Lecture #9 - Miscellaneous Conditions

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Questions and Answers

What is scoliosis, and why is it classified as a diagnosis of exclusion?

Scoliosis is a lateral curvature of the spine that is classified as a diagnosis of exclusion because other potential pathologies must be ruled out before establishing it as the primary issue.

What is the main distinction between structural and functional scoliosis?

The main distinction is that structural scoliosis involves a permanent lateral curvature and vertebral rotation, while functional scoliosis develops as a secondary response to other injuries or conditions.

What are some of the developmental associations of structural scoliosis?

Developmental associations include muscular dystrophy, connective tissue disorders, and cerebral palsy.

Identify two degenerative conditions that can contribute to scoliosis in older populations.

Disc herniations and osteoporosis are two degenerative conditions that can contribute to scoliosis in older populations. Signup and view all the answers

What is the most important consideration when managing functional scoliosis?

The most important consideration is identifying the underlying cause of the condition. Signup and view all the answers

Why might bracing and surgery not always be necessary for functional scoliosis?

Bracing and surgery may not be necessary for functional scoliosis because this condition is primarily short-term and can often be managed through therapeutic interventions addressing the root cause. Signup and view all the answers

What is the timeframe for addressing functional scoliosis effectively?

Addressing functional scoliosis effectively can take quite some time due to the complexity of the factors involved and how long these issues take to form. Signup and view all the answers

What is the primary goal for athletic therapists when dealing with scoliosis?

The primary goal for athletic therapists is to find and treat the underlying cause of scoliosis rather than just addressing the symptoms. Signup and view all the answers

What are the two most critical differential diagnoses to rule out in TOS?

Upper cervical instability and vasculature critical rule-out. Signup and view all the answers

List the four structures associated with thoracic outlet syndrome (TOS) designated by the acronym MAS.

Trunks of the brachial plexus, medial cord of the brachial plexus, subclavian artery, and subclavian vein. Signup and view all the answers

Which two neural structures are most commonly compressed in TOS?

Inferior trunk of the brachial plexus and medial cord of the brachial plexus. Signup and view all the answers

What type of TOS requires immediate physician referral and why?

Vascular type requires physician referral due to the risk of critical vascular compromise. Signup and view all the answers

Identify the most common type of thoracic outlet syndrome.

Neurogenic TOS is the most common, constituting about 90% of cases. Signup and view all the answers

In assessing Thoracic Outlet Syndrome, what is the most crucial aspect to determine?

Establishing the root cause of the symptoms is most important. Signup and view all the answers

Name two structures that could potentially pass through the thoracic outlet besides those listed in MAS.

Axillary artery and axillary vein. Signup and view all the answers

What does a diagnosis of TOS typically involve?

It is typically a diagnosis of exclusion, similar to other syndromes. Signup and view all the answers

What are the two main labels used for categorizing scoliotic curves?

The region of occurrence (Cervical, Thoracic, Lumbar) and the direction of convexity (Right or Left). Signup and view all the answers

What anatomical feature makes the C1-C2 region particularly vulnerable to injury?

The C1 transverse foramina is larger and more lateral compared to lower-level counterparts, causing the vertebral artery to change angles sharply. Signup and view all the answers

What type of motion is most problematic for vertebral arteries during cervical rotation?

Contralateral rotation poses the most risk to the vertebral arteries. Signup and view all the answers

What is the most severe form of vertebrobasilar insufficiency (VBI) and what can it lead to?

Arterial dissection, which has the potential for fatal outcomes. Signup and view all the answers

What is the significance of transient ischemic attacks in the context of VBI?

Transient ischemic attacks can precede full-blown strokes, indicating posible vascular issues. Signup and view all the answers

Which cranial nerve does not receive blood supply from the vertebrobasilar system?

The olfactory nerve. Signup and view all the answers

Why is blood pressure assessment important in the evaluation of VBI?

It provides information on hypertension and contributes to the overall diagnostic picture of VBI. Signup and view all the answers

How often does a unilateral occlusion of a vertebral artery occur with a neurological deficit?

Very rarely. Signup and view all the answers

What is the primary directive regarding manipulation when vertebral artery status cannot be cleared?

Manipulations, mobilizations, and range of motion should not be performed. Signup and view all the answers

What conundrum arises from the limitations of tests for assessing VBI?

