Podcast
Questions and Answers
What is scoliosis, and why is it classified as a diagnosis of exclusion?
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?
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?
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.
Identify two degenerative conditions that can contribute to scoliosis in older populations.
What is the most important consideration when managing functional scoliosis?
What is the most important consideration when managing functional scoliosis?
Why might bracing and surgery not always be necessary for 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 timeframe for addressing functional scoliosis effectively?
What is the primary goal for athletic therapists when dealing with scoliosis?
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?
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.
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?
Which two neural structures are most commonly compressed in TOS?
What type of TOS requires immediate physician referral and why?
What type of TOS requires immediate physician referral and why?
Identify the most common type of thoracic outlet syndrome.
Identify the most common type of thoracic outlet syndrome.
In assessing Thoracic Outlet Syndrome, what is the most crucial aspect to determine?
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.
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 does a diagnosis of TOS typically involve?
What are the two main labels used for categorizing scoliotic curves?
What are the two main labels used for categorizing scoliotic curves?
What anatomical feature makes the C1-C2 region particularly vulnerable to injury?
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 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 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?
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?
Which cranial nerve does not receive blood supply from the vertebrobasilar system?
Why is blood pressure assessment important in the evaluation of VBI?
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?
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 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 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 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?
What role does asymptomatic presentation play in the context of scoliosis?
How can addressing one pathology potentially improve scoliosis?
How can addressing one pathology potentially improve scoliosis?
What key characteristic is often seen in patients with vestibular symptoms related to VBI?
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.
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.
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 two neural structures are most commonly compressed in thoracic outlet syndrome?
Which type of thoracic outlet syndrome absolutely requires physician referral, and why?
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 is the most essential aspect to establish when assessing thoracic outlet syndrome?
What does a diagnosis of thoracic outlet syndrome typically involve?
What does a diagnosis of thoracic outlet syndrome typically involve?
What are the common symptoms presentation for thoracic outlet syndrome?
What are the common symptoms presentation for thoracic outlet syndrome?
Identify two additional structures that could potentially pass through the thoracic outlet.
Identify two additional structures that could potentially pass through the thoracic outlet.
What is a significant challenge in identifying the cause of functional scoliosis?
What is a significant challenge in identifying the cause of functional scoliosis?
How does functional scoliosis develop?
How does functional scoliosis develop?
Why is addressing functional scoliosis considered more relevant for athletic therapists?
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?
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?
In which population is degenerative scoliosis most commonly developed?
What is a common treatment limitation for addressing structural scoliosis in adolescents?
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?
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?
Why might treating functional scoliosis symptomatically be ineffective in the long-term?
What are the two classifications used to label scoliotic curves?
What are the two classifications used to label scoliotic curves?
Identify the most frequent site of injury in vertebrobasilar insufficiency (VBI).
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 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 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 are the three key vessels in the vertebrobasilar artery system?
What is a common symptom associated with vestibular disorders linked to VBI?
What is a common symptom associated with vestibular disorders linked to VBI?
Why are the current tests for assessing vertebrobasilar insufficiency considered insufficient?
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 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 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?
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.
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 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?
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?
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?
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?
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?
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 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?
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?
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 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 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?
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?
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.
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?
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 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?
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?
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?
What is the primary clinical implication of discussing vascular structures in relation to thoracic outlet syndrome?
How is thoracic outlet syndrome typically diagnosed?
How is thoracic outlet syndrome typically diagnosed?
What are the two significant factors contributing to the vulnerability of the C1-C2 region in vertebrobasilar insufficiency?
What are the two significant factors contributing to the vulnerability of the C1-C2 region in vertebrobasilar insufficiency?
What potential fatal outcome is associated with arterial dissection in the context of vertebrobasilar insufficiency?
What potential fatal outcome is associated with arterial dissection in the context of vertebrobasilar insufficiency?
Why is it important to assess blood pressure in the context of evaluating vertebrobasilar insufficiency?
Why is it important to assess blood pressure in the context of evaluating vertebrobasilar insufficiency?
What is the directive for practitioners if they cannot confidently clear the vertebral artery status before treatment?
What is the directive for practitioners if they cannot confidently clear the vertebral artery status before treatment?
What is a key symptom that may signal vestibular involvement in patients suspected of having VBI?
What is a key symptom that may signal vestibular involvement in patients suspected of having VBI?
Which cranial nerve is notably excluded from the blood supply provided by the vertebrobasilar system?
