NMS 1 test 1

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NMS 1 test 1
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NMS 1 test 1
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  1. IVD syndrome
    • discogenic pain, DDD
    • a general term
  2. intradiscal block
    • joint dysfunction
    • disc block subluxation
  3. pathophysiology of intradiscal block
    fissuring in the annulus with movememnt of nuclear material, blocking motion
  4. pathophysiology of a disc herniation
    • moderate to marked herniation of nuclear material into or thrugh the annular fibers and/or PLL
    • most often posterolateral
  5. disc protrusion
    nuclear material still within the confines of the annulus
  6. disc prolapse
    • herniation
    • nuclear material has extruded through the outer annular fibers
  7. a contained disc herniation
    outer annulus or PLL still intact
  8. noncontained (extruded) disc herniation
    broken through annulus and PLL
  9. sequestered disc herniation
    fragment of the nucleus has broken free
  10. biomechanical stages of disc degeneration
    • mechanical lesion
    • circumfrential distortion and tears
    • radial tears
    • instability
    • ddd
    • disc herniation
    • disc resorption
    • discogenic spondylosis
    • ankylosis
  11. pathophysiology of DDD/ discogenic spondylosis
    disc degeneration leading to motion segment instability and vertebral body hypertorphic changes
  12. pathophysiology of a strain
    disruption of muscle fibers, muscle tendon junction, the tendon, or the bony insertion of a muscle tendon unit
  13. 2 ways to evaluate the severity of musculoskeletal conditions
    • the amount of tissue damage
    • the effect on the patient
  14. an acute strain
    the single traumatic event resulting in the diruption of the above; vary in degree from mild injuries and minimal disruption to complete laceration
  15. chronic strain
    a product of repetitive loading resulting in the disruption of myofascial tissue
  16. a mild strain
    • no gross disruption, minimal swelling, no loss of AROM
    • there is pain with muscle contraction but no loss of strength
  17. moderate strain
    • incomplete disruption with moderate swelling and possible discoloration
    • decreased strength and limitations to movememnt
  18. severe strain
    • complete disruption, accentuation of the above, severe restriction to movement
    • possible visual conformation, may be confirmed by orthopedic tests
    • : thompson test achilles tendon
  19. tendinitis
    inflammation of the muscle tendon unit. usually resulting from traumatic teasrs in the thedon. tears vary in degree from microscopic to macroscopic. in chronic situations, tears may coalesce to completely bridge the tendon with a fibrous scar
  20. calcific tendonitis
    deposition of calcium slatins in chronically inflammed and/or necrotic tendonous tissue
  21. tendosynovitis
    inflammation of the tendon sheath
  22. myofascitis
    inflammed muscle and fascia. term is often used interchageably with myofascial pain syndrome
  23. myofascial syndrome (MFTP)
    • pain and associated referred phenomena associated with MFTPs
    • term originated by Travell less commonly used than myofascitis
  24. primary fibromyalgia syndrome
    • form of nonarticular rheumatism manifested by diffuse musculoskeletal aching and tender points at characteristic sites with absense of underlying condition.
    • term is now widely used, sometimes interchangeably with myofascial syndrome, and has replace the term fibrositis.
