Term
|
Definition
have no discs
o A-A almost pure rotation around dens
o Flexion checked by transverse ligament |
|
|
Term
|
Definition
o Uncinate processes create a “saddle” joint between the vertebrae
o Prevents side flexion in coronal plane
o Only two “pure” movements allowed
o Flexion & extension
o Axial rotation about an axis perpendicular to the facet joints |
|
|
Term
|
Definition
o Upper - horizontal
o Lower – vertical
o Planes roughly converge to bridge of nose |
|
|
Term
|
Definition
o Passes through TVP’s
o Most susceptible to manual techniques as it wraps posterior to condyles of atlas
o Esp. with upper Rotation |
|
|
Term
| o Trapezius, SCM and fascia surround the neck superficially |
|
Definition
| insert on head and shoulder girdle |
|
|
Term
| laevator scap and scalenes |
|
Definition
o Insert on the neck, not the head
o Also act on shoulder girdle |
|
|
Term
| muscle actions of levator scap and scalenes |
|
Definition
| adds compressive and shearing forces to the neck |
|
|
Term
|
Definition
o Nodding (Flex/Ext) occurs about EAM
o Side flexion occurs about a nasal axis |
|
|
Term
| palne of the facet joints |
|
Definition
| o Segmental Rotation of lower segments follows _______________ |
|
|
Term
o Upper cervical flexion
o Lower cervical extension |
|
Definition
|
|
Term
| Type I neck dominant pain |
|
Definition
o aggravated by flexion / protrusion activities
o suggestive of disc involvement |
|
|
Term
| Type II neck dominant pain |
|
Definition
o aggravated by extension activities
o suggestive of facet involvement
o frequently occurs with trauma (e.g. post MVA)
o non-traumatic onset common with cervical OA |
|
|
Term
| Type III arm dominant pain |
|
Definition
o Pain at rest, worse with loading
o Suggestive of bulging / herniated disc |
|
|
Term
| Type IV Arm dominant pain |
|
Definition
o Pain with extension, ipsilateral side flexion
o Suggestive of lateral stenosis |
|
|
Term
o Dizziness
o Diplopia
o Drop Attacks
o Dysarthria
o Dysphagia |
|
Definition
|
|
Term
|
Definition
Due to sympathetic ganglion problem
o Miosis (contracted pupil)
o Ptosis (drooping eyelid)
o Enophthalmos (eye recesses into orbit)
o Anhydrosis (loss of sweating)
o Facial flushing |
|
|
Term
|
Definition
o History of immediate severe pain ?
o Followed by severe limitation of ROM in all directions
o Observe facial, mastoid, neck bruising
o Spasm End Feel in most/all directions
o Painful weakness in multiple directions on isometric muscle testing
o Significant TOP at SP’s
o Pain with tuning fork at SP’s |
|
|
Term
|
Definition
o Illusion of rotary (or linear) motion
o Can be “objective” or “subjective |
|
|
Term
|
Definition
o Lightheadedness, nausea, wooziness, fainting
o Most common type of dizziness |
|
|
Term
|
Definition
o Actually being off-balance
o Unlikely due to VBI if seen in isolation |
|
|
Term
|
Definition
o Pt sitting, raises arms 90 degrees, supinates
o First part: pt closes eyes (non-vascular effect)
o Second part: pt turns head (vascular effect)
o Looking for proprioceptive loss |
|
|
Term
1. Pain without radiation
2. Pain + radiation to proximal extremity
3. Pain + radiation to distal extremity
4. Pain + radiation distally + neuro signs
5-6. Confirmed nerve root compression
7. Spinal Stenosis
8-9. Post-surgical status
10. Chronic Pain Syndrome
11. Other (non-mechanical) |
|
Definition
| Quebec Task Force (QTF) Classification of Activity-Related Spinal Pain: |
|
|
Term
|
Definition
Disc pain: Temple, Parietal
TMJ , Jaw
Occiput, sub-occiput,
neck, throat,
upper back, trapezius,
top of shoulder, arm |
|
|
Term
|
Definition
Disc pain:Parietal
TMJ
Occiput, sub-occiput,
neck, throat,
upper back, trapezius,
top of shoulder, arm
anterior chest |
|
|
Term
|
Definition
Disc pain: Occiput, sub-occiput
neck, throat
upper back, trapezius
top of shoulder, arm
anterior chest |
|
|
Term
|
Definition
Disc pain: neck
upper back, trapezius
top of shoulder, arm
anterior chest
scapula |
|
|
Term
|
Definition
| develops a pseudoarthritis by adolescence |
|
|
Term
|
Definition
| significant source of lateral stenosis via osteophyes along with others from facets |
|
|
Term
|
Definition
| balances the posterior pull of trapezius anteriorly |
|
|
Term
|
Definition
| synergistically contracts to prevent unwanted neck flexion |
|
|
Term
| levator scapulae and scalenes |
|
Definition
| main deep stabilizers of the neck, also act on the shoulder girdle |
|
|
Term
| above c3 (no vertebral discs) |
|
Definition
| can only get postural or dysfunction syndroms in this area |
|
|
Term
| ussually responds to sagital techniques |
|
Definition
|
|
Term
|
Definition
| suggest a large bulge- requires more time and therapist assist |
|
|
Term
|
Definition
Minor bulge, central pain
Responds to sagittal tech.