It is challenging to accurately clear the vertebral artery without ultrasound. Signup and view all the answers

What should practitioners do in cases where they suspect VBI but cannot confidently clear it?

They must refer patients to physicians for diagnostic imaging and further workups. Signup and view all the answers

What role does asymptomatic presentation play in the context of scoliosis?

Many individuals with scoliosis may be asymptomatic, making the condition potentially incidental. Signup and view all the answers

How can addressing one pathology potentially improve scoliosis?

Treatment of related conditions may lead to an improvement in scoliotic curvature indirectly. Signup and view all the answers

What key characteristic is often seen in patients with vestibular symptoms related to VBI?

Dizziness. Signup and view all the answers

Identify the two most important differential diagnoses to rule out in cases of thoracic outlet syndrome.

Upper cervical instability and vasculature critical rule-out. Signup and view all the answers

List the four structures associated with thoracic outlet syndrome designated by the acronym MAS.

Trunks of the brachial plexus, medial cord of the brachial plexus, subclavian artery, subclavian vein. Signup and view all the answers

Which two neural structures are most commonly compressed in thoracic outlet syndrome?

Inferior trunk of the brachial plexus and medial cord of the brachial plexus. Signup and view all the answers

Which type of thoracic outlet syndrome absolutely requires physician referral, and why?

Vascular TOS requires physician referral due to potential serious complications related to vascular involvement. Signup and view all the answers

What is the most essential aspect to establish when assessing thoracic outlet syndrome?

Identifying the underlying cause of the symptom(s) is the most essential aspect. Signup and view all the answers

What does a diagnosis of thoracic outlet syndrome typically involve?

A diagnosis of exclusion is involved, similar to other syndromes. Signup and view all the answers

What are the common symptoms presentation for thoracic outlet syndrome?

Symptoms often include pain, numbness, and weakness in the upper extremities. Signup and view all the answers

Identify two additional structures that could potentially pass through the thoracic outlet.

Axillary artery and axillary vein. Signup and view all the answers

What is a significant challenge in identifying the cause of functional scoliosis?

Determining what is causing the scoliosis can be quite challenging due to its multifactorial nature. Signup and view all the answers

How does functional scoliosis develop?

Functional scoliosis develops secondary to other injuries, habitual postures, muscle imbalances, or leg length discrepancies. Signup and view all the answers

Why is addressing functional scoliosis considered more relevant for athletic therapists?

It is more relevant because athletic therapists can influence functional scoliosis through treatment of underlying causes. Signup and view all the answers

What is the primary goal of an athletic therapist when working with a patient with scoliosis?

The primary goal is to find the cause of the scoliosis and treat it, rather than just addressing the symptoms. Signup and view all the answers

In which population is degenerative scoliosis most commonly developed?

Degenerative scoliosis is most commonly seen in the older population. Signup and view all the answers

What is a common treatment limitation for addressing structural scoliosis in adolescents?

Fixing the structural problem is beyond the scope of athletic therapists, who focus instead on function optimization. Signup and view all the answers

What can be a primary indicator of populations at risk for developmental scoliosis?

Individuals with conditions like muscular dystrophy, connective tissue disorders, or cerebral palsy may be at higher risk. Signup and view all the answers

Why might treating functional scoliosis symptomatically be ineffective in the long-term?

Symptomatic treatment won't provide substantial long-term impact, as it does not address the underlying causes. Signup and view all the answers

What are the two classifications used to label scoliotic curves?

The region of occurrence (cervical, thoracic, lumbar) and the direction of convexity (right, left). Signup and view all the answers

Identify the most frequent site of injury in vertebrobasilar insufficiency (VBI).

The C1-C2 region. Signup and view all the answers

What type of movement poses a significant risk to the vertebral arteries during cervical rotation?

Contralateral movement. Signup and view all the answers

What is arterial dissection in the context of VBI, and what can it potentially lead to?

Arterial dissection is the most severe form of VBI, leading to fatal outcomes. Signup and view all the answers

What are the three key vessels in the vertebrobasilar artery system?

The left vertebral artery, right vertebral artery, and basilar artery. Signup and view all the answers

What is a common symptom associated with vestibular disorders linked to VBI?

Dizziness. Signup and view all the answers

Why are the current tests for assessing vertebrobasilar insufficiency considered insufficient?

