C-Spine Flashcards
What are the 5 classifications/grades of WAD
What are the criteria of mild, moderate, and severe TBI
Process of determining appropriateness of physiotherapy for concussions during an exam
Describe the ER algorithm for management of acute neck injuries
Describe the algorithm for Canadian C-spine rules (fractures) in terms of radiography
What are the 3 categories of red flags
Name 6 red flag conditions of the neck
Signs and symptoms of cervical myelopathy
Signs and symptoms of neoplastic conditions
Signs and symptoms of upper cervical ligamentous instability
Signs and symptoms of vertebral artery insufficiency
Signs and symptoms of inflammatory or systemic disease
What to do if there is a cervical fracture
Anatomy refresher slide
C1-C2 craniovertebral refresher slide
Describe C0-C1 (Occiput-Atlas)
Describe C1-C2 (Atlantoaxial)
Describe the alar ligaments
Describe the transverse ligaments
Describe C3-C7
Describe the neural structures of the cervical spine
Describe the intervertebral disc
Describe a disc herniation
Where is pain distribution, weakness, sensory loss and reflex loss for C5
Where is pain distribution, weakness, sensory loss and reflex loss for C6
Where is pain distribution, weakness, sensory loss and reflex loss for C7
Where is pain distribution, weakness, sensory loss and reflex loss for C8
What are 6 nerves commonly damages in WAD
What are the vascular structures of the neck
What are the myofascial structures of the neck (look up their function)
Traps: Stabilizes scapula and performs scapula elevation, retraction, depression, and UR
Splenius Capitis: Ipsilateral side head and neck flexion and rotation, extension
Splenius Cervicis: Head/neck lateral flexion, rotation, and neck extension
Longus capitis: Head flexion
Longus Colli: Bilaterally flexes head and ipsilaterally tils head at CV region
Scalenes: Neck flexion, lateral flexion and rotation, and for postural control
Longissimus capitis: Neck extension and lateral flexion, head rotation
Longissimus cervicis: Neck extension and lateral flexion
Multifidus: Spine stability and neck extension
Semispinalis Capitis: Neck lateral flexion and extension
Semispinalis Cervicis: Neck ipsilateral side flexion and contralateral rotation, and extension
Splenius Capitis: Laterally flex and rotate neck, extension
SCM: Neck flexion, rotation (contralateral side), and side flexion ipsilaterally
What is the pain pattern for facet joints C2-C7
What are 3 types of pain that are a risk of chronicity in WAD
What are some non-physical factors for WAD that could induce chronicity
Individuals with upper cervical instability report
What are some symptoms of movement with WAD and some other common complaints
What are some objective findings for WAD
What are some positive findings for WAD
According to Sarrami et al. what did they conclude about prognostic factors for WAD
Post-injury pain, whiplash grades, cold hyperalgesia, post-injury anxiety, catastrophizing, compensation and legal factors, and early healthcare were associated with continuation of pain and disability with those with WAD. While factors such as MRI/radiographic findings, motor dysfunction, or factors related to the collision were not associated with continuation of pain and disability.
Walton et al found what risk factors also lead to poor prognosis
-Grade of WAD (2 or 3)
-Higher NDI score (14.5/50)
-Female
-Less than post secondary education
-Preinjury neck pain
-Catastrophizing
-Low back pain at inception
-Headache at inception
Cleland et al found what about treating cervical radiculopathy
Cervical traction, manual therapy, and deep neck flexor muscle strengthening may be beneficial to managing cervical radiculopathy
Wainner et al found
That Wainner’s cluster was the most useful for diagnosing cervical radiculopathy
Kjaer et al found what about management and treatment for neck pain and cervical radiculopathy
Management should include info about prognosis, warning signs, and advise to remain active. While treatment suggested different types of supervised exercise and manual therapy for neck pain. Acupuncture only for neck pain and not cervical radiculopathy. Traction for only cervical radiculopathy. NSAID’s and tramadol for neck pain and cervical radiculopathy
Describe specific vs non-specific neck pain
Specific - identifiable causes and less common
Non-specific - multi-dimensional and more common
How can we manage non-specific neck pain
What are 4 key points for degenerative changes of the C-spine
Describe cervical radiculopathy
What are risk factors for cervical radiculopathy
What is the clinical pattern for cervical radiculopathy
Describe cervical myelopathy
What are the risk factors for cervical myelopathy
What are the clinical presentations for cervical myelopathy
Describe the neurological scan and its components
What is Wainners cluster
Spurlings
ULNT1a
Traction
What are important education pieces on cervical radiculopathy
Prognosis of cervical radiculopathy
Describe medications for cervical radiculopathy
Is traction and exercise beneficial for cervical radiculopathy
Can you use taping for cervical radiculopathy treatment
Yes
Describe the NDI
Scoring:
0 to 4 = no disability
5 to 14 = mild
15 to 24 = moderate
25 to 34 = severe
Above 34 = complete
Describe the Patient Specific Functional Scale
Scoring:
0 = cant perform activity
10 = able to perform activity at same function as before injury
When should we perform imaging
What is important about incidental findings and imaging
Is neck pain a financial burden to society?