Which cranial nerve is notably excluded from the blood supply provided by the vertebrobasilar system?
What challenge exists in the current research on cervical spine manipulation regarding vertebrobasilar insufficiency?
What challenge exists in the current research on cervical spine manipulation regarding vertebrobasilar insufficiency?
What is often the most significant cause of functional scoliosis development?
What is often the most significant cause of functional scoliosis development?
What anatomical change occurs in the C1 transverse foramina that increases vulnerability at this level?
What anatomical change occurs in the C1 transverse foramina that increases vulnerability at this level?
What is recommended if a patient presents with nonspecific VBI symptoms during assessments?
What is recommended if a patient presents with nonspecific VBI symptoms during assessments?
What role does transient ischemic attack play in vertebrobasilar insufficiency?
What role does transient ischemic attack play in vertebrobasilar insufficiency?
Which assessment is considered most important in testing for vertebrobasilar artery status before performing cervical manipulations?
Which assessment is considered most important in testing for vertebrobasilar artery status before performing cervical manipulations?
In cases of patients with asymptomatic scoliosis, what is typically the expected management approach?
In cases of patients with asymptomatic scoliosis, what is typically the expected management approach?
What is the primary goal when dealing with functional scoliosis?
What is the primary goal when dealing with functional scoliosis?
Idiopathic scoliosis has a known cause.
Idiopathic scoliosis has a known cause.
Name one condition associated with degenerative scoliosis in older populations.
Name one condition associated with degenerative scoliosis in older populations.
Structural scoliosis is considered to have a lateral curvature and a __________ component.
Structural scoliosis is considered to have a lateral curvature and a __________ component.
Match the following types of scoliosis with their characteristics:
Match the following types of scoliosis with their characteristics:
Which type of scoliosis is primarily treated by athletic therapists?
Which type of scoliosis is primarily treated by athletic therapists?
Functional scoliosis results solely from anatomical differences.
Functional scoliosis results solely from anatomical differences.
How long does it generally take to address issues related to functional scoliosis?
How long does it generally take to address issues related to functional scoliosis?
Which type of thoracic outlet syndrome is the most common?
Which type of thoracic outlet syndrome is the most common?
Vascular thoracic outlet syndrome is the most common type of TOS.
Vascular thoracic outlet syndrome is the most common type of TOS.
What does the acronym MAS stand for in the context of thoracic outlet syndrome?
What does the acronym MAS stand for in the context of thoracic outlet syndrome?
The two most compressed neural structures in thoracic outlet syndrome are the ___ and the ___.
The two most compressed neural structures in thoracic outlet syndrome are the ___ and the ___.
Match the following types of thoracic outlet syndrome with their commonality:
Match the following types of thoracic outlet syndrome with their commonality:
Which structure would require a physician referral when experiencing thoracic outlet syndrome?
Which structure would require a physician referral when experiencing thoracic outlet syndrome?
A diagnosis of thoracic outlet syndrome is typically determined by exclusion.
A diagnosis of thoracic outlet syndrome is typically determined by exclusion.
What is one significant component of the assessment process for thoracic outlet syndrome?
What is one significant component of the assessment process for thoracic outlet syndrome?
Which region is NOT associated with scoliotic curves?
Which region is NOT associated with scoliotic curves?
Most individuals with scoliosis are symptomatic.
Most individuals with scoliosis are symptomatic.
What is the most frequent site of injury in vertebrobasilar insufficiency (VBI)?
What is the most frequent site of injury in vertebrobasilar insufficiency (VBI)?
The _______ artery is the most severe form of vertebrobasilar insufficiency (VBI).
The _______ artery is the most severe form of vertebrobasilar insufficiency (VBI).
Match the following movements with their risk associated with vertebral arteries:
Match the following movements with their risk associated with vertebral arteries:
Which of the following are symptoms of vertebrobasilar insufficiency (VBI)?
Which of the following are symptoms of vertebrobasilar insufficiency (VBI)?
Unilateral occlusion of the vertebral artery frequently results in neurological deficits.
Unilateral occlusion of the vertebral artery frequently results in neurological deficits.
What is a key consideration regarding the manipulation of the cervical spine in patients with suspected vertebral artery paths?
What is a key consideration regarding the manipulation of the cervical spine in patients with suspected vertebral artery paths?
The _______ nerve does not receive blood supply from the vertebrobasilar system.
The _______ nerve does not receive blood supply from the vertebrobasilar system.
Which of the following testing methods for VBI is considered most important?
Which of the following testing methods for VBI is considered most important?
