ORTHO III FINAL - CONCISE MASTER AI QUIZLET

Pain (IASP definition)

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Nociception

Neural encoding of noxious stimuli; not the same as pain because pain is a brain output.

Acute pain

Pain lasting less than 6 months and generally proportional to tissue injury.

Chronic pain

Pain persisting longer than 6 months and relatively independent of tissue status or normal healing time.

Normal tissue healing time

Most musculoskeletal tissues reach maximal healing within 3-6 months, even if pain persists.

Neuromatrix theory of pain

Pain is generated by a network of brain regions based on perceived threat, not just tissue input.

Nociplastic pain

Pain arising from altered nociception without clear evidence of ongoing tissue damage or somatosensory lesion.

Central sensitization

Increased excitability of central neurons leading to hyperalgesia, allodynia, and enlarged receptive fields.

Hyperalgesia

Increased pain in response to a stimulus that is normally painful.

Allodynia

Pain in response to a stimulus that is normally non-painful, such as light touch or pressure.

Temporal summation (wind-up)

Progressive increase in perceived pain with repeated, identical stimuli; a hallmark of central sensitization.

Habituation response

Normal decrease or stabilization of pain with repeated non-noxious stimulation.

Cortical smudging

Blurring of somatosensory representation areas in the brain, often associated with impaired 2-point discrimination.

Yellow flags

Psychosocial factors such as fear, catastrophizing, distress, and low self-efficacy that increase risk of chronic pain.

Pain catastrophizing

Tendency to magnify the threat of pain, ruminate about it, and feel helpless, leading to greater disability.

Fear-avoidance model

Fear of pain leads to activity avoidance, deconditioning, and worse pain, reinforcing the fear.

Exercise-induced hypoalgesia

Temporary reduction in pain sensitivity after exercise; often blunted in chronic pain populations.

Pain neuroscience education (PNE)

Education targeting pain biology and threat perception to reduce fear and improve function.

Goal of PNE

Shift beliefs from 'pain equals damage' to 'pain is a protective alarm that can be overprotective.'

Biopsychosocial model of pain

Framework recognizing that biological, psychological, and social factors interact to influence pain.

Pain pressure algometry

Tool that measures pressure-pain thresholds to identify local versus widespread sensitization.

Local sensitization on algometry

Reduced pressure-pain threshold at the symptomatic site but normal thresholds at distant sites.

Widespread sensitization on algometry

Reduced thresholds at multiple remote sites, supporting a nociplastic pain mechanism.

Two-point discrimination (TPD) testing

Somatosensory test of tactile acuity used to infer cortical map clarity or smudging.

Impaired two-point discrimination

Widened threshold distances indicating altered cortical representation in persistent pain.

Central posterior-anterior (CPA) mobilization test

Repeated PAs to a spinal segment used to evaluate temporal summation or habituation of pain.

CPA temporal summation response

Progressively increasing pain rating to repeated light CPA, suggesting central sensitization.

CPA habituation response

Stable or decreasing pain ratings during repeated light CPA, suggesting normal nociceptive processing.

Reflexive withdrawal during CPA

Sudden guarding or recoil to light joint mobilization, consistent with heightened nervous system sensitivity.

Submaximal physical capacity test

Exercise test performed at 50-60% predicted HR max to assess deconditioning and autonomic response.

Heart rate recovery after submax test

Time for HR to return within about 10 bpm of resting; delayed recovery suggests impaired autonomic regulation.

Deconditioning in persistent pain

Reduced fitness and capacity contributing to fatigue and higher perceived exertion.

Graded activity

Prescribed, time-contingent activity progression focusing on function rather than pain levels.

Graded exposure

Gradual introduction of feared movements or activities to reduce threat and avoidance.

Cervicogenic headache (CGH)

Unilateral headache associated with neck pain and restricted cervical ROM, aggravated by neck movement.

Flexion-rotation test (FRT)

Cervical test where rotation in full flexion <32° or >10° difference indicates C1-2 dysfunction and possible CGH.

Tension-type headache (TTH)

Bilateral, band-like pressure headache, mild-moderate intensity, with no nausea and minimal photophobia.

Migraine without aura

Recurrent unilateral throbbing headaches with nausea and/or photophobia, aggravated by routine activity.

Cervical myelopathy cluster

Includes gait deviation, Hoffman's sign, inverted supinator sign, Babinski, and age >45 years.

Cervical radiculopathy cluster

Positive ULTT, Spurling's test, distraction relief, and rotation <60° to involved side.

5 Ds of cervical arterial dysfunction

Dizziness, diplopia, dysarthria, dysphagia, and drop attacks.

3 Ns of cervical arterial dysfunction

Nystagmus, nausea, and numbness around the face.

Cervical artery dissection red flag

Sudden severe neck or head pain with associated neurological signs; requires emergency referral.

Thoracic manipulation indication

Mechanical neck or shoulder pain with thoracic hypomobility and no red flags.

Spinal manipulation contraindications

Suspected fracture, malignancy, infection, myelopathy, vascular compromise, or severe osteoporosis.

Temporomandibular disorder (TMD)

Group of musculoskeletal conditions involving TMJ, masticatory muscles, or associated structures.

TMD prevalence

Affects approximately 5-31% of the population, more common in women.

Disc displacement with reduction

TMJ disc is anterior at rest but recaptures during opening, often producing a click.

Disc displacement without reduction

Disc remains anteriorly displaced and does not recapture, causing limited opening and deflection.

Retrodiscal tissue

Highly vascularized and innervated tissue posterior to the disc, often a source of TMJ pain when overloaded.

