3 Neck Pain Radicular Headache Stenosis Flashcards
What are common symptoms for neck pain with radicular symptoms?
- Neck pain with raidating pain in extremity
- Upper Extremity dermatomal paresthesia or numbess and myotomal weakness
What exam findings do you expect to see in Radicular neck pain patients?
- 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
What type of patients do you typically see with radiating neck pain?
- Herniated disc in C spine
- peripheral/centralization
- Dermatomal, myotomal, reflex dimished
- pain with C rotation <60 degrees
- Adverse neurodynamic mobility
What are the 4 variables that increase the liklihood of cervical radiculopathy?
- Ipsilateral cervical rotation < 60 degrees towards side of symptoms
- ULTT
- Distraction test
- Spurlings Test
What type of patient would benefit the most for radicular symotoms?
- age < 54 years
- Dominant arm not affected
- Looking down doesnt aggravate symptoms
- multi-modal RX > 50% of visits (OMPT, traction, DNF strengthening)
What is intermittent Traction for neck pain?
- 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
What are you looking for and type of Radicular exercises?
- centralizing of symptoms
- compliment MT at home
DNF strengthening
Lower/middle trap strengthening
Neurodynamics
What is a cervicogenic headache?
- attributable to abnormalities of the C spine
- Affected by cervical movments
- primarily occipital - radiating into head and face (unilateral)
- 70% have neck pain
What is the Anatomical Basis for pain pattern?
- Trigemincervical Nucelus
- Afferents from CN V and Spinal Nerves C1-3
- Nuclei of head throat and neck afferents
What are the possible signs of intracranial pathology?
- 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
What artery does this pain distribution come from?
Vertebrak Artery
What artery does this pain distribution come from?
Internal Carotid
What are some major risk factors for a headache differential diagnosis?
“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
What are minor risk factors for differential diagnosis
- Hyperhomocysterinimia
- B12/Folate deficiency
- Oestrogran Based contraceptive
- HRT
- Infections
- poor diet
- RA
- Blood clotting disorders
- Fibromuscular Dysplasia
- Hypermobility
- ED
- BMI 25-29
What are the 5 D’s AND 3 N’s?
- Dizziness
- Drop attacks
- Diplopia
- Dysarthria
- Dysphagia
- Ataxia
- Nausea
- Numbness
- Nystagmus
What are other red flags to cervicogenic headaches?
- 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
What is the general population for cervicogenic headaches?
- .4-2.5%
- Mean age 42 years old
- onset age 30
- 4:1 female to male ratio
What are subjective exam findings for cervicogenic headaches?
- 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
What precipitates comparable symptoms of cervicogenic headaches?
- 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
What is the Cervical Flexion Rotation Test?
- 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
What is the neck flexor muscle endurance test?
- 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
What is the diagnostic cluster for a cervicogenic headache?
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