(retraction -> extension)
Often can reduce in sitting
Delay therapist assist for a while then use assisted REIL until patient can control symptoms in sitting |
|
|
Term
|
Definition
Significant (“hard”) bulge, central or symmetrical pain
May take weeks to reduce
Start with RIL - may even need pillow(s) - go slow
Often needs therapist assist
May need traction |
|
|
Term
|
Definition
Posterolateral mild to mod. bulge, unilateral pain
At least 60% respond to sagittal techniques alone
If extension works it will happen quickly (24-48 hrs)
Can use SF or a “quadrant” technique (combined Ext / SF) |
|
|
Term
|
Definition
acute wry neck”
90% recover spontaneously within a week (so you won’t see them often)
Usually needs some combination of SF and/or traction in lying |
|
|
Term
|
Definition
Progression of D3, so treat as such
(sagittal techniques first)
Pressure on nerve root is usually intermittent (no neuro signs)
If neuro deficit, more resistant to reduction
Usually requires therapist assist in lying |
|
|
Term
|
Definition
Big bad bulge, often with constant arm pain
The more significant the neuro deficit, the less the chance of responding to repeated movements
Try repeated movements first.
Then try mechanical traction
Acute may respond to fist traction |
|
|
Term
|
Definition
Symmetrical or asymmetrical pain about C4/5/6
with or without anterior/anterolateral neck pain
Dysphagia common
No deformity, but flexion obstructed (appears as flexion dysfunction)
Rapidly reversible
(about 4% of cervical problems) |
|
|
Term
|
Definition
| almost always the source of sub occipital headaches |
|
|
Term
0 No neck complaints, no physical signs
I Neck pain, stiffness, or tenderness only.
II Neck complaints & Musculoskeletal signs
III Neck complaints & Neurological signs
IV Neck complaints & Fracture / dislocation |
|
Definition
|
|
Term
|
Definition
| the head pain is itself the problem – although the pathogenesis may be unclear |
|
|
Term
|
Definition
| pain is a symptom of an underlying disorder |
|
|
Term
|
Definition
Affects 10% of the population
Pathogenesis believed to involve genetically induced hypersensitivity of pain pathways
Two main types are with / without aura
Without aura is more common |
|
|
Term
4-72 hours
• At least two of the following:
o Pulsating quality
o Moderate or severe intensity
o Aggravated by or causing avoidance of routine ADL’s (walking, climbing stairs)
• At least one of the following:
o Nausea and/or vomiting
o Photophobia or Phonophobia
• With or without aura |
|
Definition
|
|
Term
|
Definition
Most frequent primary headache
1-yr prevalence rates higher than 30% |
|
|
Term
Infrequent episodic (<1 per month)
Frequent episodic (1-14 per month)
Chronic (>15 per month) |
|
Definition
| three forms of tension type headaches |
|
|
Term
• Duration is from 30 minutes to 7 days (continuous if “chronic”)
• At least two of the following:
o Bilateral location
o Pressure/tightness (not pulsating) in quality
o Mild or moderate intensity
o Not aggravated by routine ADL’s (walking, climbing stairs)
• Both of the following:
o No nausea or vomiting
o No more than one of photophobia or phonophobia |
|
Definition
| tension type headache criteria |
|
|
Term
| tirgemnial autonomic cephalgias |
|
Definition
Group of related disorders affecting the trigeminal nerve (usually 1st division)
Short-lived unilateral pain and prominent autonomic dysfunction ipsilateral to the pain
Cluster headaches
Paroxysmal hemicrania
SUNCT |
|
|
Term
|
Definition
Excruciating unilateral orbital / paraorbital pain with autonomic accompaniments:
Conjunctivial injection, lacrimation, nasal congestion, rhinorrhea, miosis +/or ptosis
Attacks in evening/night, 15-180 min duration
Onset age 20-40, more common in males
Triggered by vasoactive substances
Attacks typically come in cycles
weeks to months separated by remissions |
|
|
Term
