Nms Exam Iii

Front 1

Is all dural pain segmental?

Back 1

No

Front 2

Could a Valsalva reproduce both segmental and non-segmental pain?

Back 2

Yes

Front 3

Which areas of the dura create "pseudoradicular" pain?

Back 3

dural sheath / sleeve

Front 4

Does dural pain radiate?

Back 4

Yes

Front 5

How do you describe the pain pattern associated with lumbago?

Back 5

Extrasegmental

Front 6

Which dural (or other) lesion would provide a lumbago pattern?

Back 6

dural sheath
PLL

Front 7

Can the sinuvertebral nerve produce radicular pain patterns?

Back 7

No

Front 8

Who is credited with the Trigger point theory?

Back 8

Janet Travell

Front 9

T or F
As seen in trigger points, in sympathetic spindle spasms, spindles are overactive due to continued release of acetylcholine.

Back 9

False
NE and epinephrine stimulation

Front 10

T or F
As seen in trigger points, "muscular overload" is eccentric stretch of a hypotonic muscle.

Back 10

True
it is hypotonic because of myofascial injury (annulospiral fires the spindle but the spindle is detached from the muscle)

Front 11

If the cord is sensitized, it could fire "antidroimically" releasing ____ into the disc.

Back 11

SP

Front 12

Dysafferentation = incr or decr nociception and mechanoreception?

Back 12

increased nociception
decreased mechanoreception

Front 13

T of F
The only way for a muscle to spasm is an overactive spindle.

Back 13

True

Front 14

What kind of motor neuron innervates muscle spindles?

Back 14

Gamma

Front 15

Renshaw cells secrete _____.

Back 15

Glycine

Front 16

Renshaw cells are inhibitory or excitatory?

Back 16

inhibitory

Front 17

Which creates the greatest tension, concentric or eccentric?

Back 17

don't know
Dr Criste said concentric in class but ECCENTRIC makes more sense. better find out.

Front 18

IIA fibers are inhibitory to what muscles.

Back 18

Group II - extensors, abductors, ext rotators, intrinsic muscles of the spine
(postural muscles)

Front 19

IA fiber

Back 19

annulospiral

Front 20

T or F
The annulospiral fiber is large and highly myelinated

Back 20

True

Front 21

T or F
The annulospiral will only stimulate the alpha motor neuron.

Back 21

False
It will in inhibit the antagonist at the same time (reciprocal inhibition)
as well as excite the gamma motor neuron b/c of its location next to the alpha motor neuron

Front 22

T or F
One annulospiral fiber can fire more than one muscle.

Back 22

True
It will recruit agonist muscles

Front 23

The annulospiral is wrapped around what intracapsular structure?

Back 23

nuclear chain

Front 24

What is primarily responsible for maintaining "internal stretch" on the center of the nuclear chain?

Back 24

gamma motor neuron
(it sits next to the alpha motor neuron cell bodies and will fire every time it does)

Front 25

Where on the nuclear chain does the gamma motor neuron stimulate?

Back 25

nuclear ends (intrafusal muscle fibers)

Front 26

Because the IIA fibers wrap around the contractile regions of the nuclear chain, tonic contraction keeps stretch ON or OFF the IIA fiber?

Back 26

OFF
stretch is kept off IIA while stretch is kept on IA

Front 27

"flower spray"

Back 27

IIA (secondary afferent)

Front 28

Maximal stretch of a muscle (last 10%) would fire ____ fibers.

Back 28

IIA fibers
(this message would override IA fibers)

Front 29

Why must a clinician hold a stretch for approx 5 seconds for the IIA fibers to have effect?

Back 29

IIA fibers travel slower

Front 30

IIA fibers are excitatory to what muscles?

Back 30

Group I - flexors, adductors, int rotators

Front 31

What is the major source of excitation of the alpha motor neuron?

Back 31

annulospiral fiber "IA"

Front 32

What is the primary purpose of the muscle spindle?

Back 32

maintain tone

Front 33

T or F
Postural muscles will be inhibited by stimulation of IIA fibers.

Back 33

True

Front 34

The use of vibration on the AGONIST or the ANTAGONIST would reduce the tone of a muscle? Why?

Back 34

ANTAGONIST
vibration stimulates the nuclear BAG which facilitates that muscle and inhibit the antagonist

Front 35

An injury that results in muscle fibers actually being torn "in half" is called a ______ ______.

Back 35

transverse strain

Front 36

RICE (rest, ice, compression, elevation) is best for TRANSVERSE or LONGITUDINAL strain injuries?

Back 36

TRANSVERSE strain

Front 37

Often described as "intercellular" tearing or "myofascial" strain.

Back 37

LONGITUDINAL strain

Front 38

Longitudinal strain is the product of stretch to a HYPERTONIC or HYPOTONIC muscle?

Back 38

HYPOTONIC
i.e. bad posture lengthening the postural muscles

Front 39

T or F
In a longitudinal strain injury, only the connective tissue matrix has been damaged, not the muscle fibers.

Back 39

True

Front 40

T or F
Contraction of a longitudinal strain injury is usually painful.

Back 40

FALSE
i.e. after sitting a long time, standing up and stretching (contracting the postural muscles)

Front 41

T or F
For a transverse strain injury, passive contraction will usually NOT hurt.

Back 41

TRUE
active and resisted will hurt

Front 42

Is the muscle fascia innervated?

Back 42

YES
with free nerve endings; this is the source of pain in longitudinal strain injuries

Front 43

CONCENTRIC or ECCENTRIC contractions are often labeled "Active stretch"

Back 43

ECCENTRIC

Front 44

Which is more demanding, CONCENTRIC or ECCENTRIC contraction?

