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MSK III > 3 Neck Pain Mobility WAD > Flashcards

3 Neck Pain Mobility WAD Flashcards

1
Q

What are the common symptoms of neckpain with mobility deficits?

A
  • Central and unilateral neck pain
  • limitation in neck motion that reproduces symptoms
  • Associated shoudler girdle and UE pain that may be present
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2
Q

What is are the expected exam findings for neck pain with mobility deficits?

A
  • Limited cervical ROM
  • Neck pain reproduced at end ranges of AROM/PROM
  • Restricted C and T segmental mobility
  • Neck and reffered pain reproduced with provication of involved C or Upper thoracic segments or cervical musculature
  • Deficits in cervicoscapulothoracic strength and motor control presented with individuals with subacute or chronic neck pain
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3
Q

What the the physical impairment measures?

A
  • Cervical AROM
  • Cervical and thoracic segmental mobility

Check for symtom reproduction and when in range is pain produced?

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4
Q

What are the Acute interventions for neck pain with mobility impairments?

A
  • Thoracic manipulation
  • Cervical mobilization or manip
  • Cervical ROM, stretching, isometric strengthening
  • Advice to stay active + ROM/Isometric HEP exercise
  • Supervised exercise
  • Stay active (general fitness training)
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5
Q

What are the subacute interventions for mobility deficits?

A
  • Cervical/Thoracic manip/mobilization
  • Cervivoscapulothoric Endurance exercise
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6
Q

What are the interventions for chronic mobility deficits?

A
  • Thoracic manipulation
  • Cervical mobilization
  • Combined Cervicoscapulothoric exercise plus mobiliation + maip
  • Mixed exercise for coordination, proprioception, postural training, stretching, strengthening, endurance, cognitive affective elemments
  • Stay active lifestyle
  • Dry needle, low level laser, High power US, traction, TENS, E stim
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7
Q

T or False Thoracic thurst improves short term and long term outcomes regardless of CPR?

A

T

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8
Q

What is the clinical prediction rule for Cervical Thrust Manipulation?

A
  • Symptoms < 38 days
  • Postive expecation of manipulation will help
  • Cervical rotation ROM side to side difference of 10 degrees or greater
  • Pain with PA testing mid cervical range
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9
Q

What are common symptoms you find with Neck Pain with movement coordination impairments (WAD)?

A
  • Mechanism of onset lined to trauma/whiplash
  • Associated shoulder girld UE pain
  • Associated non specific concussive s/s
    • Dizziness and nausea
    • Headache, concentration or memory difficulties, confusion, hypersensitivity to mechanical theral, acoutsic, odor or light
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10
Q

What findings would you expect for Neck pain with coordination impairments?

A
  • Positive cranial cervical flexion test
  • Positive neck flecor/muscle endurance test
  • postive pressure algometry
  • Strength/endurance deficits
  • Neck pain mid range that worses with end range
  • point tenderness may include myofascial trigger points
  • Sensiomotor impairment may include altered muscle activation/proprioception/ postural or balance
  • Neck and reffered pain reproduced involved cervical segments
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11
Q

What muscles are associated with movement coordination impairments?

A
  • Anterior
    • Longus colli, Longus capitus
  • Posterior
    • Cervical multifdi, semispinalis cervicis/capitus, splenius cervicus/capitus

Deep to SCM muscles

Control, stability (mid range), support of C curvature, unable to be replicated by more specific elements

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12
Q

Label 1 - 4

A
  1. Multifidus rotators
  2. Semispinalis Cervicis
  3. Semispinalis capitus
  4. Splennius Cerv/Cap
  5. Trapezius
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13
Q

What is fatty infiltrate and what muscles occur during whiplast?

A
  • Sub occipital and deep multifidus muscles
  • leads to muscle not being used to the best of its ability
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14
Q

Which muscles show hyperactivity and poor endurance after whiplash?

A
  • Hyperactivity: SCM, scalenes, trapezius
  • Poor endurance: Deep neck flexors
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15
Q

What is the Craniocervical Flexion Test?