o Atlanto-occipital joints
o Lateral atlanto-axial joints
o C2-C3 facet joints and C2-C3 IV disc
o Sub-occipital & upper posterior neck muscles
o Upper dura mater
o Vertebral arteries
o Trapezius and SCM |
|
Definition
| structure innervated by c1-3 |
|
|
Term
| rectus capitus post minor, ligamentum nuchae |
|
Definition
| have direct attachments on the pain-sensitive sub-occipital dura |
|
|
Term
|
Definition
| Trigeminocervical nucleus reaches at least as far as _______ |
|
|
Term
|
Definition
| Due to compression of the C2 ventral ramus, caused by subluxation of the lateral A- joint, creating pain radiating to the ear and numbness of the ipsilateral tongue |
|
|
Term
|
Definition
PT is more effective than massage therapy or acupuncture– esp. for patients with a high frequency of occurrence
Chiropractic manipulation may be helpful – but consider cervical vascular risk |
|
|
Term
| treatment for migrane headache |
|
Definition
PT combined with aerobic exercise is effective
PT combined with relaxation therapy and thermal biofeedback is effective |
|
|
Term
|
Definition
SMT is more effective than massage
There is no difference in outcome between chiropractic manipulation vs manipulation or mobilization done by other health professionals |
|
|
Term
|
Definition
A hyperirritable spot in skeletal muscle that is
associated with a hypersensitive palpable nodule
in a taut band.
Ø The spot is painful on compression and may give
rise to characteristic referred pain, referred
tenderness, motor dysfunction, and autonomic
phenomena |
|
|
Term
|
Definition
cause local and referred
pain which is felt somewhere else in the body as
well as a decrease in the range of motion for that
muscle. |
|
|
Term
|
Definition
do not cause pain except
for local tenderness when compressed, but they
will restrict range of motion |
|
|
Term
|
Definition
These are the primary source of pain
Ø Always occur in the muscle belly where the motor
end plate enters the muscle
Ø Multipennate muscles have several TPs |
|
|
Term
|
Definition
Secondary TP’s within the area of referred pain
Ø Create cascades of chronic pain
Ø Will not resolve unless the primary TP is inactive |
|
|
Term
|
Definition
consistently
found in the midregion
of each
muscle fiber |
|
|
Term
| Calcium relase from SR> sarcomeres contract> increased metabolism combined with local ischemia> energy crisis> failed reuptake of calcium |
|
Definition
| energy crisis theory of trigger points |
|
|
Term
| pain spasm hypothesis of trigger points |
|
Definition
| Does not stand–up to experimental verification |
|
|
Term
| muscle spindle hypothesis of trigger points |
|
Definition
intrafusal muscle fibers,
encapsulated structures about 1 cm in length,
that are made over-active by adrenalin
stimulation via the sympathetic nervous system |
|
|
Term
| neuropathic hypothesis (Gunn) |
|
Definition
proposed that the cause of TrP
hypersensitivity is neuropathy of the nerve
serving the affected muscle |
|
|
Term
| Cannon & Rosenblueth’s Law of Denervation |
|
Definition
When efferent neurons are damaged, an increased
irritability to chemical agents develops in the
target structures
Ø The denervated structures become supersenstive to
a variety of chemical and physical inputs |
|
|
Term
|
Definition
| Most common cause of neuropathy is |
|
|
Term
|
Definition
__________ in paraspinal muscles further
compresses the spondylytic segment |
|
|
Term
|
Definition
a type of nociceptor that are
“switched on” under certain physiological
conditions, morphing into TPs |
|
|
Term
|
Definition
there are usually
several trigger points responsible for any given
regional pain |
|
|
Term
neuroplastic changes at the level of the dorsal
horn which results in amplification of the pain
sensation (i.e. central sensitization)
Ø with a tendency to spread beyond its original
boundaries (i.e. expansion of receptive fields).