They lack reliability and are not effective without diagnostic imaging. Signup and view all the answers

What role does a transient ischemic attack play in the context of vertebrobasilar insufficiency?

It precedes or indicates the possibility of stroke and impaired blood supply to the brain. Signup and view all the answers

What is the significance of the cranial nerve examination in VBI assessment?

It helps identify potential ischemic impacts, as most cranial nerves are vascularized by the VBI system. Signup and view all the answers

What is recommended if a patient exhibits symptoms of VBI but cannot be effectively cleared for manipulation?

Referring the patient to a physician for further evaluation and diagnostic imaging. Signup and view all the answers

Identify one factor that contributes to the vulnerability of the vertebral artery in the C1-C2 region.

The anatomical positioning which causes sharp changes in angle and pathway. Signup and view all the answers

What do spinal manipulation and mobilization have to ensure when treating patients potentially at risk for VBI?

They should be avoided if the vertebral arteries cannot be cleared. Signup and view all the answers

What complicates the research into cervical spine manipulation and VBI?

The differences in vascular health between subjects with healthy and unhealthy blood vessels. Signup and view all the answers

How does the irregularity of the vertebral artery's pathway at C1-C2 contribute to its injury risk?

The artery has to make sharp turns, increasing susceptibility to stretching and compression. Signup and view all the answers

What is an important step clinicians can take before proceeding with cervical manipulation?

Conducting a pre-manipulation position test to evaluate risk. Signup and view all the answers

In managing functional scoliosis, what is the ultimate challenge therapists face when identifying the underlying cause?

Determining the specific factors contributing to the muscle imbalances or postural habits that lead to the scoliosis. Signup and view all the answers

Why is it essential for athletic therapists to differentiate between structural and functional scoliosis?

Understanding this distinction allows therapists to tailor their approach to improve function rather than attempting to correct an anatomical issue. Signup and view all the answers

What is the primary reason for differentiating between the types of thoracic outlet syndrome (TOS)?

To determine the appropriate treatment and whether a physician referral is necessary. Signup and view all the answers

What two conditions do athletic therapists focus on treating to help address functional scoliosis?

Muscle imbalances and postural alignments. Signup and view all the answers

Which neural structures are considered the most susceptible to compression in thoracic outlet syndrome?

The inferior trunk and medial cord of the brachial plexus. Signup and view all the answers

What role does ongoing assessment play in managing scoliosis, and why is it necessary?

Ongoing assessment is vital to monitor the progress and adapt the treatment plan based on the patient's evolving condition. Signup and view all the answers

What is the defining characteristic of neurogenic thoracic outlet syndrome?

It is the most common type, accounting for 90% of cases. Signup and view all the answers

What is a significant limitation of treating functional scoliosis symptomatically, and what approach should be taken instead?

Symptomatic treatment may not address the root cause, leading to temporary relief; instead, a focus on identifying and correcting the underlying issue is essential. Signup and view all the answers

Why is a multifactorial assessment important in diagnosing thoracic outlet syndrome?

It allows for a comprehensive understanding of the various potential underlying causes of symptoms. Signup and view all the answers

Identify two additional structures that may pass through the thoracic outlet, aside from those listed in the acronym MAS.

Axillary artery and axillary vein. Signup and view all the answers

How does leg length discrepancy contribute to functional scoliosis, and what is the resulting adaptive response?

Leg length discrepancy leads to compensatory adjustments in posture and alignment, which can result in a lateral curvature of the spine. Signup and view all the answers

What two aspects must be established when assessing symptoms in thoracic outlet syndrome?

The multifactorial nature of the condition and the ongoing assessment of symptoms. Signup and view all the answers

What associations are often seen with individuals who develop adolescent structural scoliosis, and why are these relevant?

Muscular dystrophy, connective tissue disorders, and cerebral palsy; these conditions may predispose individuals to spinal deformities. Signup and view all the answers

Why is the management of degenerative scoliosis primarily focused on optimizing function rather than structural correction?

Due to the anatomical changes and aging process in degenerative scoliosis, complete correction is impractical, so the focus shifts to maintaining function. Signup and view all the answers

What is the primary clinical implication of discussing vascular structures in relation to thoracic outlet syndrome?

These structures may require immediate medical attention if symptoms indicate vascular compression. Signup and view all the answers

How is thoracic outlet syndrome typically diagnosed?

