas
What are traction HAs? Result from traction on intracranial structures, mainly vascular, by masses; may also be d/t leakage after a lumbar puncture or b/c of an obstruction in the flow of CSF
What doesn’t Valsalva’s do in a healthy patient? Cause a headache
What are some causes of pain with traction HAs? Stretching of pain sensitive structures like tributary veins, venous sinuses, meningeal vessels, carotid, vertebrobasilar, cerebellar and cerebral aa. and tentorium, sudden or subacute overall or local changes in intracranial compartment volume
What are causes of traction HAs? Primary or mets of meninges, vessels or brain; hematomas; abscesses; post-lumbar puncture; pseudotumor cerebri and various causes of brain swelling; cysts and aneurysms
What locations would cluster, migraines, tension-type and brain tumor HAs be? Unilateral or hemicranial = cluster or migraine HA; cluster HA are almost always unilateral w/ pain in or around the eye, temple or cheek; tension-type HAs usually bilateral; >half the pts w/ brain tumor that have HA have ipsilateral pain
Define cervical radiculopathy. Nerve root dysfunction, usually d/t chronic pressure or invasion of the root, causes radicular syndrome of pain and segmental neuro deficit; causes may include trauma, disc involvement, degenerative changes, mets
What are the causes of cervical radic? Degenerative disc disease; sinal stenosis; herniated cervical disc; facet syndrome less frequently w/ arthrosis/lateral recess stenosis
What causes cervical radic in the old and young? Older: d/t foraminal narrowing from osteophyte formation/degenerative changes; younger: d/t disc herniation or acute injury (trauma)
What is the pain like w/ cervical radic? Insidious onset of neck and arm discomfort that can range from dull ache to severe burning pain; it can radiate to the scapula initially and then along the upper or lower arm and into the hand, depending on the nerve root involved
What most commonly causes C7, C5 and C8-T1 radics? C7: herniated disc; C5: brachial neuritis and spondylosis; C8-T1: pancoast tumor, TOS
What Sx of radic are present w/ C7, C5 and C8-T1 radic? C7: weak triceps and sensory deficit to middle finger; C5: weak deltoids, biceps and infraspinatus w/ sensory deficit over deltoid; C8-T1: atrophy of interossei and paresthesia along 5th digit
What part of the history w/ cervical radic aids in Dx and guiding Tx? Activities and head positions that increase or decrease symptoms
What is cervical myelopathy? A general term denoting functional disturbances and/or pathological chagnes in the spinal cord
What are common symptoms of cervical myelopathy? Clumsy or weak hands, leg weakness or stiffness, neck stiffness, painin shoulders or arms, unsteady gait
What are common signs of cervical myelopathy? Atrophy of the hand musculature, hyperreflexia, L’hermitte’s sign, sensory loss
What are degenerative changes of cervical myelopathy? Posterior protruding disc, ossified PLL, osteophytes, overriding joints of luschka, arthrosis, invagination or ossification of lig flavum
What is the finger escape sign? Patient asked to hold out their hand w/ fingers extended and the medial fingers drift into flexion
What is the inverted radial reflex? Flexion of the fingers from a testing stimulus to the biceps or brachioradialis
What conservative care can patients w/ cervical myelopathy safely receive? Physiotherapy, traction, flexion distraction and activator
What is hyperpathia? Patients have a higher threshold until they sense stimulus and at that point the stimulus is very uncomfortable; hyperesthesia is increase sensitivity/pain at a lower threshold
Where does the C2-3 facet joint refer to? Posterior upper cervical region and head
Where does the C3-4 facet joint refer to? Posterolateralcervical region w/o extension into head or shoulder
Where does the C4-5 facet joint refer to? posterolateral middle and lower cervical region and to the top of the shoulder
Where does the C5-6 facet joint refer to? Posterolateral middle and primarily lower cervical spine and the top and lateral parts of the shoulder and caudally to the spine of the scapula
Where does the C6-7 facet joint refer to? Top and lateral parts of the shoulder and extends caudally to the inferior border of the scapula
What are causes of retropharyngeal hematoma? Hyperextension injury d/t airbag deployment; bouts of coughing, sneezing, straining and vomiting; whiplash; blunt head and neck trauma; carotid artery aneurysm; mets
What do electrodiagnostic studies reflect? Neurologic functional status; pinpoints area of involvement but not the problem; can determine if radic is acute or chronic
What does acute or chronic radic show w/ needle EMG? Acute: fibrillation or sharp waves; Chronic: giant motor unit potentials
What is somatosensory evoked potential useful for? Evaluation of myelopathy but not recommended too identify radic
Why should one use electrodiagnostic studies? To determine the site of a lesion but does not ID what is causing the entrapment, just the location
What is amplitude w/ NCV? The height of the evoked response on the oscilloscope; reflects the size of the response to an electrical stimulus, or the number of conducting fibers and their degree of synchrony
What is latency w/ NCV? Measures the time from the stimulus to the onset of the evoked response; calculated measureing the time it takes to send an electrical stimulus from A to B time it takes is measured and called latency in ms
What is duration w/ NCV? Measures the time of the action potential in the negative direction along the x-axis
What is temporal dispersion? Time the wave is evident on the screen is dependent upon synchrony of the conduction b/w the fastest and slowest conducting nerve fibers
What can affect conduction velocity in myelinated fibers? Myelin thickness, internode distance, age of patient, temperature
What is neuropraxia? short term, compression of the myelin sheath; amplitude of CMAP or SNAP not affected if there is no axonal loss and all axons are conducting the stimulus
What is axonotmesis? axonal loss, nerve sheath intact, regeneration possible; NCV reduced amplitude, motor weakness, longer recovery time, latency not affected since fibers intact
What is neurotmesis? complete severing of a nerve bundle
What is an EMG? Strictly a motor test, negative w/ neuropraxia, must have axonal loss, evident as early as 7 days w/ root lesions, positive peripheral signs usually after 21 days
What are evoked potentials? Strictly sensory; can be used for peripheral nerves or roots
Created by: kabrown