1 Cervical Spine Syndromes Flashcards
What are the Mobility examination findings in a patient?
- Recent onset of symptoms
- No radicular signs and symptoms
- Restricted ROM with side to side roation and/or discrepancy in lateral flexion ROM
- no signs of nerve root compression/peripheralization
What intervention is proposed with Mobility classifed patients?
- Cervical and thoracic spine mobilization/manipulation
- Active ROM exercises
What are the Centralization findings?
- Radicular signs/symptoms
- Peripheralize or centralize with ROM
- Signs of nerve root compression
- Symptoms distal to elblow
What intervention is proposed for Centralization patients?
- Mechanical and cervical traction
- Repeated movements/activites to promote centralization symptoms
What are the Conditioning and Exercises Increase findings in a patient?
- No radicular signs/symptoms
- Chronic Symptoms
- Low pain and disability scores
- No nerve root compression signs or perhipheral/centralization
What interventions are propsed with exercise and conditioning classification patients?
- Aerobic conditioning
- Strengthening and endurance for upper neck
What are the findings for Pain Control patients?
- Acute onset of symptoms
- Traumatic mechanism
- High pain and disability scores
- recent onset of symptoms
- Reffered or radiating symptoms to Upper Quarter
- Poor Tolerance for exam
What are the intervention strategies for Pain Control patients?
- Gental ROM + activity
- ROM for adjacent regions
- Physical modalities as needed
- Activity modification
What are the examination findings for Headache patients?
- Primary complaint headache
- Cervicogenic headache
- Unilateral headache with onset by neck pain
- triggered by neck movement/positions
- Pressure on posterior neck brings symptoms
What interventions are proposed for Headache patients?
- Manual Therapy
- Neck Flexor/scapular strengthening
- C spine manipulation/mobilization
- Postural education
What is the formular for evaluating neck and upper extrimity pain?
- Know normal and recognize deviation
- Reproduce pain by reproducing abnormal movement/position
- Understand mechanism pain is caused
Describe pain originating from soft tissues
Soft tissues can cause majority of symptom s
upper C spine
Describe muscular pain from tension
- May occur at periosteal site of attachment
- Common site is base of skull
- attachment of upper trapezii and subocciptals
- May occur within belly of a muscle from either acute or sustained contractions
Muscular Pain from Tension (ACUTE)
- Isometric contractions produce greater intramuscular pressure than isotonic
- Increasd internal pressure leads to inflammation and “myositis”
Muscular Pain from Tension (Sustained Contraction)
Leads to Ischemic pain
- lack of O2
- Accumulated irritating metabolites (Factor P, potassium, Lactic Acid)
Describe Joint Pain of the NEck
- OA pain due to capsule thickening = limited ROM
- Stretching thicked and contracted periarticular tissues on attempted neck motions causes pain felt in neck
- Limits motion
Describe pain from IVD
- Distributed in broad areas, ill defined margins
- (cloward areas around scap dont apply to C3)
- Discogenic pain may be central, unilateralm bilateral or bilateral asymmetrical
Describe Pain from Vertebral canal
- Nerve roots at Upper C Spine (C123)
- Suboccipital muscles C1 C2
- Greater AUricular and lesser occiptal nerves C2 C3
- Upper trap CN XI C2 C3
- Vertebral artery within transverse foramen
What are the 3 parts of the Trigeminal nerve (Spinal Nucleus)
- Pars Oralis
- Pars Interpolaris
- PArs Caudalis
POPIPC
What is invovled in the nociceptive transmission information?
- Trigeminocervical nuclues
- seen as pain center for the entire head and upper neck
What are 2 upper C spine conditions that can give rise to cervical headaches?
- RA
- erosive synovitis of the media and lateral atlantoaxial joints (joints and ligaments supplied by C1 - C3 nerves)
- AO Osteoarthritis
- Joint innervated by C1 and C2 sinuvertebral nerves
Explain Trigger Points with cervical headaches
- Trigger points in splenius capitus, trapezius, SCM, and subocciptal muscles can refer pain to the head
- Only muscles inntervated by C1 C2 C3 are capable of producting headache
What is C3 Dorsal Raums Syndrome?
C2 3 apophyseal joint innervated by C3 dorsal ramus and many studies implicate this joint as a causation of headache
- Vulnerable to trauma
What is Cervical Spondylosis?
Occiptal headaches arise b/c spasm of the posterior neck muscles which attach to occiput
Also possible cervical spondylosis with arthosis of cervical joints
What is occipital neuralgia?
- Compression of greater occiptal nerve = headache
- Studies show could be more likely to arthritis of upper C joints
What are post traumatic headaches?
Sign of upper C injur concominant with any more obvious lower C lesion
What is RA?
- Systemic Disease
- More common in females
- Mid life 40-50
- Synovitis = major feature of TA
What is Synovitis?
- Synovial membrane becomes inflammed
- Joints become swollen, painful and feels puffy/boggy
- Persistant inflammation leads to cartilage erosion and subchondral bony proliferation
How does RA affect the C spine?
- Loosening effect on ligaments of AA joint
- Synovitis of Facet joints
- muscular aches
- fatigue
What are treatment considerations for RA?
- gengle movement and active ROM exercises during remission
- Provide support (soft collar), heat, pain relieving modalities during acute inflammatory epsidoes
- Be aware of meds ( NSAIDS, Steriods, Gold injections )
NEVER MANIPULATE
What is Acute Wry Neck?
- “Torticollis”
- Static Protective deformity
- between C2 - C7 (Usually at C2/3)
- Manifest in morning
- Atalgic posture
- Slight flexion and side bending AWAY from painful side
What is the presentation of Acute Wry Neck?
- younger adults/children
- Gradual onset 1-2 hours without cause
- Difficult to elevate painful side arm
- Movements towards side of pain hurt or restricted
- Flexion full range and painfree (movement AWAY from painful side)
What are 3 mechanisms of Acute Wry Neck?
- Meniscoid villus - impacted synovial inclusion (prolonged stretch > Slight edema > Meniscoid villus)
- Periarticular Congestion/localized irritability without inclusion
- Slow shift of cervical disc substance
- Strained posutre during sleep (lower c spine)
What is Type I Wry Neck?
- Facet
- Sudden onset (particular movement), on waking, during night or any time
- pain unilateral locallized pillar of neck
- Does no spread
- Easily relieved with MANIPULATIONS OR MOBILIZATIONS
What is Type II Wry Neck?
- Waking in the morning onset
- Pain one side base of neck and spreads unilaterally to yoke area and mid scap (Cloward), possible spread down outer/posterior arm or elbow
- Takes longer to relieve
- Can be provoked by manipulation or mobs
- u_se sustained traction in flex/rotational distraction or sustained_
What is the presentation of Cervical Joint Locking?
- Facet Joint is cause of pain
- IMpaction of synovial fold (meniscoid synovial villus) or joint capsule iteself between joint surfaces
- Patient is young/athletic wit no previous neck injury or symptoms
- Sudden onset with sudden movement
- Sidebend and rotation away from painful side
What is the treatment for cervical joint locking?
Treatment intially for gaping or opening of the facet joint for realse of synovium
Soft tissue healing