There is a strongly supported clinical prediction rule for identifying patients at risk for VBI.
There is a strongly supported clinical prediction rule for identifying patients at risk for VBI.
What factor is primarily associated with the rotational vulnerability of vertebral arteries?
What factor is primarily associated with the rotational vulnerability of vertebral arteries?
Transient ischemic attacks and ________ are precursors to vertebrobasilar insufficiency.
Transient ischemic attacks and ________ are precursors to vertebrobasilar insufficiency.
Match the following terms with their definitions:
Match the following terms with their definitions:
Which factor is most critical in managing functional scoliosis?
Which factor is most critical in managing functional scoliosis?
Idiopathic scoliosis has no known causes and is typically considered structural.
Idiopathic scoliosis has no known causes and is typically considered structural.
What are the three main developmental associations indicated by the acronym CCM related to structural scoliosis?
What are the three main developmental associations indicated by the acronym CCM related to structural scoliosis?
Functional scoliosis develops secondary to other injury, habitual _______ and movements.
Functional scoliosis develops secondary to other injury, habitual _______ and movements.
Match the type of scoliosis with its associated population:
Match the type of scoliosis with its associated population:
What is a potential impact of treating scoliosis symptomatically?
What is a potential impact of treating scoliosis symptomatically?
Bracing and surgery are effective long-term solutions for all types of scoliosis.
Bracing and surgery are effective long-term solutions for all types of scoliosis.
What is the primary concern of athletic therapists when addressing functional scoliosis?
What is the primary concern of athletic therapists when addressing functional scoliosis?
Vascular thoracic outlet syndrome is more common than neurogenic thoracic outlet syndrome.
Vascular thoracic outlet syndrome is more common than neurogenic thoracic outlet syndrome.
Name one of the two most compressed neural structures in thoracic outlet syndrome.
Name one of the two most compressed neural structures in thoracic outlet syndrome.
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 ______.
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 ______.
Match the type of thoracic outlet syndrome with its commonality.
Match the type of thoracic outlet syndrome with its commonality.
Which of the following structures is NOT typically associated with thoracic outlet syndrome?
Which of the following structures is NOT typically associated with thoracic outlet syndrome?
Thoracic outlet syndrome symptoms are mainly isolated and require no further examination.
Thoracic outlet syndrome symptoms are mainly isolated and require no further examination.
What is the most important consideration when assessing thoracic outlet syndrome?
What is the most important consideration when assessing thoracic outlet syndrome?
Vertebrobasilar insufficiency (VBI) is predominantly preceded by transient ischemic attacks and strokes.
Vertebrobasilar insufficiency (VBI) is predominantly preceded by transient ischemic attacks and strokes.
What is the most frequent site of injury in vertebrobasilar insufficiency?
What is the most frequent site of injury in vertebrobasilar insufficiency?
The key characteristic often associated with vestibular symptoms in VBI is __________.
The key characteristic often associated with vestibular symptoms in VBI is __________.
Match the following components with their relevance to vertebrobasilar insufficiency:
Match the following components with their relevance to vertebrobasilar insufficiency:
Which type of motion is particularly problematic for vertebral arteries during cervical rotation?
Which type of motion is particularly problematic for vertebral arteries during cervical rotation?
A unilateral occlusion of a vertebral artery commonly leads to a neurological deficit.
A unilateral occlusion of a vertebral artery commonly leads to a neurological deficit.
Name one critical consideration when managing functional scoliosis.
Name one critical consideration when managing functional scoliosis.
The most severe form of vertebrobasilar insufficiency is __________.
The most severe form of vertebrobasilar insufficiency is __________.
Match the following conditions with their related assessments:
Match the following conditions with their related assessments:
What is considered a strong directive regarding manipulation in VBI cases where the status cannot be cleared?
What is considered a strong directive regarding manipulation in VBI cases where the status cannot be cleared?
Healthy patients can be treated the same way as those with vulnerable cardiovascular systems when assessing for VBI.
Healthy patients can be treated the same way as those with vulnerable cardiovascular systems when assessing for VBI.
Which cranial nerve is not vascularized by the vertebrobasilar system?
Which cranial nerve is not vascularized by the vertebrobasilar system?
The three key vessels in the vertebrobasilar artery system are the left vertebral artery, right vertebral artery, and __________.
The three key vessels in the vertebrobasilar artery system are the left vertebral artery, right vertebral artery, and __________.
Flashcards
Scoliosis Definition
Scoliosis Definition
Lateral curvature of the spine.
