Acute Wry Neck

Question 1

Acute Facet Locking - Aetiology

Answer 1

largely unknown
THINK - entrapped synovial fold in joint space
due to abnormalities (poor control, sudden movement, abnormal muscle function)
prevents facet joint from moving back into normal position
movement causes further irritation - results in pain

Question 2

Acute Facet Locking - History

Answer 2

sudden onset of sharp severe pain 
caused by sudden neck movement 
mainly affected younger people 
more females 
short duration - 24 hours max 
previous episodes common 
localised unilateral neck pain - unlikely to refer, located over articular pillar

Question 3

Acute Facet Locking - Physical Exam

Answer 3

Posture
- side flexed and rotated away
- may have some flexion
Correct Deformity - are they locked in teh position?
Movement Pattern
- mainly pain/limited with side flexion and rotation
Non-Irritable
- when non moving into PD, not painful
- as soon as move into PD = severe pain
PAIVM - try to localise segment, difficult due to pain
PPIVM - confirm if locked

Question 4

Acute Facet Locking - Treatment if Locked

Answer 4

TRACTION - attempt to correct deformity
DOWNSLOPE AWAY from side of pain
- too sore to have contact on painful side
- move them more into their stuck direction
- may help to gap/open the opposite side
- make moving out of the deformity less painful

Question 5

Acute Facet Locking - Treatment post unlocking

Answer 5

heat/massage
manual therapy to promote PD - side glide, MWM
address neck and scapula mechanics
advice load management
consider long term - do they have recurring episodes, why?

Question 6

Discogenic Wry Neck - Aetiology

Answer 6

unknown

think to do with intervertebral discs

Question 7

Discogenic Wry Neck - History

Answer 7

gradual onset of pain following unaccustomed activity 
not sudden movement/pain 
pain gradually worsens and spreads 
older people 
refers to thoracic spine 
slightly irritable

Question 8

Discogenic Wry Neck - Physical

Answer 8

POSTURE 
- side flexed and rotated away 
- more flexed 
NOT LOCKED - able to move into painful direction when directed, however with pain and limited ROM 
MOVEMENT PATTERN 
- more pain with extension 
- still with side flexion and rotation

Question 9

Discogenic Wry Neck - Treatment

Answer 9

treat into deformity 
DOWNSLOPE TOWARDS side of pain 
SIDE GLIDE in extension 
AROM exercises for rotation and extension 
advice load management 
address neck and scapula

Question 10

Spasmodic Torticollis

Answer 10

Cranial dystonia affected SCM - abnormal accessory nerve function
flexed to side, rotated away from that side
have tic when moving into position - not smooth, spasm in muscle
able to move out of position without pain and easily
however when relax - automatically return to position
NOT PHYSIO
- refer to neurologist
- we can treat secondary symptoms and pain

Question 11

Atlantoaxial Rotary Fixation

Answer 11

RED FLAG - need to refer immediately
Traumatic acute wry neck - causes subluxation of atlantoaxial joint
Rotation deformity of the UCS - truly locked
most likely to have history of
- previous injury
- lcoal inflammation
- rheumatology
Means ligaments are more lax - more likely to sublux

Grisel’s Syndrome - in children, non-traumatic, post viral infection