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What will manipulation do for a hypermobile joint?
Give temporary relief.
What should the role of manpulation be for a hypermobile joint?
Leave this joint or vector alone and adjust joint restrictions.
How likely will neurologic problems be the cause of a joint dysfunction/ subluxation syndrome?
Unlikely in most circumstances.
What are the local clinical indications of a subluxation?
"P-pain (spontaneous) and tenderness (palpatory). A- asymmetry. R- Range of motion abnormaility (segmental range). T-tone
nondermatomal patterns of referred pain follow what distribution?
What is sclerotome?
"What is a dermatome
and what is a myotome?"
"What is more diffuse in arrangement a sclerotome
Nociceptive referred pain follows what pattern of distribution?
What is a more technically accurate way of saying sclerotomal pain?
Nociceptive referred pain.
With nociceptive referred pain how far will the pain travel down an extremity?
"Pain will not travel
What is hyperconvergence?
"The receptive field of such a projection neuron
What type of reflexes can cause a subluxation?
Reflex from a visceral disease.
What is a dual diagnosis?
At UWS we often assign a dual diagnosis to patients� like lumbar derangement associated with lumbar joint dysfunction.
What part of a subluxation causes local pain?
How can a hypo or hyper mobile joint cause local pain?
"This results in a shift of the axis of rotation in the motion unit resulting in abnormal loads and irritation of tissue. ""the broken door hinge analogy""."
What are the immediate effects of pain from hypomobility?
"A restricted joint itself probably wont hurt
What are the long term effects of pain from hypomobility?
Pain from degenerative tissue breaking down because of lack of local circulation of synovial fluid.
Hypomobile joints lead to what?
How many weeks will it take to get joint degeneration with a hypomobile joint?
4 weeks- articular surface changes. 8 weeks- osteophytes forming from the facets.
Can joint degeneration like osteophytes be reversed after the fixation of a hypomobile joint is fixed?
No the changes do not appear to be reversible.
What is the proposed effects of adjusting to local and referred pain?
How can adjusting reduce muscle spasms?
"Not from stretch on muscles
What causes a temporary increase in motion due to adjusting?
Changes in synovial fluid.
What else can cause increased motion due to adjusting?
How will adjusting effect inhibited muscles?
Can activate them.
What can adjusting do to proprioceptive inputs?
Restore proper proprioceptive input.
What are 2 other ways to say deep referred pain?
"Somatic referred pain
"Patients with irritaated joints often feel pain or other symptoms spreading out over their shoulders
between their shoulders and even into their arms and this can happen when?"
Pain signals from injured tissue in the facet/subluxatin cause what to happen to the spinal cell in the track that communicates the pain?
Once the spinal cells are hypersensitized (are now sensitive) what type of signals from the non symptomatic area can cause destabilization of the pathway?
Hypersensitivity and spontaneous pain projects into what?
When can radicular syndromes occur?
When the nerve root is compressed or irritated.
Name 2 things that can compress or irritate the nerve roots?
Disc hernitation and osteophyte formation.
What area must a lesion be located within to cause a radicular syndrome?
What happens when nerve roots become compressed or irritated?
"Compressed/ torn- causes loss of function like loss of sensation
Very often what happens with radicular syndromes?
The nerve root is both compressed and irritated.
What would a patient history of a radicular syndrome be like?
What are signs of a radicular syndrome from a physcial?
"Positive tension tests
What would a positive tension test suggest? What will neurological tests suggest?
tension tests- Nerve root irritation. Neurological tests- compression/ cell damage.
What is a hard positive and a soft positive for the straight leg raise?
Hard positive- must radiate past the knee. Soft- radiates up to the knee.
What are 2 things to consider with a soft positive for the straight leg raise?
1. Was the quality of the nerve tension pain nerve pain? 2. Is there any other evidence that the nerve is damaged in any way whatsoever.
What test can be done to check radicular syndromes with the nerves L2-4?
Femoral stretch test.
Neurological deficits suggest what?
"Compression/ cell damage like atrophy
Can a change in the relation of adjacent vertebrae (of the type described in chiropractic literature) result in nerve root or spinal cord compression?
In most back pain the mechanism involved is _______?
Stimulation of nerve endings in the affected structure. Nerve root compression is in no way involved.
Nerve root irritation causes what?
Nerve root compression causes what?
"Loss of function; loss of sensation
What is more common nerve root compression or irritation and why?
Compression because less tissue protection.
What is more common nerve root ischemia or compression?
Nerve root ischemia.
Will rapdid onset or slow onset cause more damage with a nerve root compression?
Rapdid onset is more damaging.
What happens with acute compression of nerve root?
"Does not usually cause pain. Causes numbness
________ + _________ = radicular pain.
irritation + minimal compression.
what type of fibers are more suscetible to compression large or small ones?
Large fibers are more suseceptible to compression.
What is double crush?
Compression at 2 sites has more effect than a larger compression at 1 site.
The nerve root takes up how much of the IVF?
What will the rest of the IVF be filled with?
CT and adipose.
What border of the IVF is narrower?
Medial is narrower and lateral is wider.
Sever compression of nerve roots are very unlikely due to what?
Subluxation syndrome alone.
Can a mild compression of a nerve root be caused by a subluzation syndrome alone>
Will radiating pain usually be due to irritation of nerve roots?
A patient with dermatomal pain/paresthesia and positive nerve tension you should think of what first?
"Chemical/ mechanical irritation from; disc herniation
When can a radicular syndrome be associated with subluxation?
"If other probable diagnoses do not seem likely
What is the co-activation model?
Manipulation acts as a counter-irritant (closing the pain gate). May help block central sensitization.
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