As a diagnosis of exclusion, ruling out other possible conditions. Signup and view all the answers

What are the two significant factors contributing to the vulnerability of the C1-C2 region in vertebrobasilar insufficiency?

Anatomical differences in C1's transverse foramina and the functional rotation mechanics between C1 and C2. Signup and view all the answers

What potential fatal outcome is associated with arterial dissection in the context of vertebrobasilar insufficiency?

It can lead to stroke or transient ischemic attacks. Signup and view all the answers

Why is it important to assess blood pressure in the context of evaluating vertebrobasilar insufficiency?

It helps identify hypertension or elevated levels that may indicate a risk for VBI. Signup and view all the answers

What is the directive for practitioners if they cannot confidently clear the vertebral artery status before treatment?

They should avoid performing manipulations, mobilizations, or any range of motion activities. Signup and view all the answers

What is a key symptom that may signal vestibular involvement in patients suspected of having VBI?

Dizziness. Signup and view all the answers

Which cranial nerve is notably excluded from the blood supply provided by the vertebrobasilar system?

The olfactory nerve. Signup and view all the answers

What challenge exists in the current research on cervical spine manipulation regarding vertebrobasilar insufficiency?

Differentiating between healthy individuals and those with compromised vascular systems. Signup and view all the answers

What is often the most significant cause of functional scoliosis development?

Asymmetrical loading or posture, often related to hand dominance or certain activities. Signup and view all the answers

What anatomical change occurs in the C1 transverse foramina that increases vulnerability at this level?

The foramina is positioned laterally compared to lower vertebrae, creating a sharper artery angle. Signup and view all the answers

What is recommended if a patient presents with nonspecific VBI symptoms during assessments?

Medical attention should be sought immediately to ensure proper evaluation. Signup and view all the answers

What role does transient ischemic attack play in vertebrobasilar insufficiency?

It acts as a precursor or warning sign indicating potential stroke risk. Signup and view all the answers

Which assessment is considered most important in testing for vertebrobasilar artery status before performing cervical manipulations?

Cranial nerve examination. Signup and view all the answers

In cases of patients with asymptomatic scoliosis, what is typically the expected management approach?

Monitor the condition without intervention, as symptoms might not necessitate treatment. Signup and view all the answers

What is the primary goal when dealing with functional scoliosis?

To find the cause and treat it Signup and view all the answers

Idiopathic scoliosis has a known cause.

False Signup and view all the answers

Name one condition associated with degenerative scoliosis in older populations.

Disc herniations Signup and view all the answers

Structural scoliosis is considered to have a lateral curvature and a __________ component.

vertebral rotation Signup and view all the answers

Match the following types of scoliosis with their characteristics:

Structural = Lateral curvature and vertebral rotation Functional = Develops secondary to posture and muscle imbalances Signup and view all the answers

Which type of scoliosis is primarily treated by athletic therapists?

Functional scoliosis Signup and view all the answers

Functional scoliosis results solely from anatomical differences.

False Signup and view all the answers

How long does it generally take to address issues related to functional scoliosis?

Quite some time Signup and view all the answers

Which type of thoracic outlet syndrome is the most common?

Neurogenic Signup and view all the answers

Vascular thoracic outlet syndrome is the most common type of TOS.

False Signup and view all the answers

What does the acronym MAS stand for in the context of thoracic outlet syndrome?

Trunks of brachial plexus, Medial cord of brachial plexus, Subclavian artery, Subclavian vein Signup and view all the answers

The two most compressed neural structures in thoracic outlet syndrome are the _ and the _.

Inferior trunk of the brachial plexus, Medial cord Signup and view all the answers

Match the following types of thoracic outlet syndrome with their commonality:

Neurogenic = Most common Vascular = Rare Non-specific/mixed = Combines both neurogenic and vascular Arterial = Least common Signup and view all the answers

Which structure would require a physician referral when experiencing thoracic outlet syndrome?

Vascular conditions Signup and view all the answers

A diagnosis of thoracic outlet syndrome is typically determined by exclusion.

True Signup and view all the answers

What is one significant component of the assessment process for thoracic outlet syndrome?

Multifactorial and ongoing Signup and view all the answers

Which region is NOT associated with scoliotic curves?

Pelvic Signup and view all the answers

Most individuals with scoliosis are symptomatic.

