Dominant Pain Mechanisms

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Questions and Answers

According to the ICF model discussed, how are patients categorized?

  • Based on impairments and effective treatments, not potential serious disease/injury. (correct)
  • Based on the therapists preferred treatment methods.
  • Based on the patient's subjective pain complaints.
  • Based on serious diseases and injuries.

What is the primary goal when determining the dominant pain mechanism after ruling out red flags?

  • Confirming the patient's initial pain assessment.
  • Ruling out any psychological contributions to the pain.
  • Identifying if the pain originates from joints and muscles.
  • Classifying which mechanism is most responsible for the patient's pain. (correct)

Which type of pain is associated with strains, sprains, and inflammation causing activation of nociceptors?

  • Cognitive affective mechanisms
  • Nociceptive pain (correct)
  • Neurogenic pain
  • Central sensitization

What characterizes neurogenic pain?

<p>Nerve injury causing the nerve itself to become a source of pain. (D)</p> Signup and view all the answers

What is central sensitization in the context of pain mechanisms?

<p>Heightened pain response to low-level stimuli due to changes in the brain. (D)</p> Signup and view all the answers

What does cognitive affective mechanisms refer to in the context of pain?

<p>Pain perception influenced by thoughts and emotions. (D)</p> Signup and view all the answers

Compensatory movements that perpetuate pain are categorized under which pain mechanism?

<p>Output (B)</p> Signup and view all the answers

What is a potential consequence of treating a patient with a processing problem as if they have an input problem?

<p>Increased pain. (D)</p> Signup and view all the answers

What is the typical duration of migraine headaches?

<p>4-72 hours (A)</p> Signup and view all the answers

Which characteristic is most indicative of cervicogenic headaches?

<p>Unilateral, non-throbbing pain starting in the neck. (D)</p> Signup and view all the answers

What is a red flag symptom that requires serious consideration when assessing headaches?

<p>Severe headache with a sudden onset. (B)</p> Signup and view all the answers

What is a key characteristic of joint mobility examination in patients with cervicogenic headache (CGH)?

<p>Dysfunction in C0-C1 and C1-C2 segments. (C)</p> Signup and view all the answers

What finding on the cervical flexion rotation test (CFRT) suggests cervicogenic headache?

<p>Rotation value less than or equal to 32 degrees. (B)</p> Signup and view all the answers

What muscle is NOT typically associated with tightness in cervicogenic headache (CGH)?

<p>Serratus anterior (C)</p> Signup and view all the answers

To ensure effective exercise progression, what must be established before strength training?

<p>Motor control (D)</p> Signup and view all the answers

Prior to strength exercises, what other aspect of treatment should be addressed?

<p>Mobility (A)</p> Signup and view all the answers

In the framework for improving motor control, what generally precedes distal mobility for efficient movement?

<p>Proximal stability (C)</p> Signup and view all the answers

Passive mobility is a prerequisite for what?

<p>Active mobility (B)</p> Signup and view all the answers

What is the definition of stability in the context of motor control?

<p>The ability to maintain a steady position against gravity. (B)</p> Signup and view all the answers

What is the definition of controlled mobility?

<p>Changing positions while maintaining stability proximally. (A)</p> Signup and view all the answers

According to clinical prediction rules, what combination of findings increases the likelihood of responding to mechanical cervical traction?

<p>Age &gt; 55, positive shoulder abduction test, positive ULTT A, symptom peripheralization with lower cervical PA motion testing, positive neck distraction test. (D)</p> Signup and view all the answers

Which of the following is a potential etiology for temporomandibular joint (TMJ) disorders?

<p>Macrotrauma from whiplash injury (B)</p> Signup and view all the answers

Which structure does the posterior region of the articular disc of the TMJ attach to?

<p>Collagen inferior retrodiscal lamina (A)</p> Signup and view all the answers

If the masseter muscle contracts unilaterally, which action would result?

<p>Ipsilateral lateral excursion (B)</p> Signup and view all the answers

What is the primary biomechanical action that occurs during the early phase of mouth opening?

<p>Primarily rotation (C)</p> Signup and view all the answers

When evaluating the TMJ, what indicates a muscle imbalance, muscle incoordination, or anterior disc displacement with reduction?

<p>S-shaped curve during opening without pain (A)</p> Signup and view all the answers

During a TMJ examination, what finding has the highest positive likelihood ratio for anterior disc displacement with internal derangement?

<p>Reciprocal clicking (A)</p> Signup and view all the answers

Which of the following is not a test within the cluster of 7 tests for TMJ disorders?

<p>Auscultation with stethoscope (B)</p> Signup and view all the answers

What is the primary purpose of categorizing patients based on the ICF and Treatment Based Classification systems?

