Ther Ex 2: Exam 2

Front 1

compression of nerves, arteries, and veins that come from the area between the clavicle and first rib. subclavian vein and artery

Back 1

what is TOS?

Front 2

disturbance of the brachial plexus due to a structural anomaly

Back 2

what is true TOS?

Front 3

a longer cervical TP or a cervical rib

Back 3

what is the reason for true TOS?

Front 4

incidence 0.74%

female:male ratio is 7:3

complete vs incomplete

Back 4

what is the % of cervical rib incidence of TOS?

Front 5

incidence: 0.76%

equal occurrence in men and women

Back 5

what is the % of anomalous 1st ribs of TOS pts?

Front 6

structural abnormalities

Back 6

what is the primary case for TOS?

Front 7

1.scalene triangle

2.costoclavicular space

3.pec minor

4.elevated 1st rib

Back 7

what are the entrapment areas for TOS?

Front 8

20-50 yo

Back 8

what is the TOS age range ?

Front 9

< 5% teenagers

10% over 50

rarely > 65

70% female

70% cervical ribs occur in females

Back 9

what % of the population has TOS?

Front 10

swelling of muscle belly - pain, parathesias,numbness, weakness

scarring/fibrosis of muscle belly - occipital headaches, muscle spasms

ex: neck trauma

Back 10

what occurs with neurogenic TOS?

Front 11

pain, parathesias, numbness , weakness, necrosis, escemia, edema, swelling throughout the affected extremity

Back 11

what are the symptoms of neurogenic TOS?

Front 12

radial and musculocutaneous nerve distributions

Back 12

what nerves are affected with the "Upper Plexus"?

Front 13

median and ulnar nerve distributions

Back 13

what nerves are affected with the "Lower Plexus"?

Front 14

distal of brachial plexus

Back 14

what is a peripheral nerve distribution ?

Front 15

occipital headaches- postural related

perceived muscle weakness - actual weakness and atrophy are rare

vasomotor symptoms- vasospasm, edema, hypersensitivity, chronic regional pain syndrome (CRPS)

Back 15

what are the symptoms of neurogenic TOS?

Front 16

careful pt history and thorough appropriate physical examination

Back 16

how is TOS diagnosed?

Front 17

no single test has sufficient specificity to prove or exclude the diagnosis

Back 17

what specific test can help dx TOS?

Front 18

neurogenic- heaviness, progressive weakness, numbness, tingling in fingers, progressing up arm

Back 18

what is nTOS?

Front 19

venous- cyanotic arm with distended forearm muscles

Back 19

what is vTOS?

Front 20

arterial- ischemic, cramping pain, temperature change, flaky dry skin, hair growth

Back 20

what is aTOS?

Front 21

scalenes aniticus and medius muscles, pec minor and costocoracoid lig., costoclavicular membrane and subclavius muscle, first rib, cervical rib anomalies, long TP, clavicle abnormalities

Back 21

what are some TOS causes?

Front 22

edema, venous distension, paget schroetter syndrome, clotting, DVT, cyanosis

Back 22

what happens with compression to a (vascular) subclavian vein?

Front 23

loss of pulse, claudication, thrombosis, aneurysm

Back 23

what happens with compression to a (vascular) subclavian artery?

Front 24

raynauds phenomenon- feeling of cold and numbness to extremities

Back 24

what happens with compression to a nerve to the sympathetic nervous system?

Front 25

pain, parathesias, motor weakness

Back 25

what happens with compression to a nerve to the peripheral nervous system?

Front 26

carpal tunnel, ulnar nerve compression, rotator cuff tendonitis, cervical spine strain/sprain, fibromyositis, cervical disk disease, cervical atrhritis, brachial plexus injury

Back 26

what are the differential diagnosis of nTOS?

Front 27

pulse exam- listen for bruits(abnormal artery sounds)

edema/cyanosis/colatteral veins

tenderness over scalene muscles or pec minor (trigger points)

reduced sensation to very light touch in fingers

provacative maneuvers

Back 27

what would be examined in a TOS physical exam?

Front 28

Scalenes

1.pt seated ,arms at sides, the radial pulse is palpated and the examiner listens for bruits above the clavicle

2.elevate arm and turn the chin both away from the involved side.

