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MSK 2 > 1c - CSpine Dx > Flashcards

1c - CSpine Dx Flashcards

1
Q

what are 2 dx that fall under the neck pain w mobility deficits category

A

facet dysfunction
cervical spondylosis/DJD

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2
Q

what dx falls under neck pain with radiating pain

A

cervical radiculopathy
- intervertebral disc herniation
- DJD

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3
Q

what care does every pt w neck pain receive

A

multimodal care
- pt ed
- exercise
- manual therapy

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4
Q

what is the significance of neck pain CPG classifications

A

tells us how to prioritize treatments

certain paths associated with each category

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5
Q

what are 3 common sx of neck pain w mobility deficits

A
  1. central and/or unilateral neck pain
  2. limitation in neck motion that consistently reproduces sx
  3. associated (referred) shoulder girdle or UE pain may be present
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6
Q

referred pain vs radicular pain

A

referred pain
- pain is felt in distal tissues from location

radicular pain
- radiating along course of nerve
- narrow band close to dermatome of what nerve supplies

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7
Q

what is the C2-3 facet joint referred pain pattern

A

L back of skull, L upper back of neck (behind ear)

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8
Q

what is the C3-4 facet joint referred pain pattern

A

R back of neck

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9
Q

what is the C4-5 facet joint referred pain pattern

A

L back of neck over upper trap area
- some overlap w C2-3 referred region

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10
Q

what is the C5-6 facet joint referred pain pattern

A

R low back of neck over shoulder to delt and upper scap area
- some overlap with C3-4 area

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11
Q

what is the C6-7 facet joint referred pain pattern

A

L upper-mid back, over shoulder, upper arm, covers majority of scap
- some overlap w C4-5 area

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12
Q

what are expected ROM exam findings in neck pain w mobility deficits

A

limited cervical ROM

neck pain reproduced at end ranges of AROM and PROM

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13
Q

what are suspected segmental mobility exam findings in neck pain w mobility deficits

A

restricted cervical and thoracic segmental mobility (PPIVMS and PAIVMS)

intersegmental mobility testing reveals characteristic restriction

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14
Q

how are neck and referred pain reproduced in neck pain with mobility deficits

A

provocation of involved cervical or upper thoracic segments or cervical musculature

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15
Q

what other deficits might be found in the exam of subacute/chronic neck pain w mobility deficits

A

cervico-scapulothoracic strength motor control deficits

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16
Q

facet dysfunction (hypomobility) common hx and MOI

A

<50yo

MOI: onset of unilateral neck pain or locking
- unguarded/awkward movt or position

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17
Q

common sx of facet dysfunction (hypomobility)

A

localized pain

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18
Q

what tests and measures will be altered in facet dysfunction (hypomobility)

A

palpation - localized changes
PPIVMS and PAIVMS
- reveal altered segmental mobility patterns
ROM - combined movements restricted

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19
Q

how does a neuro exam present for facet dysfunction (hypomobility

A

usually normal

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20
Q

what are the 2 main groups of pts w hypomobility

A

1st: younger pts w MOI from waking up w it or turn head awkwardly
- can palpate where painful/stiff

2nd: older group w DJD, CS, OA
- slow changes over long period of time

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21
Q

how do degenerative changes in the spine present

A

start in intervertebral discs w osteophyte formation and involvement of adjacent soft tissue structures

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22
Q

what about imaging for DJD/CS/OA is important to consider

A

clinical signs don’t always correlated w imaging
- neck pain (axial)
- radiculopathy
- myelopathy

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23
Q

pain w hypomobility in younger vs older pts

A

younger = localized
older = generalized

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24
Q

DJD hx

A

> 50yo
gradual onset

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25
Q

how does pain present in DJD

A

generalized chronic neck pain
morning stiffness
- loosen up w movement or hot shower

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26
Q

common posture of DJD pt

A

forward head posture
inc thoracic kyphosis

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27
Q

what tests and measures will be altered in DJD

A

ROM - dec

joint play
- generalized hypomobility (not a specific pattern of up or downglides)

palpation
- adaptively shortened tissues
- tender
- inc tissue density
- dec mobility

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28
Q

neuro exam of DJD pt?