Scoliosis Types
Scoliosis Types
Structural (anatomical) and Functional (due to other factors).
Structural Scoliosis Cause
Structural Scoliosis Cause
Developmental (adolescents/children) and Degenerative (older adults).
Functional Scoliosis Cause
Functional Scoliosis Cause
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Structural Scoliosis Treatment
Structural Scoliosis Treatment
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Functional Scoliosis Treatment Goal
Functional Scoliosis Treatment Goal
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Idiopathic Scoliosis
Idiopathic Scoliosis
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Functional Scoliosis Treatment
Functional Scoliosis Treatment
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Thoracic Outlet Syndrome (TOS)
Thoracic Outlet Syndrome (TOS)
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Neurogenic TOS
Neurogenic TOS
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Vascular TOS
Vascular TOS
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TOS Assessment
TOS Assessment
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Upper Cervical Instability
Upper Cervical Instability
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Critical vascular rule-out
Critical vascular rule-out
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Palpation for TOS
Palpation for TOS
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Differential Diagnoses for TOS
Differential Diagnoses for TOS
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Scoliosis
Scoliosis
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Scoliotic Curve Location
Scoliotic Curve Location
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Vertebrobasilar Insufficiency (VBI)
Vertebrobasilar Insufficiency (VBI)
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VBI Most Frequent Injury Site
VBI Most Frequent Injury Site
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C1-C2 Anatomy
C1-C2 Anatomy
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C1-C2 Function
C1-C2 Function
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VBI Symptoms
VBI Symptoms
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Arterial Dissection
Arterial Dissection
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VBI & Cervical Manipulation
VBI & Cervical Manipulation
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VBI Testing Limitations
VBI Testing Limitations
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VBI & Diagnostic Imaging
VBI & Diagnostic Imaging
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VBI & Referral Guideline
VBI & Referral Guideline
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VBI and vestibular symptoms
VBI and vestibular symptoms
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Cranial Nerve Test in VBI
Cranial Nerve Test in VBI
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VBI and pre-manipulation test
VBI and pre-manipulation test
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What is scoliosis?
What is scoliosis?
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What are the 2 main types of scoliosis?
What are the 2 main types of scoliosis?
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What makes Functional Scoliosis important for athletic therapists?
What makes Functional Scoliosis important for athletic therapists?
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What is the main goal when treating Functional Scoliosis?
What is the main goal when treating Functional Scoliosis?
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Why can Functional Scoliosis take time to treat?
Why can Functional Scoliosis take time to treat?
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What is NOT effective for treating Functional Scoliosis?
What is NOT effective for treating Functional Scoliosis?
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What is a key consideration with Scoliosis?
What is a key consideration with Scoliosis?
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What types of conditions might mimic Scoliosis?
What types of conditions might mimic Scoliosis?
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What are the 4 structures that can be compressed in TOS?
What are the 4 structures that can be compressed in TOS?
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What are the 2 most compressed neural structures in TOS?
What are the 2 most compressed neural structures in TOS?
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What is the most common type of TOS?
What is the most common type of TOS?
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Which type of TOS absolutely requires a physician referral?
Which type of TOS absolutely requires a physician referral?
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How is TOS typically diagnosed?
How is TOS typically diagnosed?
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What's the most important thing to establish with TOS?
What's the most important thing to establish with TOS?
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What is the assessment for TOS?
What is the assessment for TOS?
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Scoliosis Curve Label
Scoliosis Curve Label
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Scoliosis and Other Conditions
Scoliosis and Other Conditions
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Most Frequent VBI Injury Site
Most Frequent VBI Injury Site
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VBI & Movement
VBI & Movement
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VBI Symptoms Progression
VBI Symptoms Progression
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Most Severe VBI
Most Severe VBI
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Functional Scoliosis
Functional Scoliosis
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Structural Scoliosis
Structural Scoliosis
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Scoliosis Diagnosis
Scoliosis Diagnosis
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Functional Scoliosis Treatment Time
Functional Scoliosis Treatment Time
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VBI & Manipulation
VBI & Manipulation
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TOS Palpation
TOS Palpation
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TOS Differential Diagnoses
TOS Differential Diagnoses
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Most Important Structures in TOS
Most Important Structures in TOS
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Physician Referral for TOS
Physician Referral for TOS
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Scoliosis: What is it?
Scoliosis: What is it?
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Scoliosis Types: Structural vs. Functional
Scoliosis Types: Structural vs. Functional
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Why is functional scoliosis important for ATs?
