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MSK III > 3 Neck Pain Radicular Headache Stenosis > Flashcards

3 Neck Pain Radicular Headache Stenosis Flashcards

1
Q

What are common symptoms for neck pain with radicular symptoms?

A
  • Neck pain with raidating pain in extremity
  • Upper Extremity dermatomal paresthesia or numbess and myotomal weakness
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2
Q

What exam findings do you expect to see in Radicular neck pain patients?

A
  • Neck related radiating pain reproduced or relieved with radiculopathy testing
    • positive test cluster: upper limb nerve mobility, spurlings, cervical distraction, cervical ROM
  • Upper extremity sensory, strength, or reflex deficits
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3
Q

What type of patients do you typically see with radiating neck pain?

A
  • Herniated disc in C spine
  • peripheral/centralization
  • Dermatomal, myotomal, reflex dimished
  • pain with C rotation <60 degrees
  • Adverse neurodynamic mobility
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4
Q

What are the 4 variables that increase the liklihood of cervical radiculopathy?

A
  • Ipsilateral cervical rotation < 60 degrees towards side of symptoms
  • ULTT
  • Distraction test
  • Spurlings Test
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5
Q

What type of patient would benefit the most for radicular symotoms?

A
  • age < 54 years
  • Dominant arm not affected
  • Looking down doesnt aggravate symptoms
  • multi-modal RX > 50% of visits (OMPT, traction, DNF strengthening)
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6
Q

What is intermittent Traction for neck pain?

A
  • Supine position
  • On/Off cycle: 60 sec
  • Force: 12 lbs
  • Angle of pull: if less than full flexion AROM 15
  • Full Flexion AROM 24
  • Duration 15 minutes
    • 2 min before getting up
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7
Q

What are you looking for and type of Radicular exercises?

A
  • centralizing of symptoms
  • compliment MT at home

DNF strengthening

Lower/middle trap strengthening

Neurodynamics

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8
Q

What is a cervicogenic headache?

A
  • attributable to abnormalities of the C spine
  • Affected by cervical movments
  • primarily occipital - radiating into head and face (unilateral)
  • 70% have neck pain
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9
Q

What is the Anatomical Basis for pain pattern?

A
  • Trigemincervical Nucelus
    • Afferents from CN V and Spinal Nerves C1-3
    • Nuclei of head throat and neck afferents
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10
Q

What are the possible signs of intracranial pathology?

A
  • Sudden onset of sever headache with increasing intensity
  • persistently unilateral headaches
  • headaches that wake the patient during the night or early morning
  • Generalized stiff neck or other signs of meningits
  • Systemic symtoms (fever, weight loss, malaise)
  • Focal neurologic symptoms

WORST HEADACHE OF MY LIFE = RED FLAG

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11
Q

What artery does this pain distribution come from?

A

Vertebrak Artery

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12
Q

What artery does this pain distribution come from?

A

Internal Carotid

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13
Q

What are some major risk factors for a headache differential diagnosis?

A

“pain in my neck or head unlike anything i have ever had before”

Major:

  • HTN 140/90
  • Hypercholesterolemia
  • Hyperlipidemia
  • Diabetes
  • Fam history of MI
  • BMI > 30
  • Repeated/recent injury
  • Upper cervical instability
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14
Q

What are minor risk factors for differential diagnosis

A
  • Hyperhomocysterinimia
  • B12/Folate deficiency
  • Oestrogran Based contraceptive
  • HRT
  • Infections
  • poor diet
  • RA
  • Blood clotting disorders
  • Fibromuscular Dysplasia
  • Hypermobility
  • ED
  • BMI 25-29
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15
Q

What are the 5 D’s AND 3 N’s?

A
  • Dizziness
  • Drop attacks
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Ataxia
  • Nausea
  • Numbness
  • Nystagmus
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16
Q

What are other red flags to cervicogenic headaches?

A
  • altered taste
  • altered facial or peri-oral sensation
  • Visual changes - retinal dysfunction
  • Unusual headaches
  • Facial numbness
  • Tinnnitus
  • Gait distrubances
  • Horarseness
  • Vomiting
  • memory loss, motor loss
17
Q

What is the general population for cervicogenic headaches?

A
  • .4-2.5%
  • Mean age 42 years old
    • onset age 30
  • 4:1 female to male ratio
18
Q

What are subjective exam findings for cervicogenic headaches?

A
  • Pain area: posterior head and neck (big distribution of pain)
  • Primarily unilaeteral
    • ipsilateral neck shoudler arm
  • Provocked by sustained awkward positions
  • increasing frequency or short alsting headache attacks
19
Q

What precipitates comparable symptoms of cervicogenic headaches?

A
  • Neck movement and/or sustained awkward head postioning
  • External pressure over upper cervical or occipital region
    • Trigger points
  • Restriction of ROM and joint mobility in the neck
    • Abnormal joint mobility testing
    • Cervical flexion - rotation test
  • Poor Deep Cervical Endurance
    • CCFT
    • Neck flecor endurance test
20
Q

What is the Cervical Flexion Rotation Test?

A
  • Purpose: Asses deep cervical flexor strength
  • Supine with occiput on table
  • Tuck chin
  • normal test 26-30mmHg pressure for 10 seconds without compensation

Common compensation: Chin Protrudes

21
Q

What is the neck flexor muscle endurance test?

A
  • Asses deep cervical flexion strength
  • Hook lying with occiput on table
  • “tuck chin and hold head up, maintain flexion 2.5cm. Asses crease in ear and elevate head, hold”
  • Normal >38 seconds
22
Q

What is the diagnostic cluster for a cervicogenic headache?

A

Decreased AROM cervical Extension

Palpably painful somewhere from OA to C3-4 joint dysfunctions

Deep Cervical flexor strength impairments w/ cranio-cervical flexion test

NOT PRESENT IN MIGRAINE OR TENSION HEADACHES

MSK III (13 decks)

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