A

no radicular s/sx

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29
Q

CPGs for acute neck pain w mobility deficits

A

thoracic manip
neck ROM exercises
scap-thoracic and UE strength

may provide cervical manip/mob

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30
Q

CPGs for subacute neck pain w mobility deficits

A

neck and shoulder girdle endurance exercises

may provide thoracic manip and cervical manip/mob

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31
Q

CPGs for chronic neck pain w mobility deficits

A

multimodal approach:
1. thoracic manip and cervical manip/mob
2. mixed exercise for cervical/scapulothoracic region:
- NM (coordination, proprioception, postural training)
- stretching
- strengthening
- endurance training
- aerobic conditioning
- cog affective elements
3. dry needling, laser, or intermittent mechanical/manual traction

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32
Q

what should the initial focus be of interventions for neck pain w mobility deficits

A

joint mob of hypomobile segments in cervical and thoracic

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33
Q

what should be included in the interventions for neck pain w mobility deficits

A

combo of education, manual therapy, and exercise

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34
Q

what are 5 interventions for neck pain w mobility deficits

A

joint mobs***
ROM exercises - C and T-spine
- combined movements
postural and ergonomic ed
soft tissue mob
strengthening/endurance program

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35
Q

direct vs indirect treatment mobs for mobility deficits

A

direct = unilateral PA
- palpate right over facet and downglide

indirect = central PA
- get downglide on both sides
- pt might tolerate better

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36
Q

what neck pain w mobility deficits patient population is mobilization movement esp good with

A

younger pts w lingering twinge after initial mobilization

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37
Q

common sx of neck pain w radiating pain (4)

A
  1. neck pain with narrow band of lancing/burning/electric pain in involved extremity
  2. nerve root irritation, inflammation, compression
  3. may have referred pain from IV disc
  4. UE dermatomal paresthesia or numbness
38
Q

what is the most common cause of neck pain w radiating pain

A

cervical disc herniation
- results in inflammation around nerve

39
Q

location of most common cervical disc herniations

A

C5-6
C6-7

40
Q

4 risk factors for a cervical disc herniation

A

smoking
sedentary lifestyle
poor posture
excessive lifting

41
Q

what are the most common sources of radiculopathy and why

A

C7 and C6

inc load at those levels

42
Q

common pt age for radiculopathy

A

age 40-50yo

43
Q

common causes of radiculopathy

A

herniated nucleus pulposis (HNP)
spondylosis

44
Q

5 differential dx for radiculopathy

A

peripheral n. disorders
TOS
brachial plexus disorder
parsonage-turner syndrome (PTS) - brachial neuritis
systemic dz

45
Q

dx procedures for radiculopathy

A

radiographs
MRI
EMG and nerve conduction studies

46
Q

what test has a high specificity w radiculopathy

A

distraction test

47
Q

prognosis for radiculopathy and recovery timeline

A

good

substantial improvements first 4-6mo post onset
complete recovery 2-3yr in 80% of pts

48
Q

MOI for radiculopathy

A

insidious or traumatic

49
Q

radiculopathy pain aggravating factors

A

worse w coughing or sneezing
- valsalva pressure -> inc interspinal pressure
may refer to scap region

50
Q

palpation of radiculopathy exam

A

ms guarding to protect area
not one specific area

51
Q

how does ROM present in radiculopathy

A

limited and painful
- not a mechanical restriction
- limited by pain
- will improve w pain dec

52
Q

what ab repeated motions are important in a radiculopathy exam

A

does it centralize or peripheralize sx

cervical retraction = centralize

53
Q

what is included in a neuro exam for a radiculopathy and what are common findings

A

myotomes/dermatomes/DTRs
- myotomal ms weakness
- sensory/reflex deficits associated w involved nerve roots

54
Q

what r/i a cervical radiculopathy

A

r/i by presence of 4 (+) exams from the test item cluster:

(+) spurling A test
- SB and compression
(+) upper limb tension test A
- median n.
(+) cervical distraction test
(+) <60deg cervical rotation toward sx side

with 99% specificity

55
Q

what r/o a cervical radiculopathy

A

(-) ULTTA

56
Q

what are other tests for cervical radiculopathy not included in the Test Item Cluster

A

valsalva test
shoulder ABD test (badoky sign)
arm squeeze test**
- (+) good to r/i
- (-) good to r/o

57
Q

what are 3 things that nerves need to be healthy and thrive

A

blood supply
space
movement

58
Q

CPGs for acute neck pain w radiating pain

A

may provide mobilizing and stabilizing exercises, laser, and short-term use of c-collar

59
Q

when is a soft cervical collar appropriate to use in neck pain w radiating pain

A

acute radiculopathy
- hot and irritated nerve where every move hurts
- if difficult getting comfortable at night or hurts during certain activities

