(5.2) Cervical Spine Pathologies Flashcards
What is the diagnostic triage of neck pain?
- Non-specific neck pain
- Radicular syndrome
- Serious pathology
What are the 4 categories of grades?
I - no signs serious illness/injury
II - no signs serious illness/injury but difficulty in activities
III - signs nerve injury
IV - signs major illness/injury
What is an acute neck trauma?
Encompasses a wide range of potential injuries to ligaments, muscle, bone and spinal cord.
What is the Canadian C-Spine Rule?
It is used to determine whether or not the patient is in need for radiography
What is non-specific neck pain?
Neck pain without an underlying disease causing the pain, where no abnormal pain or anatomic structure is found
What is indicates that the patient needs radiography in the Canadian C-Spine Rule?
- If they are at a high risk that mandates radiography
- If there is not a low enough risk to allow safe assessment and ROM
- If they are not actively able to rotate their neck
What are the causes of non-specific neck pain?
- Mechanical / postural/ degenerative
- Discogenic / facet joint / ligamentous
What is cervical radiculopathy?
Pain in a radicular pattern in one or both upper extremities caused by compression and/or of the cranial nerves
What causes cervical radiculopathy?
- Non-traumatic > traumatic
- C7 n root most common
- Disc herniation
- Spondylosis
How does cervical radiculopathy occur?
Mechanical compression:
- localised ischemia
- nerve damage
Nucleus pulposus-nerve:
- pro-inflammatory cascade
What can be seen on clinical examination of cervical radiculopathy?
- neck + arm pain
- parasthesia / numbness / weakness etc
- altered ROM
- dermatomal / myotomal / reflex changes
- +ve cervical distraction test
- +ve brachial plexus tension test
How is cervical radiculopathy treated?
Usually resolves spontaneously 4-6/12
What causes cervical spondylosis?
Degenerative changes:
- discs
- facet joints
- osteophytes
- ligament thickening
- inflammation
What can be seen on clinical examination in a patient with cervical spondylosis?
- pain (agg: movement)
- stiffness
- crepitus
- functional impairment
- decreased ROM
- segmental tenderness
What is Degenerative Cervical Myelopathy (DCM)?
Injury or compression to the spinal cord
How does DCM occur?
- decreased diameter spinal canal with compression
- advanced degenerative changes
- central disc herniations
- congenital narrowing spinal canal
What are the symptoms of DCM?
- neck pain/stiffness
- unilateral/bilateral limb pain
- upper limb weakness & numbness
- paraesthesia
- bowel or bladder incontinence
- imbalance/unsteadiness
What would be found on clinical examination of DCM?
- extensors > flexors
- limb hyperreflexia
- spasticity
- clonus
- +ve Hoffmans and Babinski
- sensory loss
- gait disturbance
- Lhermittes sign
What is Whiplash Associated Disorder (WAD)?
- An acceleration-deceleration mechanism of energy transfer to the neck
- Describes constellation of neck-related clinical symptoms manifesting post RTA etc
What are the various soft tissue injuries that may occur following a WAD?
Facet Joint:
- haemarthrosis, capsular tears and damage
Spinal Nerve Root:
- ligamentous, disc, muscle injury
What are the different classifications of WAD?
I - Neck complaint pain, stiffness or tenderness
II - Neck complaint, decreased ROM, point tenderness
III - Neck complaint and neuro signs
IV - Neck complaint and fracture or dislocation
What can be seen on clinical examination of WAD?
- varying pain
- stiffness
- upper limb paraesthesia
- headaches
- heavy head
- psychological distress
- decreased ROM
- abnormal movement
- localised tenderness
What is Acute Torticollis?
- aka ‘Wry Neck’
- abnormal, asymmetrical head or neck position
What causes Acute Torticollis?
Cause is currently unknown
(unusual posture?)
What are the symptoms of Acute Torticollis?
- pain
- decreased ROM
- muscle spasm
- contralateral rotation
What is a Cervicogenic Headache?
- headache of cervical origin
- referred pain arising from irritation of upper cervical structures
What are the symptoms of Cervicogenic Headaches?
- headache associated with neck pain / stiffness
- unilateral (starts one side of posterior head & migrates to front
- decreased cervical ROM
- Palpable upper cervical joint involvement
- +ve cervical flexion rotation test
What is Polymyalgia Rheumatica?
- inflammatory muscle pain and weakness
- neck and shoulders
What causes Polymyalgia Rheumatica?
- > woman (2:1)
- develops over two weeks (sudden / gradual)
- cause is unknown
What are the symptoms of Polymyalgia Rheumatica?
- ACHES and pains
- stiffness esp mornings
- limited ROM affected joints
- upper arm tenderness
- possibly a low grade fever
What is the treatment of Polymyalgia Rheumatica?
Refer to a GP
What is Thoracic Outlet Syndrome (TOS)?
Compression of the neurovascular bundle exiting the thoracic outlet
What are the most common types of TOS?
- Neurogenic (95%)
- Venous (3-5%)
- Arterial (1-2%)
Where does neurogenic TOC normally occur?
- unilateral > bilateral
- Upper brachial plexus (20%)
- Lower brachial plexus (80%)
What are symptoms of neurogenic TOC?
- pain (shoulder, lat neck, clavicular, arm, pecs)
- paraesthesia
- difficult distinguish b/t cervical radiculopathy and peripheral nerve lesion
What are clinical tests that can be used to identify neurogenic TOC?
- Adson’s test
- Elevated arm stress test (EAST)
How do you carry out the Adson test?
- Affected arm abd 30 degrees at shoulder whilst fully extended
- Extend and turn head towards ipsilateral side
- +ve decrease or absence radial pulse
What is the elevated arm stress test (EAST)?
- arms surrender position
- shoulders at 90 degrees and in ER
- elbows flexed 90 degrees
- patient slowly open/close hand 3 mins
- +ve reproduction pain, stiffness, paraesthesia etc