3.a positive test results in diminished radial pulse, bruit, numbness , tingling. subclavian artery is being subcluded

Back 28

what is the Adson test?

Front 29

up to 50% of healthy volunteers have a positive test-unreliable for diagnosis of TOS

Back 29

what % of people have a positive Adson test?

Front 30

pec minor

examines neural tissue compromise through the pec minor axillary interval

Back 30

what is the Wrights Test?

Front 31

Vascular compromise- axillary interval

1.elevated arm stress test

2.most accurate clinical test

3.hold surrender position for 3 min. while opening/ closing hands

creating oxygen build up of pain/fatigue

Back 31

what is the ROOS test?

Front 32

decreased radial pulse

military brace

dropping the clavicle onto the first rib

Back 32

what is the costoclavicular maneuver?

Front 33

putting strain on UE nerve distribution .

positive response indicates compression of cervical roots or brachial plexus

negative response is usually adequate to rule out nTOS

Back 33

what is the Upper Limb Tension Test (ULTT)?

Front 34

nerve glides

used to help reduce nerve impingement symptoms down the extremity

Back 34

what is nerve flossing?

Front 35

inert and dynamic structures

Back 35

what structures does stability require?

Front 36

introduced a model of spinal stabilization with three interdependent subsystems

Back 36

who is Panjabi?

Front 37

lig, capsule, structures that cannot contract

Back 37

what is a passive subsystem?

Front 38

multifidii, TrA. , muscle

Back 38

what is an active subsystem?

Front 39

nerves that innervate

Back 39

what is a neural control subsystem?

Front 40

spine stays in position where there is no stress or strain on passive subsystem

Back 40

what is the neutral zone?

Front 41

activation of the subsystems

Back 41

what is the elastic zone?

Front 42

osteoligamentous and neuromuscular components of the spine fail to prevent slippage

Back 42

what is postural instability?

Front 43

pain increases , ligaments expand to support

Back 43

what is a ligament stretch?

Front 44

will create hyper mobility , we need stability

Back 44

what will and adjustment do to lower back pain?

Front 45

occurs during function, not at rest. theres a malignancy if theres pain at rest.

Back 45

when would a pt feel low back pain?

Front 46

the TrA and the multifidii

Back 46

what muscles are the first to activate with rapid UE movement?

Front 47

with isometric contractions

Back 47

how is the TrA activated?

Front 48

a moth eaten effect happens to this muscle with atrophy. does not spontaneously return

Back 48

what happens to the multifidii during a L/S injury?

Front 49

shuts off during injury

Back 49

What happens to the multifidii after injury?

Front 50

slow oxidative, endurance

Back 50

what are type 1 muscle fibers?

Front 51

fast glycolitic, power

Back 51

what are type 2 muscle fibers?

Front 52

turn into FT instead of ST

Back 52

what happens to the stabilization muscles after an injury?

Front 53

creates intramuscular stability that compresses the diaphragm , creating intrabdominal pressure

Back 53

what happens when you hold your breathe (Valsalva Manuever)?

Front 54

shoulder flex

Back 54

trunk ext

Front 55

shoulder ext

Back 55

trunk flex

Front 56

hip flex

Back 56

trunk flex

Front 57

hip ext

Back 57

trunk ext

Front 58

lipping

Back 58

what is a direct correlation of instability in the spine?

Front 59

dysfunctions off the spine and its, not diseases

Back 59

what are DDD and DJD considered?

Front 60

self manipulater- crack head

fidgety-constantly changing position

postural nystagmus-juddering back and forth

use of UE to return from forward bent position

steppage found in standing- refers to SP

segmental muscle guarding/ chemical holding pattern in standing which disappears in prone

grades 5 and 6 of mobility

Back 60

what are the signs of instability?

Front 61

unstable

Back 61

when the SP disappears in prone?

Front 62

stable

Back 62

when the SP remains in prone?

Front 63

condition of the spine or degeneration

Back 63

what is spondylosis?

Front 64

fx of the pars articularis

Back 64

what is spondololysis?

Front 65

slippage of the body, ant. slippage , and going to see steppage

ex: gymnasts-backbending

Back 65

what is spondylolithesis?