    • current theory associated disrubted non REM sleep with producing and perpetuating this condition
  25. myofibrosis
    • fibrous CT repair of injured or degenerated muscle
    • muscle tissue does not possess the ability to regenerate and once injured it undergoes fibrous tissue repair resulting in CT cross linkage and an inelastic scar
  26. rheumatism
    a general term for acute and chronic conditions characterized by inflammation, soreness, and stiffness of muscles and pain in joints and associated structures. imprecise term, includes many different specific pathophysiologic processes
  27. sprain
    disruption of ligamentous tissue or their own attachements
  28. acute sprain
    a single traumatic event resulting in the disruption of ligamentous tissue
  29. chronic sprain
    a product of repetative loading resulting in the disruption of ligamentous tissue
  30. grading sprains
    based on the number of fibers disrupted and the resulting joint instability
  31. mild sprain
    some minor ligament tearing, swelling and tenderness. no loss of ligamentous integrity
  32. moderate sprain
    large portion of fibers are torn and marked swelling with ome integrity of ligament remaining
  33. severe sprain
    • complete disruption
    • stress testing demonstrates complete loss of ligamentous integrity
  34. syndesmitis
    inflammation of ligmanetous tissue, often result of mechanical stress. supra and interspinal ligaments are commonly involved demonstrating marked tenderness with palpation
  35. capsulitis
    inflammation of the joint capsule resulting from acute or chronic trauma
  36. periarticular fibrosis
    • process of fibrous repair applied to the periarticular ligamentous tissue
    • typically resulting in joint fixation and dysfunction
    • occurs around the facet (frozen shoulder)
  37. adhesive capsulitis
    fibrous repair if injured joint capsule leading to adhesions, joint fixation and chronic inflammation
  38. bursitis
    • inflammation of the bursa, most commonlyh involving the shoulder and the knee
    • traumatic bursitis is usually casued by chronic repetitive trauma leading to irritation of the synovial membrane, excessive production of serous fluids and distension
  39. periosteitis
    inflammation of membrane investing a bone and the periostium. traumatic periostitis typically results from a blow to the periosteum or a tearing of ligamentous attachements. a persistent fibrous scar and chronic inflammation may result
  40. contousion
    injuries produced from direct blows resulting in tissue damage, capillary rupture and hemorrhage. may involve any of the connective tissues and typically leads to come degree of swelling and discoloration
  41. Radiculopathy
    nerve root compression syndrome, radiculitis
  42. pathophysiology of radiculopathy
    orthopedic space occupying lesion diminishes the space of the IVF or lateral recess producing altered function and possible inflammation of the nerve roots
  43. pathophysiology of spinal stenosis
    stenosis of the lumbar canal leading to direcet lumbar nerve root entrapment of indirect nerve toot dysfunction through altered blood supply
  44. pathophysiology of myelopathy
    altered spinal cord function secondary to degenerative spinal stensosis, orthopedic space occupying lesion, traumatic compression and/or traction. injury mary result from direct trauma to the cord or secondarily through interruption of blood supply
  45. pathyphysiology of peripheral neuropathy
    function disruption of peripheral nerves. orthopedic peripheral nerve lesions usually result from local entrapment or direct trauma
  46. polyneuritis and polyneuropathies
    multiple sites of peripheral nerve inflammation and/or dysfunction. results from some systemic metabolic or infammatory disorder and is not the product of local mechanical irritation or injury
  47. neuralgia
    pain in the dystribution of a peripheral nerve. does not necissarily denote peripheral nerve inflammation, may be strictly process of referred pain
  48. intermittent claudicationat
    due to ischemia, peripheral artery disease
  49. neurogenic claudication
    due to spinal stenosis
  50. epidemiology of LBP
    • 80% of human pop will experience significant LBP in lifetime
    • 60% of at risk population has had LBP in past year
    • as high as 2nd cheif presenting complain
    • 2nd only to CVD as cause of physical disability, leading cause age 30-50
    • 1989 estimate: 9.2 million americans impaired, 2.4 millino disabled by LBP
    • chiropractic patients 2:1 chronic:acute ratio
  51. economic impact of LBP