False Signup and view all the answers

What is the most frequent site of injury in vertebrobasilar insufficiency (VBI)?

C1-C2 Signup and view all the answers

The _______ artery is the most severe form of vertebrobasilar insufficiency (VBI).

arterial dissection Signup and view all the answers

Match the following movements with their risk associated with vertebral arteries:

Contralateral rotation = Most vulnerable to injury Cervical rotation = Can lead to ischemia Severe flexion = Potential for arterial dissection Extension = Less likely to cause injury Signup and view all the answers

Which of the following are symptoms of vertebrobasilar insufficiency (VBI)?

Dizziness Signup and view all the answers

Unilateral occlusion of the vertebral artery frequently results in neurological deficits.

False Signup and view all the answers

What is a key consideration regarding the manipulation of the cervical spine in patients with suspected vertebral artery paths?

If you can’t clear it, you shouldn’t perform manipulations. Signup and view all the answers

The _______ nerve does not receive blood supply from the vertebrobasilar system.

olfactory Signup and view all the answers

Which of the following testing methods for VBI is considered most important?

Cranial nerve testing Signup and view all the answers

There is a strongly supported clinical prediction rule for identifying patients at risk for VBI.

False Signup and view all the answers

What factor is primarily associated with the rotational vulnerability of vertebral arteries?

The amount of rotation between C1 and C2. Signup and view all the answers

Transient ischemic attacks and ________ are precursors to vertebrobasilar insufficiency.

stroke Signup and view all the answers

Match the following terms with their definitions:

Vertebrobasilar insufficiency = Circulation disruption supplying the posterior brain Arterial dissection = Severe form of VBI with potential fatal outcomes Cervical rotation test = Used to assess VBI symptoms Basilar artery = Formed by merging of left and right vertebral arteries Signup and view all the answers

Which factor is most critical in managing functional scoliosis?

Identifying the underlying cause Signup and view all the answers

Idiopathic scoliosis has no known causes and is typically considered structural.

False Signup and view all the answers

What are the three main developmental associations indicated by the acronym CCM related to structural scoliosis?

Muscular dystrophy, connective tissue disorders, cerebral palsy Signup and view all the answers

Functional scoliosis develops secondary to other injury, habitual _______ and movements.

postures Signup and view all the answers

Match the type of scoliosis with its associated population:

Structural Scoliosis = Adolescents Degenerative Scoliosis = Older Adults Functional Scoliosis = Individuals with muscle imbalances Idiopathic Scoliosis = Unknown cause Signup and view all the answers

What is a potential impact of treating scoliosis symptomatically?

It may not lead to long-term improvement. Signup and view all the answers

Bracing and surgery are effective long-term solutions for all types of scoliosis.

False Signup and view all the answers

What is the primary concern of athletic therapists when addressing functional scoliosis?

Finding the cause and treating it Signup and view all the answers

Vascular thoracic outlet syndrome is more common than neurogenic thoracic outlet syndrome.

False Signup and view all the answers

Name one of the two most compressed neural structures in thoracic outlet syndrome.

Inferior trunk of the brachial plexus Signup and view all the answers

The acronym 'MAS' in the context of thoracic outlet syndrome refers to structures including trunks of the brachial plexus, medial cord of the brachial plexus, , and .

subclavian artery, subclavian vein Signup and view all the answers

Match the type of thoracic outlet syndrome with its commonality.

Neurogenic = Most common Venous = More common than arterial Arterial = Least common Non-specific/mixed = Rarer than neurogenic Signup and view all the answers

Which of the following structures is NOT typically associated with thoracic outlet syndrome?

Lumbar vertebrae Signup and view all the answers

Thoracic outlet syndrome symptoms are mainly isolated and require no further examination.

False Signup and view all the answers

What is the most important consideration when assessing thoracic outlet syndrome?

Identifying the cause of the symptoms. Signup and view all the answers

Vertebrobasilar insufficiency (VBI) is predominantly preceded by transient ischemic attacks and strokes.

True Signup and view all the answers

What is the most frequent site of injury in vertebrobasilar insufficiency?