Front 66

fx of the pars articularis that looks like a collar

Back 66

what is the scottie dog fx sign?

Front 67

posterior displacement of one of the vertebral bodies

Back 67

what is a retrolisthesis?

Front 68

creep, nociceptors, fidgity

Back 68

what are the effects of mechanical stress on the spine?

Front 69

exaggerated curves lead to stretch on passive structures-creep and fluid redistribution-making tissue vulnerable to injury

Back 69

what are the effects of impaired postural support from trunk muscles?

Front 70

loss of length tension curve

Back 70

what happens with stretch weakness?

Front 71

loss of elasticity

Back 71

what happens with tight weakness?

Front 72

nods and or nutates

Back 72

what does the multifidii do to the sacrum?

Front 73

greater demand on passive structures creating fatigue

Back 73

what is the effect of impaired muscle endurance?

Front 74

postural fault, postural dysfunction

Back 74

what are the pain syndromes related to impaired posture?

Front 75

deviation from normal alignment but no structural limitation.pain usually due to mechanical stress. correct posture, correct pain.

Back 75

what is postural fault?

Front 76

adaptive shortening and weakness .leads to further dysfunction

ex:impingement

Back 76

what is postural dysfunction?

Front 77

idiopathic, irreversible fixed lateral curve . rib promenance on convexity posteriorly no matter the position , theres always a fixed curve

Back 77

what is structural scoliosis?

Front 78

AKA: postural

changed with position, or align pelvis. L/L discrepancy

Back 78

what is nonstructural/functional scoliosis?

Front 79

stretch: concavity

strengthen: convexity

Back 79

what do we want to do to the convexity and concavity with scoliosis?

Front 80

1.proprioception and control: put them in the position we want and don't want. awareness of symptoms and verbal cueing

2.impaired jt ,muscle, and connective tissue mobility-use mobs and stretching

3.impaired muscle performance strengthening

Back 80

what are the general management guidelines to postural alignment?

Front 81

most common c/o with impaired posture. about 20% of all recurrent HA are cervicogenic

Back 81

what is the most common cause of tension and cervical headaches?

Front 82

1.between vertebra of C1 & C2

2. under and around Inferior capitis obliques

3.under semispinalis

4.under upper trap

Back 82

what are the 4 entrapment sites of the cervical spine?

Front 83

unilateral HA

neck pain-to head

fluctuates from mild to severe

increased with sustained postures, neck positions

postural dysfunctions

Back 83

what are the signs and symptoms of cervicogenic headaches?

Front 84

joint mobs- subcranial, thoracic

strengthen deep flexors

increase lumbar posture

increase shoulder girdle strength/posture

increase neuro tissue

Back 84

what are the general management guidelines for cervicogenic headaches?

Front 85

cervical flexion-rotation test. loss of ROM to either side by 10 degrees is correlated to CHAs

Back 85

what test can identify CHAs?

Front 86

hydraulic, weight bearing, shock absorber

body and intervertebral disk

Back 86

what is the functional component of ant. portion of the spine?

Front 87

provides movement .TP and SP as attachments for muscles for control and stability

articular processes and facet jts

Back 87

what is the functional component of post. portion of the spine?

Front 88

same as the lumbar spine

Back 88

what is the lower thoracic mobility compared too?

Front 89

SB and rotation and occur to opposite sides

Back 89

what happens to the lumbar /thoracic facets in neutral?

Front 90

facets slide down (closing)

Back 90

L/T backward bending?

Front 91

facets slide up (opening)

Back 91

L/T forward bending?

Front 92

contralateral facet slides up (opens)

ipsilateral facet slides down (closing)

Back 92

L/T sidebending?

Front 93

contralateral facet becomes a fulcrum, ipsilateral facet opens

Back 93

L/T rotation?

Front 94

same as the cervical spine

Back 94

what is upper thoracic mobility compared too?

Front 95

rotation and side bending occur to the same side

Back 95

what happens to the C/T facet of C2 and below?

Front 96

facets slide anteriorly and superiorly (up and forward)

Back 96

C/T forward bending?

Front 97

facets slide posteriorly and inferiorly (down and back), ligamentum lava folds inward-could cause compression to cord

Back 97

C/T backward bending?

