STI II QUIZ 3 (UNITS 5&6)Solved And Graded To Pass Questions With Solutions.

Free nerve endings connected to CNS by thin myelinated (group III)/unmyelinated (group IV) afferent fibers. Specific muscle nociceptors What are two important stimuli for muscle pain? ATP and low tissue pH Which of the following is not a characteristic of soft tissue mechanical dysfunction? a. structural or functional asymmetry of related parts of the MSK system, ascertained by observation and palpation. b. abnormality of texture in the MSK system soft tissues, ascertained by observation and palpation. c. ROM abnormality of a joint, several joints, or regions of the MSK system (either restrictive or hypermobile qualitative changes in ROM, such as cogwheel movement, hesitations, and compensations), ascertained by observations and palpation, utilizing both active and passive testing. d. all of the above are characteristics d. all of the above are characteristics Muscle pain disorder characterized by the presence of a myofascial trigger point within a taut band, local tenderness, referral of pain to a distant site, restricted ROM, and autonomic phenomena. Myofascial pain What is the main criterion for the diagnosis of myofascial pain? Presence of an active myofascial trigger point. Hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. trigger point Produces symptoms, including local or referred pain or other paresthesia. a. active trigger point b. latent trigger point a. active trigger point Does not induce pain without being stimulated. a. active trigger point b. latent trigger point b. latent trigger point List the diagnostic criteria of identifying a myofascial trigger point. -full stretch, limited by pain -taut band palpable -tender spot or nodule within a taut band -reproducible pain of patient's complaint List the confirmatory observations needed to identify a myofascial trigger point? -local twitch response -referred pain in the expected distribution of that muscle -endplate noise or spontaneous electrical activity (SEA) demonstrated by an EMG study What are the 5 major features of a trigger point based on which excellent interrater reliablity was established? -palpable taut band -tenderness -local twitch response -referred pain -reproduced pain Which of the following is not an imaging technique used to view trigger points? a. magnetic resonance elastography b. ultrasound imaging and vibration sonelastrography c. extracorpeal shock wave d. x-ray d. X-ray Endogenous localized contracture within the muscle without the activation of the motor end plate. a. taut band b. spasms a. taut band EMG activity as the result of increased NM tone of the entire muscle and are the result of nerve initiated contractions. a. taut band b. spasms b. spasms What is the gold standard to differentiate between a taut band and spasm? EMG What are the motor and mechanical dysfunctions caused by trigger points? a. restrictions in ROM b. lengthening of the muscle c. muscle weakness d. all of the above e. both a and c f. both b and c e. both a and c What type of work tasks increase the risk of myofascial pain? -Constrained work posture -high repetition frequency and static muscle loading Presence of trigger points in what muscles can present as carpal tunnel syndrome? Asymmetrical loading of SCM and cervical paraspinals and trigger points in infraspinatus. Presence of trigger points in what muscles can present as lumbar radiculopathy? glute min Which of the following is not a sensory dysfunction caused by trigger points? a. lowering of the pain threshold over active trigger points in overlying cutaneous and subcutaneous tissues b. hypoalgesia c. peripheral sensitization d. neuroplastic changes in dorsal horn e. allodynia/non-nociceptive hypersensitivity at latent trigger points f. referred pain/paresthesia b. hypoalgesia trigger points cause hyperalgesia What are the autonomic dysfunctions caused by trigger points? -vascular changes -secretory, pilomotor, trophic changes -ptosis -changes in skin temp -hypersecretion -increased sympathetic outflow -increased intrathoracic pressure -psychological arousal or stress Electrical activity of trigger points resulting from excessive release of ACH at the motor endplate. End plate noise Does end plate noise result in local or global phenomenons? Local. It is not mediated through spine/supraspinal influences. Indicates irritability of trigger points. Describe