    1994 us cost for LBP treatment between $50-100 billion
  52. risk factors for LBP
    • smoking
    • whole-body vibration
    • repeated heavy lifing/twistin
    • sustained static postures
    • work requirements exceed trunk strength/endurance
    • job dis-satisfaction
    • increasing age not necessarily associated with higher risk
  53. principles of spinal degeneration
    • certain disease and degenerative processes have a predictable and progressive pattern of physiological changes
    • spinal degeneration is inevitable; aging, morbidity and degree of symptoms; however are very variable
    • spinal degeneration is modified by such factors as: sex, body type, weight, posture, and occupation
  54. stage 1 of spinal degeneration
    dysfunction: stage of functional abnormality. minimal structural pathological change. confimed by manual exam and biomechanical assessment of x-ray
  55. stage 2 of spinal degeneration
    instability: stage where repetitive trauma leads to capsular and annular degeneration and laxity confirmed by chronic recurring patterna nd evidence of instability on clinical exam and x-ray
  56. stage 3 of spinal degeneration
    stabilization: stage of fibrosis and stabilization confirmed by joint and muscle stiffness. decreased mobility and marked degenerative change on x-ray
  57. aging and degeneration are not directly proportional to symptoms
    • peak age is 35-55
    • symptoms often decrease with age
  58. pain sensitive spinal tissue
    • joint capsule
    • vertebral periosteum
    • posterior longitudinal ligament
    • NR and fibroadipose tissue
    • vertebral body
    • muscle and tendon
    • anterior longitudinal ligament
    • ligamentum flavum
    • interspinous ligaments
    • disc (annulus)
  59. non-pain sensitive spinal tissue
    • vertebral body end plate
    • disc
    • articular cartilage
    • synovial tissue
    • interarticular menisci
  60. dermatomal referred pain
    • pain in the dermal layer of the skin
    • well localized- sharp and superficial
    • segmental- dermatomal distrobution
  61. myotomal referred pain
    • pain in the muscular layer
    • deeper felt- less intense
    • achy or crampy quality
    • myotomal pattern
  62. sclerotomal referred pain
    • pain in the deep somatic tissues
    • deep, aching, generalized
    • sclerotomal segmental pattern
    • often more proximal than distal
  63. pain referred from myofacial TP
    • achy quality similar to myotomal and sclerotomal
    • specific pattern associated with TP
    • pain increasing with pressure over TP
    • associated with autonomic phenomena
  64. radicular pain
    local and referred pain produced by local irritation of nociceptors and sensory afferent fibers (projected pain)
  65. psycho-social aspects of pain perception
    • all pain is real to the patient wheather it is psychogenically or organically based
    • most chronic pain patients have a mix of organic and psychogenic pain
    • chronic pain patients often develop behavior patterns and complaints in common with depressed patients
  66. modulation of pain perception
    pain perception is not simply the end product of stimulation of sensory receptors and their registration at the thalamus and cortex
  67. gate theory of pain perception
    pain can be inhibited at the level of the dorsal horn through mechanoreceptor stimulation
  68. central modulation of pain perception
    pain can be modified by higher cortical centers inhibiting pain trasmission or the individuals resp0onse to pain
  69. clinical applications of gate theory
    • immobilization
    • massage
    • cold
    • heat
    • tens
    • vibrator
    • rocking chair
    • manipulation
  70. clinical application of central modulation
    • culture- role expectation
    • personality
    • emotional status
    • work status
    • socioeconomic status
    • past experiences
    • motivation
    • techniques
  71. SMT
    involves the application of accurately determined and specifically directed manual forces to the body. it's objective is to improve mobility in areas that are restricted wheather the restrictions are within joints, in connective tissues, or skeletal muscles. the consequences may be the involvement of posture and locomotion, the relief of pain and discomfort, the improvement of function elsewhere in the body and the enhancement of the sense of well being
  72. indication for manipulation
    • history and complaints
    • visual observation
    • palpation
    • muscle testing
    • radiology
    • instrumentation
  73. visual observation of patient