Front 98

contralateral facet slides superiorly and anteriorly (up glide), ipsilateral facet slides posteriorly and inferiorly( down glide)

Back 98

C/T sidebending

Front 99

same as for side bending

Back 99

C/T rotation?

Front 100

the same as occiput

Back 100

what direction does the atlas always move?

Front 101

acts as a washer between the skull and C2

Back 101

what does atlas act as between the skull and C2?

Front 102

knodding, 20 degrees of flexion and extension

Back 102

what is AO primary motion?

Front 103

occipital condyles are stuck to atlas

Back 103

what is a sticky atlas?

Front 104

aa jt

Back 104

what jt provides the largest component of cervical axial rotation?

Front 105

10 degrees of flexion/extention, 5 degrees sidebend and 45-50 degrees of rotation

Back 105

what are the degrees of movement at the AA jt ?

Front 106

alar ligaments

Back 106

what ligament restrains rotation at the AA jt?

Front 107

initially -sharp, local LBP -may experience a ripping or tearing sound.

pain increased with sitting/ forward bending

SLR: 30-60 degrees

once settled (+/- 2weeks) radiating symptoms develop

loss of skin sensation and motor function, diminished DTRs, neurotension signs

Back 107

what are the signs and symptoms of a HNP?

Front 108

LB first aid and education

Back 108

what is a HNP tx immediately(acute)?

Front 109

positional distraction

Back 109

what is a HNP tx in the settled stage?

Front 110

manipulation to hypomobile segments (avoiding rotation), stabilization, general conditioning. with gradual return to function

Back 110

what is the HNP tx in the chronic stage?

Front 111

movement of the spine

Back 111

what are facet its responsible for?

Front 112

1.synovitis/hemarthrosis

2.stiffness

3.painful entrapment

4.mechanical blocking

5.arthrosis

Back 112

what are the 5 typical facet jt dysfunctions?

Front 113

facet strain,guarded movements, voluntary and involuntary muscle guarding,treat with rest, cautious movements for 10 days

Back 113

what process occurs during synovitis/hemarthrosis?

Front 114

resolved synovitis,hemarthrosis-presents with stiffness (asymptomatic) - increase risk of re injury , treat with manipulation

Back 114

what occurs with stiffness during FJD?

Front 115

inferior articulating facet unable to glide down on superior articulating facet. pain with return to neutral-pain free into forward bending, treat with isometric contraction of multifidii-3 protective mechanisms of the facet, manipulation, gapping

Back 115

what occurs with painful entrapment during FJD?

Front 116

loose body in jt or impact,relatively pain free, motion blocked in one direction, treat with rotational manipulation over bolster (L spine), strong traction with SB away, rotate towards ( C-spine)

Back 116

what occurs with mechanical blocking during FJD?

Front 117

trauma, overuse, posture, dull ache, or local pain. treat with postural corrections and manipulation to segments above and below

Back 117

what occurs with arthrosis during FJD?

Front 118

constriction or narrowing of a passageway

Back 118

what is stenosis?

Front 119

gives bilateral symptoms, lordosis can relieve pressure

Back 119

what is central stenosis?

Front 120

gives unilateral symptoms, foramen innervated

Back 120

what is lateral stenosis?

Front 121

bike test

Back 121

what test is used to distinguish between vascular and neurogenic signs?

Front 122

intermittent claudication

Back 122

what is a vascular sign of stenosis?

Front 123

used when extension activities are contraindicate

Back 123

what are Williams flexion exercises?

Front 124

to move the pain to a central location. person

Back 124

who is Robert McKenzie?

Front 125

back bending only relieves pressure, does not put the NP back in the disk. grades 1&2 mechanoreceptors help this pain.

Back 125

what does back bending do, with an ext. bias?

Front 126

steppage, guarding, fidgiting ,etc

Back 126

what are signs of instability?

Front 127

grades 5&6 of mobility

Back 127

what grades of mobility are used with signs of instability?

Front 128

pain with non organic origin. we cannot tx, its psychological

Back 128

what are Waddell signs?

Front 129

skin discomfort on light palpation

Back 129

what is WS for superficial tenderness?

Front 130

tenderness crossing multiple anatomic boundaries

Back 130

what is the WS for nonatomic tenderness?