C1-C2 Signup and view all the answers

The key characteristic often associated with vestibular symptoms in VBI is __________.

dizziness Signup and view all the answers

Match the following components with their relevance to vertebrobasilar insufficiency:

Left vertebral artery = Supplies blood to the left side of the brain Right vertebral artery = Supplies blood to the right side of the brain Basilar artery = Formed by the union of left and right vertebral arteries Cranial nerve examination = Used to evaluate blood supply from the vertebrobasilar system Signup and view all the answers

Which type of motion is particularly problematic for vertebral arteries during cervical rotation?

Contralateral Signup and view all the answers

A unilateral occlusion of a vertebral artery commonly leads to a neurological deficit.

False Signup and view all the answers

Name one critical consideration when managing functional scoliosis.

Addressing underlying pathologies Signup and view all the answers

The most severe form of vertebrobasilar insufficiency is __________.

arterial dissection Signup and view all the answers

Match the following conditions with their related assessments:

Blood pressure = Evaluating hypertension Eye examination = Assessing visual effects of VBI Cranial nerve examination = Checking blood supply to neurological functions Vertebral artery tests = Evaluating risk of arterial occlusion Signup and view all the answers

What is considered a strong directive regarding manipulation in VBI cases where the status cannot be cleared?

Avoid manipulations Signup and view all the answers

Healthy patients can be treated the same way as those with vulnerable cardiovascular systems when assessing for VBI.

False Signup and view all the answers

Which cranial nerve is not vascularized by the vertebrobasilar system?

Olfactory nerve Signup and view all the answers

The three key vessels in the vertebrobasilar artery system are the left vertebral artery, right vertebral artery, and __________.

basilar artery Signup and view all the answers

Study Notes

Scoliosis

Scoliosis is a lateral curvature of the spine.
It's a diagnosis of exclusion, meaning other pathologies must be ruled out before confirming it as the primary or contributing cause, especially with functional scoliosis.
The most crucial factor in addressing scoliosis is identifying its cause, which can be challenging.
Many cases are idiopathic (unknown cause) but are often multifactorial.
Assessing scoliosis typically involves ongoing evaluation.
Two main types:
- Structural:
  - Exhibits lateral curvature and vertebral rotation to varying degrees.
  - Both rotation and curvature contribute to spinal deformity.
  - Develops due to:
    - Developmental causes (adolescence, but onset can be as early as 3 years old), sometimes associated with conditions like muscular dystrophy, connective tissue disorders, and cerebral palsy.
    - Degenerative causes (older population) – associated with disc herniations, osteoporosis, and vertebral fractures.
  - Differentiating factor from functional scoliosis: fixing structural scoliosis is outside the scope of an athletic therapist, while optimizing function around the condition is within our role.
  - Treatment for adolescents involves bracing and surgery in severe cases, but influence on its development is limited due to the anatomical nature of the issue.
- Functional:
  - Develops secondary to other injuries, postures, movements (sports/ADL related), muscle imbalances, leg-length discrepancies (which could be anatomical or functional for adaptation reasons), or pelvic/lower extremity malalignments.
  - More relevant to athletic therapists as intervention is possible.
  - Treating scoliosis symptomatically doesn't have a substantial long-term impact.
  - Fixing functional scoliosis takes time as it forms over time.
  - The main goal is to assess the cause and treat it.
  - Hand dominance can significantly impact functional scoliosis, especially in one-arm dominant sports/occupations.
  - A significant portion may be asymptomatic.
Scoliotic curves are labeled based on:
- Region of occurrence (cervical, thoracic, lumbar).
- Direction of the curve's convexity (right or left).
Finding scoliosis can be incidental during the assessment of another issue. Linking the two is possible but not always the case. Addressing one issue may contribute to improvement in the other.

Vertebrobasilar Insufficiency (VBI)