Mandibular depression norm

Normal mouth opening is about 40-50 mm; 36 mm is usually sufficient for normal function.

Mandibular lateral excursion norm

Lateral excursion is roughly 10 mm to each side from the midline.

4:1 opening-to-excursion ratio

For every 4 mm of mandibular depression, expect approximately 1 mm of lateral excursion.

Deviation

S-shaped jaw path that returns to midline at end range, often associated with disc displacement with reduction.

Deflection

Jaw deviates toward one side and does not return to midline at full opening, suggesting ipsilateral hypomobility or non-reducing disc.

Myalgia (DC/TMD)

Familiar muscle pain in jaw or temple reproduced with palpation or mandibular movement.

Arthralgia (DC/TMD)

TMJ joint pain reproduced with joint palpation or loading.

Hypermobility of TMJ

Excessive translation or subluxation of the condyle beyond articular eminence in opening.

Rocabado 6x6

Postural and jaw-positioning exercise program used to normalize cranio-cervical-mandibular alignment.

Parafunctional habits

Non-functional jaw activities like clenching or grinding that increase TMJ load.

Systemic hypermobility and TMD

Generalized joint laxity (e.g., EDS) increases risk of TMJ instability and pain.

TMD self-care strategies

Resting jaw position, soft diet, parafunction reduction, heat/ice, and gentle exercises.

Cervical spine contribution to TMD

Upper cervical dysfunction and muscle overactivity can refer pain to the jaw and aggravate TMD.

Pelvic girdle pain definition

Pain located between the posterior iliac crest and gluteal fold, sometimes involving the pubic symphysis.

Antepartum PGP risk factors

Prior low back or pelvic pain, multiparity, physically demanding work, higher BMI, and low recovery expectations.

Postpartum PGP risk factors

Persistent pregnancy PGP, depressive symptoms, physically heavy work, and poor support.

PGP poor prognosis signs

Early onset, multiple pain sites, many positive provocation tests, and significant fear-avoidance.

PGP provocation tests

Thigh thrust (P4), FABER, Gaenslen's, compression, and distraction used to reproduce pelvic pain.

Active straight leg raise (ASLR)

Test to evaluate load transfer and stability across the pelvis.

Pelvic belt

External device applied around pelvis to improve force closure and decrease PGP in some patients.

Diastasis rectus abdominis (DRA)

Separation of rectus abdominis along the linea alba, affecting abdominal wall function.

Postpartum pelvic floor dysfunction

Common condition involving urinary leakage, heaviness, or pelvic pain after childbirth.

Pelvic floor muscle training

Exercise intervention to improve continence, support, and lumbopelvic stability.

Bone stress injuries postpartum

Femoral neck or sacral stress fractures linked to low BMD and high demand; require imaging when suspected.

Psychosocial factors in PGP

Depression, kinesiophobia, and low expectations worsen disability and delay recovery.

Exercise in antepartum PGP

Recommended as low-risk and generally beneficial despite limited condition-specific evidence.

Manual therapy in PGP

May improve pain and function; evidence is emerging and should be combined with exercise and education.

Female athlete triad

Spectrum of low energy availability, menstrual dysfunction, and low bone mineral density.

RED-S (Relative Energy Deficiency in Sport)

Expanded triad concept affecting multiple physiological systems (CV, immune, endocrine).

High-impact sport and PFD

Activities like running and gymnastics increase risk of urinary incontinence in women.

Pelvic floor overactivity

Excessive PFM tone that can cause pain, urgency, and paradoxical leakage.

Pelvic floor underactivity

Inadequate PFM strength or endurance leading to stress incontinence and prolapse.

Postpartum return to running

Requires screening for leakage, pelvic pain, DRA, and adequate strength and impact tolerance.

Menopause and cardiovascular risk

Menopausal transition associated with decreased endothelial function and increased CV risk.

Flow-mediated dilation (FMD)

Measure of endothelial function; declines around menopause and improves with exercise in impaired women.

Menopause and bone health

Estrogen loss accelerates bone loss, increasing osteoporotic fracture risk.

Exercise in menopause

Resistance and impact training to maintain bone mass, plus aerobic exercise with BP monitoring.

Vertical loading rate (VLR)

Slope of the vertical GRF curve; higher rates associated with tibial stress injuries.

Rearfoot strike pattern

Characterized by initial heel contact, higher impact peak, and increased tibial shock.

Forefoot strike pattern

Initial contact on forefoot; decreases knee load but increases calf and Achilles tendon load.

Minimal shoe transition in youth

Associated with increased VLR and risk of anterior shin and calf pain if not gradual.

Crossover gait

Narrow step width with foot crossing midline; linked to ITB strain and lateral knee pain.

Contralateral pelvic drop

Downward drop of the pelvis on the swing side; associated with gluteus medius weakness and ITB syndrome.

Cadence increase cue

Increasing step rate by 5-10% to lower VLR and patellofemoral joint stress.

"Run softer" cue

Verbal cue to decrease impact noise and loading rate during running.

UW Running Injury and Recovery Index (UWRI)

Patient-reported outcome measure for running-related injury severity and recovery.

Return-to-run progression

Graduated walk-jog intervals based on symptom response and functional readiness.

Single-leg loading test

Functional test (e.g., SL squat) reflecting tolerance for running-type loads.

Carpal tunnel syndrome (CTS)

Median nerve compression at the wrist causing numbness in digits 1-3 and nocturnal symptoms.

Phalen's test

Wrist flexion for 60 seconds reproducing CTS paresthesias.