7.2: Cervical Spine - Medsurg Flashcards
Persistence of pain whatever the neck’s position is normally present in what conditions?
Traumatic Conditions
If pain is mechanical (e.g. muscle tightness or nerve root impingement) it is _____ in certain positions
Relieved
Condition associated if pt presents with dizziness, diplopia, drop attack, dysarthria, dysphagia
Vertebrobasilar Insuffeciency
Condition brought by forward head posture
Upper Cross Syndrome
Tight and weak muscles in upper cross syndrome
Tight - Pecs major and minor, Upper traps, Levator scapulae
Weak - Lower traps and rhomboids
Deformity of the neck that includes both rotation and flexion; can be congenital or acquired
Torticollis / Wry Neck
Ocular Findings in torticollis
Head is tilted toward the affected side while the chin is rotated to the opposite side
What is affected in torticollis
SCM
Congenital torticollis is more common in
Females
Common causes of acquired torticollis
Acute traumatic/Inflammatory - atlantoaxial rotary sublaxation; muscle inflammation; lymphadenitis
Chronic infectious or neoplastic - osteomyelitis; TB; tumor of spine or spinal cord
Arthritic - RA; OA; ankylosis spondylitis
Cicatrical - Ex: Burn Scars
Paralytic
Hysterical - psychologic inability of pt to control neck muscles
Spasmodic - CNS or cervical root lesion manifested by involuntary rhythmic contraction of neck muscles
Signs and Sx of Degenerative Disc Disease
Radicular Sx; aggravated by coughing or sneezing
Occipital headaches
Blurring of vision
Arm function weakness
Vertigo
Limited Neck motion; tenderness over cervical spine; neurologic changes in the upper limb
Three distinct spaces where TOS occurs
Interscalene triangle
Costoclavicular space
Retropectoralis Minor space
Congenital Synostosis of cervical spine (usually C3-C5 vertebra)
Klippel Feil Syndrome
T?F: Klippel Feil Syndrome can be acquired
False
Clinical presentation of pts c klippel feil syndrome
Short neck
Posterior hairline is abnormally lower
Webbing of the neck
Flexion/Extension has higher ROM than lateral flexion
Head held in oblique position
MOI of Cervical Spondylosis
Degenerative changes of the vertebrae c osteophyte formation
Most common intervertebral spaces affected in cervical spondylosis
C5-C6 & C6-C7
___ of those older than 45 y/o can be affected in cervical spondylosis
60%
Chances of developing cervical spondylosis in ages 60 above
85%
C/C of pts c cervical spondylosis
Unilateral neck pain and stiffness increasing c extension and decreases during flexion
Can include radicular Sx
Possible instability
Palpation findings in cervical spondylosis
tenderness over affected vertebra or facet joint
ROM findings for pts c cervical spondylosis
limited lateral flexion and rotation
inc pain in extension
T/F: Pts c cervical spondylosis may present with muscle weakness
True, esp in affected myotomes
Confirmatory tests for Cervical spondylosis
distraction test
spurling’s
bakody’s
ULNT
rule out tests for cervical spondylosis
Sharp-purser to rule out ligamental instability
Differential Dx for cervical spondylosis
Disc herniations
T/F: cervical spinal stenosis may be accompanied by cervical spondylosis and/or disc herniation
true
Differential diagnosis for myofascial pain syndrome
fibromyalgia
How many trigger points to be considered MPS
at least 3
C/C for MPS
localized aching pain which have lasted for 3 mos or more c no h/o trauma
Muscle stiffness
some cases c/o tension headaches
Occular inspection findings in MPS
poor posture d/t pain
atrophy in some cases
ROM limitations in pts c MPS
Cervical extension and Rotation (Dutton and Delisa)
MMT findings of pts c MPS
weakness of affected muscle d/t pain
Fibromyalgia neck pain Sx
Persistent, dull, aching pain that can intensify into sharp pain and is widespread/generalized
Differential Dx for pts c disc herniation
Cervical Spinal stenosis
MOI for WADs
Traumatic; Whiplash
MOI for cervical strain
Whiplash; traumatic
Confirmatory Special tests for Disc herniation
Distraction test - if pain increases during procedure
Spurling’s
Jackson’s
Valsalva
Rule out test for disc herniation
Distraction test - if Sx are relieved or decreased
Disc Herniation may limit what motion
Flexion d/t pt’s apprehension
most common OI findings in pts c cervical disc herniation
Pt is usually in extension to prevent disc from herniating/pressing on the affected structures
C/C for Disc herniation
Neck pain which may increase in flexion/extension
Radicular Sx
Commonly unilateral Sx but can be bilateral
MOI for disc herniation
Traumatic forces such as whiplash injury
can be caused by degenerative disc disease
overweight pts have increased risk
age group that is most common for cervical disc hernitation
17-60 y/o (Magee)
MOI for MPS
repeated motion and pressure in muscle, creating trigger points
may also be caused by postural dysfunctions (Dutton)
Injuries to the cervicobrachial region can lead to what Sx?
neck pain alone, arm pain alone, or both neck and arm pain. Thus, symptoms include neck and/ or arm pain, headaches, restricted range of motion (ROM), paresthesia, altered myotomes and dermatomes, and radicular signs.
Sx related to vertebral artery lesion
vertigo, nausea, tinnitus, “drop attacks” (falling without fainting), visual disturbances, or, in rare cases, stroke or death.
Injury to the cervicocephalic region leads to what Sx?
headache, fatigue, vertigo, poor concentration, hypertonia of sympathetic nervous system, and irritability. In addition, there may be cognitive dysfunction, cranial nerve dysfunction, and sympathetic system dysfunction.