Back 44

ECCENTRIC
most damage to the muscle happens here, usually group II muscles (extensors, etc.)

Front 45

Often referred to as "occult" muscle lesions.

Back 45

Longitudinal strain.
(well hidden)

Front 46

How should the examiner perform the ROM examination to elicit pain from a longitudinal strain injury?

Back 46

must induce "eccentric" contraction, overpowering the muscle.
i.e. If suspecting ext rotators, ask patient to externally rotate while forcing them into internal rotation

Front 47

4 properties of a healthy muscle.

Back 47

IRRITABILITY (responds to stimulus)
CONTRACTIILITY (shortening from irritation)
ELASTICITY (comliance to allow lengthening during active shortening)
TONICITY (background shortening of sarcomeres)

Front 48

Which requires all 4 properties of a healthy muscle (irritability, contractility, elasticity, tonicity), CONCENTRIC or ECCENTRIC contraction?

Back 48

ECCENTRIC

Front 49

What nerve do the nociceptive C fibers of the IVD belong to?

Back 49

sinuvertebral
(aka recurrent meningeal or Luschka nerve)

Front 50

Because the disc is innervated by sympathetic fibers as part of the sinuvertebral nerve, what may be released into the disc (even though it is healthy) as a result of central excitation of the cord?

Back 50

NE from the sympathetic fibers
SP from the C fibers

Front 51

Are standard orthopedic tests effective in reproducing pain in "Discogenic pain"?

Back 51

NO

Front 52

T or F
A patient may elicit some neurological findings in the case of discogenic pain.

Back 52

FALSE

Front 53

T or F
In discogenic limb pain, a patient may have hyperesthesia.

Back 53

TRUE
due to the sensitization of the sencondary neurons in the dorasl horn

Front 54

Can the scleratome pain associated with "discogenic limb pain" be reproduced on examination?

Back 54

YES
the exam may exacerbate the C fiber referral to the extremity

Front 55

The dural sheath is innervated by the _____?

Back 55

sinuvertebral nerve

Front 56

In the case of sciatica without neurological deficit, will the patient present a positive Valsalva or straight leg raise?

Back 56

Yes, possibly.
Likely the result of dural sheath irritation and the examiner should however note that the pain is dull and there is no paresthesia.

Front 57

In true sciatica (nerve compression), what is first to be affected, "A" fibers or motor fibers?

Back 57

"A" fibers

Front 58

T or F
To reduce the tone of an extensor, you may apply a QUICK stretch to the flexor antagonist.

Back 58

TRUE
you may also apply a SLOW stretch to the antagonist in submax - maximal range

Front 59

To reduce the tone of an extensor, could you use SUSTAINED MAXIMAL STRETCH TO THE EXTENSOR or VIBRATION TO THE FLEXOR ANTAGONIST?

Back 59

BOTH

Front 60

Once a "IA" fiber fires, is the result always homonymous facilitation?

Back 60

YES
however, also consider the firing of the gamma and the reciprocal inhibition of the antagonist through the interneuronal pool)

Front 61

What lesions?
+ Babinski

Back 61

pyramidal

Front 62

What lesions?
Hypertonicity without paralysis

Back 62

extrapyramidal
i.e. Parkinsons

Front 63

What lesions?
Paralysis

Back 63

pyramidal (UMN)
alpha motor neuron (LMN)

Front 64

What lesions?
Loss of DTR

Back 64

annulospiral
alpha motor neuron
extrafusal
gamma

Front 65

Which one would NOT be compromised by a radiculopathy?
gamma, somatic afferent, extrapyramidal, alpha motor neuron, or annulospiral

Back 65

extrapyramidal

Front 66

What lesions?
Increased amplitude on a EMG

Back 66

alpha motor neuron
(neuropathy - gains amplitude by recruitment)

Front 67

What lesions?
Decreased amplitude on a EMG

Back 67

extrafusal muscle fiber
(myopathy)

Front 68

What lesions?
Hyperreflexia without weakness

Back 68

extrapyramidal

Front 69

What lesions?
Hyperreflexia with weakness

Back 69

extrapyramidal AND pyramidal both

Front 70

Do myopathies present segmentally?

Back 70

No

Front 71

How does "recruitment occur from a neuropathy?

Back 71

Lesioned motor units become "decentralized", thus developing more acetylcholine receptors to compensate. This will make them sensitized and they will "fibrilate"

Front 72

What could potentially happen to the IVD if the cord becomes "sensitized"? How does it happen?

Back 72

It could cause disc pain by the afferent fiber firing "antidroimically" releasing SP.

Front 73

Who is credited with the theory of "extrasegmental"?

Back 73

Dr. Ceriax

Front 74

T or F
For a posterolateral disc bulge, a lateral disc will present a negative well leg raise test.

Back 74

True
Medial disc will present a positive test

Front 75

A lesion of the cuada equina will present a SEGMENTAL or EXTRASEGMENTAL finding

Back 75

EXTRASEGMENTAL
(Lumbago)

Front 76

Would a central disc bulge produce SEGMENTALLY or EXTRASEGMENTALLY

Back 76

EXTRASEGMENTALLY

Front 77

T or F
The dural sleeve is neural, thus it may produce a radiculopathy.

Back 77

False
It is SOMATIC, so it may produce SCLERATOME pain

Front 78

Can a Renshaw cell inhibit another Renshaw cell?

Back 78

Yes
This is called "disinhibition" because an inhibitory cell is being inhibited, thus allowing an excitation to take place.

Front 79

The intercapsular component of the spindle that is involved in the DTR is the nuclear ______.

Back 79

bag

Front 80

During a Contract/Relax/Stretch technique to remove hypertonicity, what gives a sudden burst of afferentation that inhibits the contaction then allowing further stretch?

Back 80

GTO