Ø In some instances segmental central
sensitization leads to the phenomena of mirror
image pain (i.e. pain on the opposite side of the
body in the same segmental distribution) |
|
Definition
| persistence of a trigger point may lead to |
|
|
Term
|
Definition
T or F: A newly activated isolated TrP is very responsive to
simple stretch therapy |
|
|
Term
|
Definition
T or F: has a strong local anti-inflammatory effect
• Has been shown to relieve the pain and
inflammatory reaction from a ligamentous sprain
• And total abolition of pain of a first- or seconddegree
burn, including the prevention of blister
formation, when applied immediately |
|
|
Term
|
Definition
acts by blocking release of ACh at the NMJ –
therefore it quickly inactivates TrPs at the NMJ
• Only clear indication is if the perpetuating factors
cannot be addressed (eg spasticity form a CNS lesion) |
|
|
Term
|
Definition
| o If history of headaches – isolate motions to |
|
|
Term
S1. often no trauma (can happen with trauma but commonly none)
S2. extraspinal pain – just deltoid, rhomboids, and no cervical pain
(often younger person)
S3. pain at rest or sitting
O4. Responds to repeated movements (centralizes or peripheralizes; often won’t really do this – it will just go away)
O5. PDM
O6. Marked increase in ROM when unloaded (lying instead of sitting/standing) |
|
Definition
| Suspected pathology : disc derrangement D1-4 |
|
|
Term
S1. history of trauma/OA (can be just woke up with kink, sharp pain after activity)
S2. location of pain tends to include neck – intrinsic/localized
(can refer if acute, inflamed but not always will)
S3. intermittent/movement related pain – not at rest
O4. ERP
O5. Responds to SNAGs |
|
Definition
suspected pathology: facet
dysfunction |
|
|
Term
1. sudden onset
2. dermatomal/in to the hand (if it was central stenosis myelopathy)
3. + Spurlings test (extension plus ipsi SF)
4. relief with traction
5. effect of contralateral side flexion varies – depends on amount of bony stenosis vs disc bulge and how narrow it is
6. MAY centralize with repeated movements
S7. more sensitive to loading (carrying objects, lifting arm overhead makes pain shoot down arm) |
|
Definition
suspected pathology: nerve root pain from a herniated disc
arm dominat sudden onset D5-6 |
|
|
Term
1. gradual onset (age over 50) (younger than in lumbar)
2. dermatomal (radicular) – or UMNL symptoms if central (bilateral, quadrilateral)
3. + Spurlings – (really the extension componene)
4. relieved by traction (esp in flexion; with added contralateral SF for lateral stenosis) |
|
Definition
suspected pathology: nerve root impingement from stenosis
arm dominant |
|
|
Term
1. (gradual onset, chronic)
Long time since trauma – not acute
2. constant pain/pain out of proportion to loading
3. shows “quasi-contractile” pattern on assessment – (not a contractile lesion but will present party as contractile; quasi-weakness)
4. signs of TPs:
-taut band
-sensitive nodule – may or may not be able to feel it within band
-pressure refers pain
-reproduces symptoms
-not always but may have local twitch response |
|
Definition
| suspected pathology: myofascial trigger points |
|
|
Term
1. recent trauma (or overloading)
2. pain with contralateral active and passive ROM
3. nil pain with mid RIM resisted
4. pain with traction and contralateral stretch |
|
Definition
| suspected pathology: ST trauma articular |
|
|
Term
1. recent trauma (including contact sports)
2. pain with ipsilateral active and especially resisted ROM
3. pain with contralateral stretch
4. localized TOP
May also refer pain |
|
Definition
| suspected pathology: ST trauma extra articular |
|
|
Term
1. trauma or disease (RA, down’s syndrome, laxity)
2. variable neuro symptoms (light/sound sensitivity, changes in smell/taste, off and on, intermittent)
3. clicking/clunking (or people that crack their neck repeatedly or long term chiro!)