<p>To guide effective treatment strategies based on impairments and evidence-based approaches. (D)</p> Signup and view all the answers

According to the classification of dominant pain mechanisms, what is the source of pain in nociceptive pain?

<p>Strains, sprains, and inflammation activating pain receptors. (C)</p> Signup and view all the answers

What is the primary feature of output related pain mechanisms?

<p>Pain stemming from dysfunctional autonomic or motor responses. (A)</p> Signup and view all the answers

Why is it crucial to accurately identify the dominant pain mechanism in a patient?

<p>To prevent ineffective or counterproductive treatment approaches. (C)</p> Signup and view all the answers

According to the information provided, what is the typical pain quality of cervicogenic headaches?

<p>Non-throbbing (D)</p> Signup and view all the answers

What characteristic differentiates cervicogenic headaches from migraines or tension-type headaches?

<p>Association with neck movements or positions. (C)</p> Signup and view all the answers

Which of the following examination findings is consistent with cervicogenic headache (CGH)?

<p>Dysfunction in C0-C1 and C1-C2 spinal segments. (D)</p> Signup and view all the answers

A positive cervical flexion-rotation test (CFRT) suggests what in a patient experiencing headaches?

<p>Cervicogenic involvement (B)</p> Signup and view all the answers

Why is it considered important to address motor control before focusing purely on strength training?

<p>To ensure movements are performed without compensation. (D)</p> Signup and view all the answers

When is it appropriate to begin postural training in relation to mobility, motor control, and strength?

<p>Early, but understand the lack of mobility will limit the patient's ability to assume certain postures. (D)</p> Signup and view all the answers

In the framework for improving motor control, what is the relationship between proximal stability and distal mobility?

<p>Proximal stability generally precedes distal mobility for efficient movement. (A)</p> Signup and view all the answers

Why is mobility considered a prerequisite for controlled mobility?

<p>Because a joint must be able to move before it can be controlled in movement. (A)</p> Signup and view all the answers

According to the provided information, what is the definition of stability in the context of motor control?

<p>The capacity to maintain a steady position against gravity. (C)</p> Signup and view all the answers

What is controlled mobility defined as?

<p>The ability to shift weight within a posture or between postures while maintaining stability. (A)</p> Signup and view all the answers

Which anatomical structure does the temporomandibular joint's (TMJ) posterior region of the articular disc attach to?

<p>Collagen inferior retrodiscal lamina and elastin superior retrodiscal lamina (A)</p> Signup and view all the answers

Which muscles elevate the mandible?

<p>Masseter and Temporalis (B)</p> Signup and view all the answers

What biomechanical movement primarily occurs during the early phase of mouth opening?

<p>Rotation of the mandibular condyle. (D)</p> Signup and view all the answers

What movement occurs during the late phase of mouth opening?

<p>Translation (C)</p> Signup and view all the answers

During mandibular depression (mouth opening), what type of movement is associated with the condyle sliding together with the disc?

<p>Translational (D)</p> Signup and view all the answers

What is the average range of mandibular depression?

<p>40-50mm (D)</p> Signup and view all the answers

What is the average range of lateral excursion?

<p>10mm each way (B)</p> Signup and view all the answers

During a TMJ examination, what might an S-shaped curve indicate?

<p>Muscle imbalance, incoordination, or anterior disc displacement with reduction. (B)</p> Signup and view all the answers

During TMJ range of motion assessment, a C-shaped opening pattern that deflects to one side and does not return to midline indicates what?

<p>Capsular restriction (B)</p> Signup and view all the answers

In a clinical setting, where would you expect to palpate the internal pterygoid during a TMJ examination?

<p>Medial to the angle of the mandible. (A)</p> Signup and view all the answers

C1-C4 spinal nerves fibers have projections that coordinate sensation from what nerves?

<p>Ophthalmic, Maxillary and Mandibular portions (B)</p> Signup and view all the answers

What extraoral landmark can be used to identify the temporalis?

<p>Coronoid process. (A)</p> Signup and view all the answers

During a TMJ examination a lateral excursion is performed and is found to be greater than 15mm. This would be considered as an indication of what?

<p>Hypermobility (B)</p> Signup and view all the answers

Which statement best reflects the relationship between anterior translation of the condyle and capsular mobility in the TMJ?

<p>Decreased anterior translation upon palpation may indicate limited capsular mobility. (D)</p> Signup and view all the answers

What is a component of the cluster of 7 tests for diagnosing temporomandibular joint disorders?

<p>Joint Sound test (D)</p> Signup and view all the answers

Flashcards

Patient Categorization

Categories defined by the ICF based on impairments, and the Treatment Based Classification system based on effective treatments.

Nociceptive Pain

Strains, sprains, and inflammation of tissue that cause firing of nociceptors, resulting in achy, sharp pain.

