Week 2 – Study Guide Questions

1. What does the mnemonic ‘LODCTRRAPPA” stand for? When is it used?

Location
Onset
Duration
Course (better or worse)
Type of pain
Radiation
Relieving factors
Aggravating factors
Previous episode
Previous treatment
Associated signs and symptoms

It is use when taking a patient history. The purpose is to pinpoint the location and
origin of the pain.

2. Describe what is meant by a system’s review.

A systems review is a brief overview (can be done with the help of a questionnaire)
of all the systems of the body, looking for any related/unrelated or new information
pertaining to the patient’s conditions.

3. What does VIPPIRONEL stand for? When is it used?

V - Vitals
I – Inspection (posture, gait, habitus, alertness etc)
P - Palpation
P – Percussion (if appropriate)
I – Instrumentation (charts, goniometers, inclinometers, scanning devices)
R – Range of motion (active, passive)
O – Orthopaedic tests
N – Neurological tests
E – Extra studies (x-rays, CT, MRI)
L – Lab studies
It is used after taking the patient history to evaluate all body systems.

4. Describe the difference between dermatomes, sclerotomes and myotomes.

Dermatomes – form connective tissue and skin. A dermatome is the skin area
supplied by the sensory component of a single spinal nerve root. Pain will be
radiating, sharp, stabbing and well demarcated; area of sensation attributed to a
particular nerve root level.
Sclerotomes – form vertebrae and skin. An area of bone innervated by a single
nerve segment. Pain will be dull, achy, diffuse and difficult to pinpoint; referred pain
from somatic structures (cartilage, ligament, joint capsule or bone).
Myotomes – form skeletal muscles of neck, trunk and limbs. A myotome is the
group of muscles innervated by the motor component of a single spinal nerve root.
Pain referral within muscular or fascial tissue.

5. Describe the differences between nerve root pressure and nerve trunk
pressure.

Nerve root pressure is called a radiculopathy and will have either sensory or motor
deficits depending on if the ventral or dorsal root has been pressured. A nerve trunk
is the junction where the sensory fibres (afferent fibres) and motor (efferent fibres)
come together and become mixed for the first time since leaving the spinal cord so
pressure on this area can have both sensory and motor deficits.

6. Describe the differences between spinal cord pressure and peripheral

nerve pressure.

Spinal cord pressure results in myelopathy which is the result of trauma, congenital
stenosis, degenerative disease or disc herniation. Myelopathy will be both upper and
lower motor neuron type lesions.

Peripheral nerve pressure results in neuropathy, which is a general term describing

disease affecting the peripheral nerves (nerves outside of the CNS). Neuropathy’s
will only result in lower motor neuron types of lesions.
7. What are tension signs?

Hypertonicity
Decreased ROM

8. Describe what you would find in a typical feature of irritation of

the C5 nerve root.

Neck, shoulder, scapula pain. Lateral arm paraesthesia. Affects shoulder

abduction and elbow flexion; may be weak shoulder flexion, external
rotation and forearm supination. Decreased bicep reflex.

9. What spinal nerve has no dermatome associated with it?

C1 nerve root

10. Dermatomes, sclerotomes and myotomes are derived from embryological

structures?

Somite

11. Between which two vertebrae does the spinal nerve C7 exit the
intervertebral foramen (IVF)?

Between C6 and C7

12. Which choice best describes C7 muscle test, Deep tendon reflex and
sensory testing?

a) finger abduction, pectoralis deep tendon reflex, and medial

upper arm sensory from the elbow to the axilla
b) wrist extension, brachial radialis deep tendon reflex, and lateral
forearm and digits 1 and 2 sensory from the elbow to the tip of
the fingers
c) wrist flexion, triceps deep tendon reflex, and anterior and
posterior middle finger sensory from the wrist to the tip
d) shoulder abduction, biceps deep tendon reflex, and lateral
upper arm sensory from the shoulder to the elbow.

13. 25-year-old AFL player fell on his shoulder vertically and violently
stretched his neck in the opposite direction. He was later
diagnosed with a brachial plexus injury. His arm is hanging at his
side in medial rotation in the ‘waiter’s tip” position. What results
are expected from the neurological examination?
a) Paralysis of the deltoid, triceps, wrist extensors (long and
short carpi radialis) and finger extensors
b) Paralysis of all intrinsic muscles of the hand, flexor muscles
(claw hand), loss of sensation over C8-T1 dermatomes and
Horner’s syndrome
c) Hypaesthesia over C5-C6 and weakness of the deltoid,
supraspinatus and infraspinatus, biceps and brachioradialis
muscle
d) Klumpke paralysis caused by forced hyperabduction of the arm