4. worse with loading and quick movements
5. + Sharp Purser and/or alar stress tests and/or + PAs in the lower segments
7. feeling of having to hold the head when they bend forward (could also be dens fracture) |
|
Definition
| suspected pathology: instability |
|
|
Term
1. trauma or repetitive loading
2. LOS: occipital – confirmed; anywhere else – not sure
3. S: worse with cervical positions or movements
4. O: affected by cervical positions or movements
5. altered by traction /compression
6. reproduced by palpation
7. Triggerpoint palpation only – TTH headache likely |
|
Definition
| suspected pathology: cervicogenic headaches |
|
|
Term
1. TRAUMA
2. immediate onset of pain and decreased ROM in all directions
3. SP TOP
4. pain with MMT in all directions
5. < 45 degrees rotation |
|
Definition
| suspected pathology: fracture |
|
|
Term
1. 5 D’s and 3 N’s
2. nystagmus during movement testing
3. (-) vestibular tests (do these 1st) |
|
Definition
|
|
Term
atlanto axial jts
uncovertbral joints
bidirectionalreferral of pain
uncovertebral clefts invad discs
rotation
nerves exit above level |
|
Definition
|
|
Term
|
Definition
| extend from uncovertebral joints into discs |
|
|
Term
| flex/ext, rotation abou an axis perpindicular to the plane of the faets |
|
Definition
| movements allowed by uncovertebral joints |
|
|
Term
o Facial paresthesia
o Syncope (periodic LOC)
o Sudden deafness, or pulsatile tinnitus
o “Sounds not having an external source”
o Objective (the examiner can hear also)
o Vascular bruit potentially most serious
o Subjective (only heard by patient)
o Frequency of tinnitus is usually related to frequency of hearing loss
o Low frequency tinnitus is normal when very quiet (eg holding sea shell to ear)
o Problems with Mentation
o Coman’s 5 D’s of VBI |
|
Definition
|
|
Term
o Facial paresthesia
o Syncope (periodic LOC)
o Sudden deafness, or pulsatile tinnitus
o “Sounds not having an external source”
o Objective (the examiner can hear also)
o Vascular bruit potentially most serious
o Subjective (only heard by patient)
o Frequency of tinnitus is usually related to frequency of hearing loss
o Low frequency tinnitus is normal when very quiet (eg holding sea shell to ear)
o Problems with Mentation
o Coman’s 5 D’s of VBI |
|
Definition
|
|
Term
| almost pure rotation around the dens |
|
Definition
| the motion of the atlanto axial joint is _________ |
|
|
Term
| the planes of the facet joints |
|
Definition
| segmental rotation of the lower segments follows _______ |
|
|
Term
| hold the lower joints in flexion |
|
Definition
| how do you isolate the motion of the upper cervical joints? |
|
|
Term
|
Definition
| in lateral stenosis, from spinal and peripheral impingement, aggrivated by thoraci kyphosis is called |
|
|
Term
disc bulge/herniation
inflammation post trauma
lateral stenosis |
|
Definition
| causes of radicaular pain |
|
|
Term
No neck complaints, no physical signs
I Neck pain, stiffness, or tenderness only.
II Neck complaints & Musculoskeletal signs
III Neck complaints & Neurological signs
IV Neck complaints & Fracture / dislocation |
|
Definition
|
|
Term
|
Definition
| fx of posterior arch of atlas |
|
|
Term
|
Definition
| fx of the dens of the axis |
|
|
Term
Jefferson’s
Hangman’s
Dens type II
Flexion teardrop
Extension teardrop (in extension |
|
Definition
|
|
Term
Greater response to greater occipital nerve block
Decreased pressure-pain threshold
Greater loss of flexion/extension, rotation ROM
Increased pain response to skin roll test |
|
Definition
| Comparing CGH to TTH, CGH _______ |
|
|
Term
|
Definition
| wind around the posterior aspect of the condylar facets of the atlas |
|
|
Term
Posterior suboccipital muscles
Cervical erector spinae muscles
Scalenes (anterior, medius, posterior)
Sternocleidomastoid
Levator scapula
Trapezius, upper fibers |
|
Definition
|
|