Why is functional scoliosis important for ATs?
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Main Goal of Functional Scoliosis Treatment
Main Goal of Functional Scoliosis Treatment
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Why does functional scoliosis treatment take time?
Why does functional scoliosis treatment take time?
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Scoliosis is a diagnosis of...
Scoliosis is a diagnosis of...
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What are some conditions that might mimic scoliosis?
What are some conditions that might mimic scoliosis?
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What makes TOS a problem of the upper extremity?
What makes TOS a problem of the upper extremity?
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Scoliosis Curves
Scoliosis Curves
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What is a scoliosis finding often?
What is a scoliosis finding often?
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Scoliosis Types: What are the 2 main types?
Scoliosis Types: What are the 2 main types?
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TOS - What structures are compressed?
TOS - What structures are compressed?
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TOS - Most Compressed Neural Structures
TOS - Most Compressed Neural Structures
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TOS - Most Common Type
TOS - Most Common Type
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TOS - Physician Referral Type
TOS - Physician Referral Type
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TOS - Diagnosis Method
TOS - Diagnosis Method
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TOS - Assessment Importance
TOS - Assessment Importance
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TOS - Assessment Characteristics
TOS - Assessment Characteristics
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TOS - Assessment Structures
TOS - Assessment Structures
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Scoliosis: Incidental Finding
Scoliosis: Incidental Finding
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VBI & Contralateral Rotation
VBI & Contralateral Rotation
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VBI: Most Severe Form
VBI: Most Severe Form
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VBI & Manipulation Caution
VBI & Manipulation Caution
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TOS: Structures Affected
TOS: Structures Affected
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TOS: Most Affected Neural Structures
TOS: Most Affected Neural Structures
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TOS: Vascular TOS Referral
TOS: Vascular TOS Referral
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TOS Assessment: Multifactorial & Ongoing
TOS Assessment: Multifactorial & Ongoing
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TOS Palpation: 8 Structures
TOS Palpation: 8 Structures
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VBI: Diagnostic Imaging Referral
VBI: Diagnostic Imaging Referral
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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.
- Structural:
- 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)
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VBI involves localized or widespread disruption of blood circulation to the posterior brain and brainstem.
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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.
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The most problematic cervical rotation is contralateral (ex., left vertebral artery is most vulnerable with right rotation).
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Pathologically , VBI is often preceded by transient ischemic attacks and stroke.
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While a network of redundant vessels exists in the area, unilateral occlusion is rare with a neurological deficit.
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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).
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Research on cervical spine manipulation faces challenges due to variations in patient health (healthy vs. compromised blood vessels).
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The vertebrobasilar artery system contains 3 key vessels: left vertebral artery, right vertebral artery, and basilar artery.
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A pre-manipulation algorithm (Cook, 2007) exists, but the principles should be adapted to mobilization/pre-mobilization techniques.
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Immediate referral to a physician is required for indiscriminate VBI symptoms with the cervical rotation test.
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A key symptom is dizziness.
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A vestibular therapist may be involved in such cases where dizziness is presented.
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The pre-manipulation position test is crucial before performing spinal manipulation.
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Cranial nerve testing is crucial for VBI assessment as most are supplied by the VB system, but the olfactory nerve is not affected.
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Blood pressure monitoring (looking for hypertension) can provide clues, though it's not definitive in identifying VBI.
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Eye examinations should be conducted as part of the assessment process
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VBI tests are not definitive, relying on ultrasound to truly clear the vertebral arteries, a significant issue given the lack of imaging.
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In the absence of clearing the artery, any manipulations/mobilizations/ROM exercises for VBI, should be avoided.
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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
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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)
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TOS involves obstructions of structures emerging from the superior thoracic aperture.
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Key affected structures include brachial plexus trunks, medial cord of the brachial plexus, subclavian artery and vein, and potentially the axillary artery and vein.
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Most commonly, TOS is neurogenic (90% of cases).
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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.
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Vascular TOS requires physician referral.
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TOS diagnosis is typically a process of exclusion, with a focus on identifying the underlying cause. A multifactorial and ongoing assessment is crucial.
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Palpation assessment should include: Upper trapezius, Pectoralis minor, Scalenes, Erb's point, Clavicle, Upper Quadrant Soft Tissues, First rib Joint Play, and Distal pulses.
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Potential assessment division might include: initial focus on vascular ruling out, followed by treatment, assessment, and finding causes in future appointments.
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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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