VBI involves localized or widespread disruption of blood circulation to the posterior brain and brainstem.
The most frequent injury site is C1-C2 due to anatomical features and the significant rotation occurring between these vertebrae which can stretch/compress/kink the vertebral arteries.
The most problematic cervical rotation is contralateral (ex., left vertebral artery is most vulnerable with right rotation).
Pathologically , VBI is often preceded by transient ischemic attacks and stroke.
While a network of redundant vessels exists in the area, unilateral occlusion is rare with a neurological deficit.
The most severe form of VBI is arterial dissection, which can have fatal consequences and is frequently associated with traumatic forces (e.g. MVAs, whiplash).
Research on cervical spine manipulation faces challenges due to variations in patient health (healthy vs. compromised blood vessels).
The vertebrobasilar artery system contains 3 key vessels: left vertebral artery, right vertebral artery, and basilar artery.
A pre-manipulation algorithm (Cook, 2007) exists, but the principles should be adapted to mobilization/pre-mobilization techniques.
Immediate referral to a physician is required for indiscriminate VBI symptoms with the cervical rotation test.
A key symptom is dizziness.
A vestibular therapist may be involved in such cases where dizziness is presented.
The pre-manipulation position test is crucial before performing spinal manipulation.
Cranial nerve testing is crucial for VBI assessment as most are supplied by the VB system, but the olfactory nerve is not affected.
Blood pressure monitoring (looking for hypertension) can provide clues, though it's not definitive in identifying VBI.
Eye examinations should be conducted as part of the assessment process
VBI tests are not definitive, relying on ultrasound to truly clear the vertebral arteries, a significant issue given the lack of imaging.
In the absence of clearing the artery, any manipulations/mobilizations/ROM exercises for VBI, should be avoided.
There's a strong need for a clinical prediction rule to identify VBI risk as history and screening tests lack strong reliability. It's crucial to avoid false negatives and be cautious due to potential for serious complications. Physician referral remains critical for diagnostic imaging
Common differential diagnoses for VBI include: spondylosis, disc pathology, stenosis, upper cervical instability, multiple sclerosis, cerebrovascular accident, tumors, facet dysfunction, concussion, Bell's palsy, CV disease, BPPV, epilepsy, medication side effects.

Thoracic Outlet Syndrome (TOS)

TOS involves obstructions of structures emerging from the superior thoracic aperture.
Key affected structures include brachial plexus trunks, medial cord of the brachial plexus, subclavian artery and vein, and potentially the axillary artery and vein.
Most commonly, TOS is neurogenic (90% of cases).
Types of TOS (sorted in order from most to least common and least to most common):
- Most common: Neurogenic, then Venous, then Non-specific/mixed, then Arterial.
Vascular TOS requires physician referral.
TOS diagnosis is typically a process of exclusion, with a focus on identifying the underlying cause. A multifactorial and ongoing assessment is crucial.
Palpation assessment should include: Upper trapezius, Pectoralis minor, Scalenes, Erb's point, Clavicle, Upper Quadrant Soft Tissues, First rib Joint Play, and Distal pulses.
Potential assessment division might include: initial focus on vascular ruling out, followed by treatment, assessment, and finding causes in future appointments.
Common Differential diagnoses include: disc pathology, spondylosis, radiculopathy, brachial plexus injury, peripheral nerve entrapment, diabetes, shoulder injury, tumours, multiple sclerosis, Raynaud’s, cardiac events, angina, myofascial pain, and chronic regional pain syndrome.

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Description

Explore the complexities of scoliosis, including its causes, types, and assessment methods. This quiz highlights key aspects of structural and functional scoliosis, focusing on the diagnostic challenges involved. Ideal for those studying spinal health and related disorders.

Lecture #9 - Miscellaneous Conditions

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Questions and Answers

What is scoliosis, and why is it classified as a diagnosis of exclusion?

What is the main distinction between structural and functional scoliosis?

What are some of the developmental associations of structural scoliosis?

Identify two degenerative conditions that can contribute to scoliosis in older populations.

What is the most important consideration when managing functional scoliosis?

Why might bracing and surgery not always be necessary for functional scoliosis?

What is the timeframe for addressing functional scoliosis effectively?

What is the primary goal for athletic therapists when dealing with scoliosis?

What are the two most critical differential diagnoses to rule out in TOS?

List the four structures associated with thoracic outlet syndrome (TOS) designated by the acronym MAS.

Which two neural structures are most commonly compressed in TOS?

What type of TOS requires immediate physician referral and why?

Identify the most common type of thoracic outlet syndrome.

In assessing Thoracic Outlet Syndrome, what is the most crucial aspect to determine?

Name two structures that could potentially pass through the thoracic outlet besides those listed in MAS.

What does a diagnosis of TOS typically involve?

What are the two main labels used for categorizing scoliotic curves?

What anatomical feature makes the C1-C2 region particularly vulnerable to injury?

What type of motion is most problematic for vertebral arteries during cervical rotation?

What is the most severe form of vertebrobasilar insufficiency (VBI) and what can it lead to?

What is the significance of transient ischemic attacks in the context of VBI?