*not long term

60
Q

CPGs for chronic neck pain w radiating pain

A

mechanical intermittent cervical traction combined with stretching/strengthening exercises + cervical and thoracic mob/manip

give pt ed to encourage participation in occupational and exercise activities

61
Q

what is the initial focus of interventions for neck pain w radiating pain and why

A

centralize arm pain
- indicates better prognosis

if pain peripheralizing, that is a poor prognostic factor

62
Q

what are 6 interventions for neck pain w radiating pain

A
  1. pt ed
    - posture & ergonomics
  2. shoulder girdle elevation or unloading or foraminal opening positions
  3. cervical traction
  4. centralization exercises
  5. manual therapy
  6. strengthening exercises
63
Q

what pt pop is the intervention of shoulder girdle elevation appropriate for

A

for high irritability and very acute patients

64
Q

what is the goal of cervical traction

A

unload nerve to give more space and centralize the sx

65
Q

what is an important pt ed component for centralization interventions

A

pain may get more intense as moves prox, but this is part of healing process
- should warn pts ab this

66
Q

what are examples of centralization exercises

A

retraction = lower cervical ext/upper cervical flexion
- repeated movement

67
Q

what are manual therapy interventions for neck pain with radiating pain and when is this introduced in POC

A

cervical spine joint mob
thoracic joint manip/mob

later on in treatment

68
Q

what strengthening exercises are appropriate for neck pain w radiating pain

A

deep neck flexor
scapulothoracic ms

69
Q

what are 3 types of traction

A

positional
manual
mechanical

70
Q

what are modes of cervical traction and who are they appropriate for

A

static
- joint and/or nerve root irritability/severe arm pain

intermittent
- acute joint derangement or pts needing joint mob

71
Q

what pt pop is manual traction most commonly used with and why

A

more acute radiculopathy
- more specific
- can get feedback and adjust
- won’t spend a lot of time w traction initially

72
Q

what position should the pt be in for manual traction

A

hooklying - take pressure off lower back
elbows flex to take tension off nerve

73
Q

what are 2 pros to manual traction

A

more specific
easier to adjust force and neck position

74
Q

why is head halter over door (a form of mechanical traction) rarely used now

A

compressing thru TMJ
less relaxed in sitting than in supine

75
Q

when do you transition from manual to mechanical traction

A

if pt doing well w manual
- may be more efficient to put them on mechanical traction unit

76
Q

what are 2 common mechanical traction units used today

A

sub-occipital grip (Saunders)
pronex pneumatic traction unit

77
Q

mechanical effects of spinal traction (4)

A
  1. distraction/separation of vertebral bodies
  2. distraction of facet joints
  3. inc ligamentous tension/stretch joint capsules and tendons and spinal ms
  4. widening of intervertebral foramen
78
Q

physiological effects of spinal traction (esp intermittent) - 3

A
  1. inc circulation
  2. mechanoreceptor input
  3. dec pain
79
Q

what is the goal of spinal traction

A

maximum sx reduction and centralization of sx

80
Q

4 indications of traction

A

HNP
radiculopathy
DJD
facet/joint hypomobility

81
Q

5 contraindications of traction

A
  1. structural dz
    - tumor or infectious
    - fx, severe osteoporosis, TB of bone, bone tumors
  2. vascular compromise (ie VBI, cervical vascular disorder)
  3. any time movement is contraindicated
    - fx, recent fusion, ligamentous rupture, evidence of instability
  4. impaired cog function
  5. claustrophobia
82
Q

angle of traction force to inc IV space at C1-C5

A

0-5deg flex

83
Q

angle of traction force to inc IV space at C5-C7

A

25-30deg flex

84
Q

what angle of traction force is needed for facet joint separation and what is an indication for this

A

24-35deg

DJD, stiff neck

85
Q

angle of traction force appropriate for HNP and why

A

0deg flex

flex would further protrude disc post
- could have trouble returning to neutral/ext after bc disc has moved

86
Q

time on traction for acute conditions and HNP

A

5-10min

87
Q

time on traction for non-acute conditions and not HNP

A

15-30min

88
Q

minimum force needed for traction

A

8-10lbs
or 7-10% of pt body wt

89
Q

what does evidence show for the addition of mechanical traction to exercise in cercial radiculopathy

A

lower disability and pain, particularly at long term f/u

compared to exercise alone

90
Q

what is an repeated movements intervention mean

A

pt controlled repeated AROM movements at end-range or sustained posture
- centralizes pain and diminish peripheral sx

91
Q

what repeated movements are assessed in a pt exam (4)

A

retraction
retraction + ext
protraction
flexion

MSK 2 (20 decks)

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