Front 131

eliciting pain when pressing down on the top of the pts head

Back 131

what is the WS for axial loading?

Front 132

rotating the shoulders and pelvis together should not be painful as it does not stretch the structures of the back

Back 132

what is the WS of pain on simulated rotation?

Front 133

if pt complains of pain on straight leg raise , but not if the examiner extends the knee with the pt seated

Back 133

what is WS for distracted leg raise?

Front 134

stocking sensory loss, or sensory loss in an entire extremity or side of the body

Back 134

what is the WS for regional sensory change?

Front 135

weakness that is jerky , with intermittent resistance ( such as cog wheeling, or catching)

Back 135

what is the WS for regional weakness?

Front 136

exaggerated painful response to a stimulus , that is not reproduced when the same stimulus is given later

Back 136

what is the WS of overaction?

Front 137

same side as the concavity

Back 137

what side of the body would you place a pt who has scoliosis in sideline to manipulate?

Front 138

awareness of the pts movement and how it increase symptoms. help the pt understand the link. neuromuscular re-education

Back 138

what is kinesthetic awareness?

Front 139

should be relative to the pts comfort

Back 139

what is considered a neutral spine?

Front 140

starting with stabilization exercises to fundamental body mechanics

Back 140

what is kinesthetic training integration?

Front 141

scalene muscle stretch, posterior occiput glide. end with traction

Back 141

what techniques can increase axial extension?

Front 142

short sub occipital muscle stretch / subcranial release

Back 142

what techniques can increase upper cervical flexion?

Front 143

mobilization-glenohumeral jt, scapula, AC/SC jt

Back 143

what techniques increase scapular and humeral muscle flexibility ?

Front 144

k to c, ppt, prayer stretch, manual techniques

Back 144

what techniques can increase lumbar flexion?

Front 145

90 degrees is bad

Back 145

what degree of motion should a total hip pt never be stretched?

Front 146

press up, standing BB

Back 146

what techniques can increase lumbar ext?

Front 147

prayer stretch, side lying over ball/ bolster, manual techniques

Back 147

what techniques can increase lateral flexibility of the spine?

Front 148

superficial muscles around injury, not localized

Back 148

what is global stabilization?

Front 149

wt shifts, quadriped, standing, squatting

Back 149

what are transitional stabilization exercises?

Front 150

designed specifically for the pts condition

Back 150

what should HEPs be designed for?

Front 151

repetitive- lifting , reaching, pushing/pulling, rot./turning, transitional movements. transfer of training

Back 151

what are intermediate and advanced exercise techniques for functional training ?

Front 152

splenius cervicis

semispinalis

sternocleidomastoid

rectus capitis post. major

rectus capitis post minor

sup. obliqus capitis

inf obliques capitis

splenius capitis

Back 152

what mm do cranial/ cervical ext?

Front 153

sternocleidomastoid

scalenes

longus colli

Back 153

what mm do cranial/cervical flexion?

Front 154

splenius cervicis

sternocleidomastoid

scalenes

spinalis

longissimus

illiocastalis

external obliques

internal obliques

quadratus lumborum

rectus capitis post. major

sup. obliques capitis

splenius capitis

Back 154

what mm do ipsilateral side bending?

Front 155

sternocleidomastoid

scalenes

multifidii

external obliques

Back 155

what mm do contralateral rotation?

Front 156

spinalis

longissimus

illiocastalis

quadratus lumborum

Back 156

what mm do back bending?

Front 157

splenius cervicis

internal obliques

rectus capitis post. major

inf. obliques capitis

splenius capitis

Back 157

what mm do ipsilateral rotation?

Front 158

rectus abdominis

external oblique

internal oblique

Back 158

what mm do trunk flexion?

Front 159

multifidii

Tra

Back 159

what mm are primary spine stabilizers?

Front 160

longus colli

Back 160

what mm is the primary cervical stabilizer?

Front 161

external intercostals

Back 161

what mm aids in inspiration?

Front 162

internal intercostals

Back 162

what mm aids in expiration?

Front 163

prone ,supine, quadriped,bridge, tallknealing, standing

Back 163

what is the lumbar stabilization sequence?

Front 164

meniscoids, lig. flavum, multifidii

Back 164

what are the protective mechanisms of the facets?