    • static: body contour and symmetry; posture evaluation
    • kinetic: gait and locomotion, GROM
  74. palpation of patient
    • static: osseous alignment; superficial tissue texture; skin temperature and moisture; muscle nd connective tissue tone and consistency
    • kinetic: GROM, SROM, end plya, joint play, modification pain by postural changes
  75. instrumentation of patient
    • thermography
    • toftness radiation detector
    • moire topography
    • emg
    • nerve conduction
    • anatometer
  76. contraindications to SMT
    • treatment may produce injury
    • may worsen an associated disorder
    • is inappropriate- not effective for patient condition
    • inadequate examination or adjustive skills
    • etiologic categories: bone weakening, active inflammatory diseas, vascular disorders, marked or progressive neuro deficits
  77. danger signals in consideration of contraindications to SMT
    • serious doubt- diagnosis
    • failure of conservative treatment
    • bowel or bladder dysfunction
    • progressive neuro deficit
    • marked muscle weakness
    • UMN lesion signs
    • considerable night pain
    • insidious and progressive symptoms
    • progressive weight loss
    • pain not effected by mechanical means
    • systemic disease
  78. myofascial effects of SMT
    • increased flexibility, plastic range
    • promote flexible, functional healing, control fibrosis
    • revers effects of adhesions, contracture, immobilization
    • minimize abnormal collagen cross-link formation
  79. ligamentous effects of SMT
    same as myofascial but specific segmental ligaments may be involved
  80. posterior joint effects of sMT
    • release entrapped meniscoid
    • unlocking of joint surfaces and intra-articular adhesions
    • improved imbibitions/nutrition to articular cartilage
    • potential to minimize or prevent DJD
  81. intervertebral disc effects of sMT
    • reposition or improve dynamics of nucleus
    • reposition herniation or fragment away from nerve root
    • improve imbibitions/nutition to IVD
    • alter tension or load on annular fibers
  82. nerve compression effects of SMT
    • improve joint position and dynamics
    • increase dimensions of IVF
    • change constant compression to intermittent
    • improve axoplasmic flow
    • improve circulation to nerve root
  83. nerve reflex effects of SMT
    • arthrokinetic reflex
    • co-activation of receptors
    • viscerosomatic/somatovisceral
    • normalization of sympathetic activity
    • mechanoreceptor stimulation and retraining
    • gate mechanisms
    • DNIC mechanism
    • endorphins, substance P??
  84. direct vascular effects of SMT
    • speed diffusion of inflammation byproducts
    • increased circulation, venous return, oxygenation to injured tissues
    • decreased edema and congestion
  85. indirect vascular effects of SMT
    • sypathetic-vasomotor effects in target tissues
    • promote neovascularization/healing
  86. physical therapy- soft tissue
    PIR, RI, cross-friction, MFTP, petrissage, tapotment, pin and stretch, graston, mobilization
  87. physical therapy- mechanotherapy
    • sustain or motorized traction
    • braces, supports, casts
    • active and passive exercises
  88. hydrotherapy
    • moist heat- hydroculator (140-160)
    • muscle relaxation, analgesic, vasodilation, increases collagen elasticity
    • ice- vasoconstriction, analgesic (48-72 hours acute)
  89. ultrasound
    • vibrating quartz crystal produces sound waves
    • used in water
    • molecular massage
    • deep heat
    • decrease adhesions, fibroses
    • increases molecule and fluid
  90. galvanic electrotherapies
    • low volt
    • high volt
  91. muscle stimulating electrotherapies
    • sine wave
    • russian stimulation
  92. interferential electrotherapies
    analgesic, muslce stimulation, muscle relaxin, pumping effect. decreased edema, possible anti-inflammatory effects
  93. microcurrent electrotherapies
    portable, dont feel them, very mild
  94. diathermy
    • deep heat brings blood into lungs
    • dont do it when there is metal in the area
  95. light therapy
    radiant light, infra-red, ultra-violet
  96. stages of healing- inflammation
    • 72 hours post injury
    • cell membranes disrupted, preleasing inflammatory agents
    • local edema
    • platelets activated
    • chemical mediators
    • local vasodilation
  97. stages of healing- consolidation
    • 72 hours- 7 days post injury
    • fibroblasts and myofibroblasts organize around fibrin to begin synthesis

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