What are the 4 categories of differential diagnosis for c-spine
What was found on the CBG for neck pain
What are the clinical findings for cancer
What are clinical findings for vascular pathologies in the neck
Describe the circle of willis
- Paired vertebral arteries – arise from subclavian, to transv foramen of C6, join to create basilar arteries
- Three arteries to the cerebellum = problems with coordination, balance etc
Pons
* Cranial nerve nuclei
* Midbrain
* Vasc compromise to vert artery/basilar will have clin presentation assoc w/ CN findings !!
Basilar artery to circle of willis = supplied by ICA = gives off INtCA and middle cerebral artery
Any disease or dysf of cerebrovascular system
What are some pathologies for cerebrovascular dysfunction
Ones circled
Should dizziness be a red flag?
Describe cervicogenic dizziness
Alt in somatosensory input – mechanoreceptors, spindles, GTOs in upper c-spine
* In jt capsule, in tendon units
*Results in altered proprioceptive/kinesthetic sense in that region
What are some MSK sources of dizzines
What are 4 types of dizziness
Describe vestibular dizziness
- Common is BPPV
- Complaints:
○ Sense that the world is spinning around them
§ Caused by large angular/rot movements of the head
§ Slight delayed response
○ Symptoms aggravated when they go to lie down at night or roll over, moving quickly to tip over and tie shoes etc - Symptoms will last 30s to a min and resolve
-Common after trauma
- Complaints:
Describe concussion-related dizziness
- Light and sound sensitivity
- MOI: clear trauma
-Headache
- MOI: clear trauma
Describe cervicogenic dizziness
- Sense of feeling “not right”
- Walk w/ hand on wall to balance themselves
- Temporal association developing neck pain
- Dizziness getting worse as neck pain gets worse
- Often related to mechanical things in the neck
○ Ex. Working at computer for period of time, getting up + feeling off balance/not right, unsteady
-Wont resolve on its own decisively
What are all the types of flags in clinical history
Differential diagnosis for neck pain + Headache categories
Cervicogenic headache clinical pattern
- Pain MUST start in the neck
- Inc of neck pain results in headache
- Neck pain PRECEDES headache
- Unilateral – side locked (always on that side)
- Mechanical aggravating factors
○ Assoc w sustained postures or movements of the head/neck - Intensity can be variable from one episode to the next
- Duration can vary
Migraine clinical pattern
- Tendency to side shift, doesn’t stay on same side/location all the time
- Cause: known triggers that the px is aware of
○ Foods, hormonal, stress, weather - Preceded by an aura (sense of flashing lights, unique to migraine itself)
- Predictable behavior
○ Know when they get one, how bad it’ll get
○ Lasts predictable amount of time - Starts in the head
- Neck may get stiff after a day or two
- CLUSTER = subcategory
- Cause: known triggers that the px is aware of
Tension type clinical pattern
- Bilaterally – crossing post occiput or forehead
- Low grade
- Assoc w/ stress
Post-concussive clinical pattern
- MOI; concussion
- Concussion related symptoms
Pain pattern for each type of headache
What is post concussion syndrome
Screening criteria for different types of neck pain
Describe migraines
Describe tension type headaches
Differential diagnosis chart for cervicogenic headaches, migraines, and tension type headaches
Should you check blood pressure with headaches
Yes, could be vascular pathology
What are the 10 cranial nerves and tests for each one (also should it be used for testing cervicogenic headaches)
Yes for headaches
What is the physical exam for vascular issues
What are week 1 exam objectives for neck pain + headache (not all necessary)
What are week 2 exam objectives for neck pain + headache (not all necessary)
What are the risks and benefits of manual therapy for a person with neck pain + headache
What is week 1 management for headache + neck pain person
What is week 2 management for headache + neck pain person
What prognostic factors can affect outcome for neck pain +headache persons
What are some outcome measures for a person with neck pain + headache
According to Ogince et al. what does the cervical flexion-rotation test do
Measures movement impairment of C1/2 region and cervicogenic headache