Neurogenic Pain

Injury to a nerve that causes the nerve itself to become a source of pain, often presenting with pins and needles.

Central Sensitization

Hypersensitivity to low-level stimuli due to physiological changes in the brain, leading to increased pain perception.

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Cognitive Affective Mechanisms

Pain perception related to thoughts and emotions, often occurring simultaneously with central sensitization.

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Output Pain

Pain caused by ongoing output of the system, such as autonomic responses (e.g., CRPS) or motor patterns (e.g., compensatory movements).

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Acute Subarachnoid Hemorrhage

Severe headache with sudden onset that may include vomiting, seizures, and is often described as the “worst headache ever”.

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Cervicogenic Headache

A headache stemming from an issue or pathology in the cervical spine.

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Cervical Flexion Rotation Test (CFRT)

A test used to assess for dysfunctions in the upper cervical spine, specifically C0-C1 and C1-C2.

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Mobility (Motor Control)

Sufficient motor unit activity to initiate a contraction and available mobility for the movement in question.

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Stability

The ability to maintain a steady position in a weight-bearing or anti-gravity posture.

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Controlled Mobility

Ability to change positions while maintaining stability proximally; shift weight within a posture or between postures.

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Static-Dynamic Control

The ability to lift a previously weight-bearing component furthering balance and equilibrium reactions.

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Skill (Motor Control)

Highly coordinated movements allowing interaction with the environment; involves movement of distal components over dynamically stable proximal components; coordination, timing, and sequencing are key.

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Temporomandibular Disorder (TMD)

Term describing symptoms affecting the cranio-facial-mandibular complex, including TMJ, orofacial muscles, cervical spine, and nervous system

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C-shaped Deviation

Jaw deviates to one side during opening, returning to center at end of opening.

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Deflection (Jaw)

Jaw deviates during opening without returning to midline.

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Protrusion (TMJ)

Condyle and disc translate anteriorly without significant rotation

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The dental stick test

When chewing pain is elicited on the same side mouth or the opposite side

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ADDwR

The disc only reduces when some movement is being performed. This can cause pain and or clicking.

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Dominant Pain Mechanism Categories

A system to categorize dominant pain mechanisms: Input, Processing, Output

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Headache 'Red Flag'

A headache with severe pain and sudden onset; requires immediate medical attention

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Vomiting and Seizures with headache

Acute subarachnoid hemorrhage requires immediate medical attention

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CGH Joint Mobility Examination

Dysfunction in C0-C1 and C1-C2

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Muscle Dysfunction in CGH

Muscle tightness in upper trapezius, suboccipitals, levator scapulae, and pectoralis minor

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Inflammation First

Address inflammation and pain before focusing on strength

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Establish Motor Control

Movement without compensations; normal motion, start small, with no resistance. AROM is ok

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What is Posture Built On?

Posture relies on, motor control, and strength (primarily endurance).

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Prescriptive Designs

Studies using a prescriptive approach found manipulation to be superior to mobilization

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PROM arthrokinematic

Term for joint play assessment

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Cervical extension < 30

Term for cervical extension ROM

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TMD Prevalence

Estimated 50-75% population suffer from one symptom of TMD

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TMD Etiology

Macrotrauma, Microtrauma, arthritis and Mental health disorders

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TMJ Predisposing Factors

Posture, stress, and Habits

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Muscles of Mastication

Innervated by mandibular nerve, branch of CN V

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Biomechanics translational Slides

TMJ disc translation together

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TMJ Special Tests

Neurological, palpation, joint/capsular mobility

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Reciprocal Clicking

Clicking on TMJ range increases the liklihood

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Capsulitis

Trauma, oral habits, pain, inflammation

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7 tests

deviation, laterotrusion, joint mobility, joint sounds

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Study Notes

Muscle Function During Mastication

  • Suprahyoids aid in mandibular opening.

TMJ Movement and Depression

  • During rotational movement, the mandibular condyle rolls relative to the inferior surface of the disc.
  • During translational movement the mandibular condyle and disc slide together on the fossa.

Clinical Examination of the TMJ

  • AROM (Active Range of Motion) is considered a good reliability
  • A patient should be able to fit 2-3 fingers in the mouth

TMJ opening abnormalties

  • S-shaped opening during opening without pain may indicate muscle imbalance or some anterior disc displacement and muscular and skeletal dysfunctions.
  • Pain and dysfunction can become limited due to disc involvement.
  • C-shaped deviations happen during opening and the jaw will deviate to one side.

Capsular Mobility Testing

  • OA, AA lower cervical spinal conditions is important.

Exam treatment models for TMJ

  • Follow opening and closing practices to establish what is required as an assessment guide

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