the energy crisis hypothesis. Pathogenesis of trigger points stating that ongoing contractures compromise the local circulation and reduce O2 supply, triggering several vicious cycles. Hypoxia, production of ATP impaired, decreased pH, hypoperfusion, increased ACH, failure of Ca+ pump, increased levels of Ca+ caused contracture to occur because crossbridges never break down. Describe integrated trigger point hypothesis. Incorporates insights from pain science. Excessive Ach at the motor endplate causes constant activation. Describe the mechanism of allodynia and hyperalgesia of a myofascial trigger point. Ongoing barrage of nociceptive afferent from trigger points in dorsal horn can alter responsiveess of dorsal horn and lead to increased local pain or referred pain to other spinal cord segments. Afferent barrage from joints, skin, and viscera can result in central sensitization by unmasking of "sleeping" nociceptors and low threshold mechanosensitive neurons. The afferent input from these newly effective receptors may result in spatial summation in the dorsal horn and the appearance of new receptive fields Central sensitization changes are associated with... a. allodynia b. hyperalgesia a. allodynia Peripheral sensitization changes are associated with... a. allodynia b. hyperalgesia b. hyperalgesia Describe modified convergence projection theory. Based on pathophysiological unmasking process of interneurons within the dorsal horn. Because interneurons are located over various segments, pain may be experiences in regions outside the segmental innervation of myofascial trigger points. This mechanism may result in in formation of satellite trigger points in the area of the now enlarged receptive field leading to referred pain. Which of the following chemicals were NOT found in trigger points by Shah et al? a. substance P b. calcitonin c. GABA d. bradykinin e. serotonin f. norepinephrine g. tumor necrosis factor alpha h. interleukin-1 alpha i. interleukin 6 j. interleukin 8 c. GABA What chemicals may be associated with increased autonomic activity in the motor end plate of trigger points? a. serotonin b. bradykinin c. norepinephrine d. all of the above e. both a and b f. both a and c f. both a and c Describe the physiological change that occurs in the muscle due to dry needling? Evokes a local twitch response. This changes the chemical environment of the trigger points in order to restore normal functioning of acetylcholinesterase and Ach receptors. Chronic widespread non-articular MSK pain. Diffuse CNS disorder with pain and dysfunctional sensory processing. Fibromyalgia Syndrome Is FMS a diagnosis of inclusion or exlcusion? Exclusion Immunological dysregulations with abnormal 2'-5' oligodenylate (2-5A) synthetase/RNase L pathway a. chronic fatigue syndrome b. fibromyalgia c. both a and b a. chronic fatigue syndrome Lower blood perfusion in brainstem. a. chronic fatigue syndrome b. fibromyalgia c. both a and b a. chronic fatigue syndrome Elevated levels of substance P. a. chronic fatigue syndrome b. fibromyalgia c. both a and b c. both a and b person's diagnosed with FMS and FMS + chronic fatigue syndrome COMBINED have elevated levels of substance P, whereas those diagnosed with chronic fatigue syndrome do not. Which of the following is NOT an updated criteria to diagnose fibromyalgia syndrome? a. WPI score >/= 7 and symptom severity scale >/= 5 OR WPI score 3-6 and symptom severity score >/= 9 b. symptoms have been present at a similar level for at least 6 months c. patient does not have a disorder that would otherwise explain the pain b. symptoms have been present at a similar level for at least 6 months Symptoms need only be present for at least 3 months. Norepinephrine and serum serotonin are (increased/reduced) in patients with fibromyalgia and contributes to central sensitization. Reduced What chemicals are ELEVATED in the CSF of patients with fibromyalgia? Substance P - lowers synaptic excitability threshold within the spinal cord resulting in sensitizing neurons away from the local stimulus Glutamate both correspond to patients' levels of reported pain intensity In those with fibromyalgia... (Hypoperfusion/hyperperfusion) in seen in the anterior and posterior cingulate, amygdala, medial frontal and parahippocampal gyrus, cerebellum (Hypoperfusion/Hyperperfusion) in radioligand within the somatosensory cortex. Hypoperfusion Hyperperfusion