Acute Cervical Injury Flashcards
OA and AA joints and ligaments
- are supported mainly by the ligaments
- OA joint is convex occiptial condyles on concave facets of C1
- Transverse ligament spans atlas and prevents C1 from sliding
- Alar ligament is the 2nd line of defense
vertebral artery describe anatomy
- VA takes right angle over C1
- gutter invertebrae w/spinal nerve root
- VA gets stretched on oppsite side you are turing to
- palpate facet joints not TP
Disc and nerve root relationship
in the cervcal spine
- Disc is thinner due to less weight bearing in C/S due to uncinate process taking some weight bearing
- no Disc between C1-C2
- NR exits above respective vertebral body
- C8 exits below C7 vertebrae
neck classification system
- neck pain with movement/coordination impairments (whiplash)
- neck pain with headache HA
- Neck pain and mobilty deficits
- Neck pain with radicular symptoms
neck classification system
Neck pain with movement/coordination impairments (whiplash)
- exam
- treatment
- acute/subacute/chronic
Exam:
- posture
- ROM
- Cranio-cervical flexion test of deep flexors
- neck flexor endurance
Treatment:
- minimal use of collar
- E-stim/TENs
- return to activity
- postural training
- ROM muscle reeducation
- strengthening
Aute/subacute/chronic:
- treatment appropriate for each stage with reassurance of recover in 2 months
neck classification system
neck pain with headache
- exam
- treatment
- acute/subacute/chronic
Exam:
- posture
- C/S ROM
- cervical flexion rotation test
- C/S, T/S segmental testing
Treatment:
- posture
- AROM stretching
- C/S and T/S mobs/manipulation
- C/S re-ed
- craniocervical deep neck flexor strength/endurance
Acute/subacute/chronic: based on stage of healing
neck classification system
Neck pain with mobility deficits
- exam
- treatment
- acute/subacute/chronic
hypomobile
Exam:
- C/S, T/S ROM
- cervical flexion rotation test
- C/S, T/S segemntal testing
Treatment:
- C/S T/S mobilization/manipulation
- SNAGs
- AROM
- Scapulothoracic muscle strength and endurance
Stage of healing needs to be considered
neck classification system
Neck pain with radicular symptoms
exam and treatment
Exam:
- repetitive movements
- neurodynamic ULTT
- spurling
- distraction test
- valslva
Treatment:
- repeated motions to centralize
- C/S traction
- T/S mobs/manipulation
Typical Acute cervical injury causes
- MVA: whiplash associated disorders
- Falls
- diving
- sports
- Misc trauma
Whiplash associated disorder
recovery
- most individuals recover in 3 weeks time but 42-50% dont and it becomes chronic
- results in economic, personal and emotional burdens
Whiplash/acceleration injury MVA mechanics
- rear ended: head retract => C/S hyperextends => C/S hyperflexes
- Front collision: 1. head and C/S flexes 2. extends
- struck on R side cuases RSB: compresses R neck tractions L neck => rebound into LSB opposite occurs
whiplash MOI with rear ended MVA
consquences of each component
- retraction: subocciptal muscles spasm, UC ligaments instability
- hyperextension: injury to anterior structures
- hyperflexion: injury to posterior sturcutres
Hyperextension - anterior injury and what the injuries may cause
- muscles: longus colli, and capitis, rectus capitis anterior, supra/infra hyoids and SCM
- anterior longitudinal ligament
- DIsc: anterior annulus
- facets and capsules
May result in…
- loss of C/S lordosis as head gets pulled into flexion
- spasm of longus colli and capitis
- difficulty/pain swallowing from spasm of hyoid
Hyperflexion - injury to posterior structures
- posterior C/S muscles and subocciptials
- posterior ligament: ligamentum nuchae, interspinous, ligament flavum, PLL
- disc posterior annulus
- facets and joint capsules
may result in…
- spasm posterior musculature
- increased C/S lordosis
- subocciptial headache
- disc related symptoms => bulge HNP
Injuires specific to tissue: consequences
- musculature: stretch, torn, muscle guarding/spasm
- ligaments: over-stretched, torn = instability
- Disc: annulus => bulge => HNP
- NR IV narrowing - pinched nerve
- facet joint injury: capsule stretch, torn, pinched, facet joint compression
- fractures: vertebral body, facets, TP, SP, avulsion fx, in UC - life threatening
Diagnostic testing - Whiplash
- radiological exams = X-rays to rule out serious fx, open mouth X-rays to view UC region
- MRI, CT scans are not proven to be overly beneficial
- They fail to identify patho-anatomical lesions, patho-mechanics, patho-phsyiological mechanisms
- no definte correlation between patients complaints and abnormal image findings
WAD
WAD
Grades
- Grade 0 = no symptoms
- grade 1 = neck pain/point tenderness only
- grade 2= neck pain, stiffness, no radicular symptoms
- grade 3= neck pain, stiffness and + radicular symptoms
risk factors for persistent problems following acute whiplash
- high intensity pain >5.5/10
- female
- report of headache at inception
- lower education (< post secondary)
- high NDI score ( > 14.5/50)
- WAD grade of 2 or 3
- Pre-injury neck pain
- report of LBP at inception
What can cause/occur with a
severe Hyperflexion injury:
- MVA, Diving, tackling
- death of quadriplegia
- Dens fx, tearing Alar, transverse ligament
- vertebral body dislocation sheering spinal cord
- fractures at C4 above usually dont survive
- diaphragm innervated by C3-C5
Fractures
odontoid/Dens fx
- tearing alar or transverse cruciate ligaments
- life threatening, cord injury
- ER - X-ray. open mouth
Fractures
Compression fx and burst fracture
- axial compression, hyperflexion
- vertebral body fx and burst
- disc collases = anterior wedging
- fragments may move posteriorly into spinal cord
fractures
SP/TP
facet
- SP/TP = direct trauma or avulsion fx
- facet = compression, extension
Canadian C-Spine rule for radiology need
High risk and radiology needed if
- > 65 y/o
- dangerous MOI
- paresthesia into extremity
Radiology not needed if
- able to sit in ER
- simple rear end accident
- ambulatory at anytime
- delayed onset of neck pain
- no midline C/S tenderness
- able to rotate head 45 degress both directions
Cervicogenic headaches
- neck pain precedes headahce
- injury to UC, MC, LC regions
- muscle gurading and spasm
- foreward head posture common
- headache U/L - radiating upward = greater occiptial N compression
- PT intervention helpful
Cervicogenic headaches
S&S of neck involvement
- headache from neck movement/posture
- headache when pressure applied to cervical, subocciptial region
- restricted neck ROM
- ips neck shoulder referred pain NOT radiular
- unilateral headache
non- Cervicogenic headaches
mirgaines/vascular headaches
- F > M
- hx or family hx of mirgrains
- nausea
- blurred vision, sensitivity to light, light flashes (scotoma)
- HA alternates sides
- preceded by aura (euphoria/depression)
- menstrual cycle
Non-Cervicogenic headaches
Cluster headaches
- Men > women
- HA appearing in clusters
- autonmic signs: tearing, flushin, sweating