Which cranial nerve does not receive blood supply from the vertebrobasilar system?

Why is blood pressure assessment important in the evaluation of VBI?

How often does a unilateral occlusion of a vertebral artery occur with a neurological deficit?

What is the primary directive regarding manipulation when vertebral artery status cannot be cleared?

What conundrum arises from the limitations of tests for assessing VBI?

What should practitioners do in cases where they suspect VBI but cannot confidently clear it?

What role does asymptomatic presentation play in the context of scoliosis?

How can addressing one pathology potentially improve scoliosis?

What key characteristic is often seen in patients with vestibular symptoms related to VBI?

Identify the two most important differential diagnoses to rule out in cases of thoracic outlet syndrome.

List the four structures associated with thoracic outlet syndrome designated by the acronym MAS.

Which two neural structures are most commonly compressed in thoracic outlet syndrome?

Which type of thoracic outlet syndrome absolutely requires physician referral, and why?

What is the most essential aspect to establish when assessing thoracic outlet syndrome?

What does a diagnosis of thoracic outlet syndrome typically involve?

What are the common symptoms presentation for thoracic outlet syndrome?

Identify two additional structures that could potentially pass through the thoracic outlet.

What is a significant challenge in identifying the cause of functional scoliosis?

How does functional scoliosis develop?

Why is addressing functional scoliosis considered more relevant for athletic therapists?

What is the primary goal of an athletic therapist when working with a patient with scoliosis?

In which population is degenerative scoliosis most commonly developed?

What is a common treatment limitation for addressing structural scoliosis in adolescents?

What can be a primary indicator of populations at risk for developmental scoliosis?

Why might treating functional scoliosis symptomatically be ineffective in the long-term?

What are the two classifications used to label scoliotic curves?

Identify the most frequent site of injury in vertebrobasilar insufficiency (VBI).

What type of movement poses a significant risk to the vertebral arteries during cervical rotation?

What is arterial dissection in the context of VBI, and what can it potentially lead to?

What are the three key vessels in the vertebrobasilar artery system?

What is a common symptom associated with vestibular disorders linked to VBI?

Why are the current tests for assessing vertebrobasilar insufficiency considered insufficient?

What role does a transient ischemic attack play in the context of vertebrobasilar insufficiency?

What is the significance of the cranial nerve examination in VBI assessment?

What is recommended if a patient exhibits symptoms of VBI but cannot be effectively cleared for manipulation?

Identify one factor that contributes to the vulnerability of the vertebral artery in the C1-C2 region.

What do spinal manipulation and mobilization have to ensure when treating patients potentially at risk for VBI?

What complicates the research into cervical spine manipulation and VBI?

How does the irregularity of the vertebral artery's pathway at C1-C2 contribute to its injury risk?

What is an important step clinicians can take before proceeding with cervical manipulation?

In managing functional scoliosis, what is the ultimate challenge therapists face when identifying the underlying cause?

Why is it essential for athletic therapists to differentiate between structural and functional scoliosis?

What is the primary reason for differentiating between the types of thoracic outlet syndrome (TOS)?

What two conditions do athletic therapists focus on treating to help address functional scoliosis?

Which neural structures are considered the most susceptible to compression in thoracic outlet syndrome?

What role does ongoing assessment play in managing scoliosis, and why is it necessary?

What is the defining characteristic of neurogenic thoracic outlet syndrome?

What is a significant limitation of treating functional scoliosis symptomatically, and what approach should be taken instead?

Why is a multifactorial assessment important in diagnosing thoracic outlet syndrome?

Identify two additional structures that may pass through the thoracic outlet, aside from those listed in the acronym MAS.

How does leg length discrepancy contribute to functional scoliosis, and what is the resulting adaptive response?

What two aspects must be established when assessing symptoms in thoracic outlet syndrome?

What associations are often seen with individuals who develop adolescent structural scoliosis, and why are these relevant?

Why is the management of degenerative scoliosis primarily focused on optimizing function rather than structural correction?

What is the primary clinical implication of discussing vascular structures in relation to thoracic outlet syndrome?

The two most compressed neural structures in thoracic outlet syndrome are the _ and the _.

The acronym 'MAS' in the context of thoracic outlet syndrome refers to structures including trunks of the brachial plexus, medial cord of the brachial plexus, , and .