A
  • Start with pressure unit to 20mmHg
  • pt gives chin tuck at 5 different pressures (22, 24, 26,28, 30)
  • Hold for 10 seconds/30 second rest
  • Testing ends when patient can hold pressure for 10 seconds

Looing for engagement of superficial muscles and hyperactivity

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16
Q

What is the Deep Neck Flexor Endurance Test?

A
  • pt in supine and hooklying
  • Tuck and lift your chin
  • Maintained ISOMETRICALLY
  • Head lifted 1in/2.5cm off table with chin retracted
  • Testing ends Skin sepatates >1 sec or head falls to table

Norm: Males 39sec, Females, 29 seconds

No neck pain

17
Q

What is a joint position error test?

A
  • Test to determine neck proprioception
  • Target on wall with lazer 3 ft away
  • pt closes eyes and rotates to starting position on target
  • should be in green
  • Yellow = clininically significant poor proprioception of C spine
18
Q

How do you train the DNF muscles?

A

ENDURANCE

  • Low load at <20% MVC
  • longer duration (hold 5-10 seconds)
  • May progress to higher load based off functional demands (consider proprioception)
19
Q

What are some muscle training ares to target?

A
  • Axioscapular
  • Restore functional deficits
  • be respective of pain but not guided
20
Q

What are you to educate the patient?

A
  • Decrease cervical collar use
  • Stay active/act as usual
  • Perform mobilizing exercises
21
Q

What is Whiplash?

A
  • Rear end MVA injury
  • Encompass any accerlation-decelelration injury to neck
  • Non physiological movements producing S shaped Curve
22
Q

What is the local and systemic clincal presentation for whiplash?

A
  • Local: Localized pain and tenderness, limited cervical ROM, Headaches, Muscle weakness
  • Systemic: Widespread pain, Sensory disturbance, Dizziness, fear/anxiety
23
Q

What is the Quebec Trask Force Classification grade?

A

0 = no complaint/no physical signs

I = Neck pain, stiffness or tenderness only, no physical signs

II = neck complaint, MSK signs: decreased ROM, pointed tenderness (MOST will resolved 6-8 weeks)

III= Neck complaint + neuro signs

IV = Fracture or disloation

24
Q

How does muscle loss of the deep neck affect performance?

A
  • Loss of stability
  • loss of ROM and pain for chonicity
  • Leads to aptients relying on superficial muscles (SCM)
25
Q

What are the prognostic indicators of whiplash?

A
  • Patients who score higher lead to more progression of chonicity
  • Age >45
  • Women
26
Q

What are predcitors of poor outcomes folling whiplash injury?

A
  • Restricted neck movemnt <90 L and R combined
  • Cold Hyperalgesia (low threshold for pain activation with sensory stimuli (cold, theral input and pressure) - altered pain processings
  • Moderate levels of acute post traumatic stress (PTSD)
  • High intial pain and disability
  • Age >45
  • Gender ?
27
Q

What are psychological factors in WAD?

A
  • Pain catastrophising
  • fear of movement
  • Lower pain self efficacy
  • Distress

Post traumatic stress symptoms

HIGH PAIN AND DISABILITY IN ACUTE WAD

28
Q

What are the Post Traumatic Stress signs?

A
  • Exposure to event - life threatening
  • Fear, helplessness or horror
  • Symtoms in 3 domains
    • Re-experience/intrustion (thoughts, dreams, recurring thoughts, anxiety in related situations)
    • Avoidance (similar or connected)
    • Physiolocal arousal (sleep disturbance, hypervigilance, startled, irritable)
  • Duration > 1 month
  • Signifncant distress or impairment in functioning
29
Q

What is the management strategy for acute WAD?

A
  • Assesment
  • No psychological debriefing
  • Assurance
  • allow for natural recovery
  • Refferal at 6 weeks
30
Q

What are manangement strategy for Chronic WAD?

A
  • Screening assesment
  • IES
  • Referral if moderate
  • Integral or delay PT

MSK III (13 decks)

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