C-Spine lecture1 Flashcards
Why is the c-spine more mobile than other regions of the spine?
positioning of head (vision, balance), need for rapid motion at times
which joints comprise upper c spine
C0-2
which jts comprise lower c spine
C3-C7, C7 transitional segment
neck pain is ___ greatest contibutor of global disability
4th
Chronic neck pain ___ to chronic LBP as most common MSK disorder associated with injury and disability claims in workplace and MVA
2nd
Lifetime prevalence of neck pain
66%
prevalence ___ with age, peaking in ____ year group
increases, 35-49
C-spine risk factors (health, psychological)
cycling, smoking, previous neck pain, depression, job stress, low co-worker social support
demographic risk factors
female, 45-59 years, better prognosis in younger pts.
occupation risk factors
heavy labor, office jobs, healthcare workers, unemployed
physical work risk factors
sedentary, repetitive work, working with neck flexed, working with arms above or at shoulder height, head carrying
T/F most patients with neck pain:specific pathoanatomic cause is not known
T
Non-MSK causes of neck pain
infection, tumor, cardiac, endocrine, gastrointestinal, neurological, pulmonary, systemic disease
MSK causes of neck pain
soft tissue injury, degenerative changes in facet joints, joint pain, fracture, dislocation
Onset exam questions
insidious or acute
trauma exam questions
incident details, loss of consciousness, immediate treatment
neuro exam questions
pain pattern, sensory changes, muscle weakness, gait changes, loss of balance/coordination
Other exam questions (a lot)
bowel and bladder, weight loss, night pain, fever, dizzines, fainting episodes, headache-location, TMJ symptoms, facial pain, pulmonary symptoms-SOB, coughing, blood in sputum, effect of cough/sneeze on neck/arm pain, cardiac symptoms-palpitations, angina, sleeping habits, postural stressors, litigation
Score summary of NDI
0-4 - no disability 5-14- mild 14-24- moderate 25-34- severe >35- complete disability
T/F elevated fear-avidance beliefs do not contribute to muscle guarding and the persistence of pain and disabiltiy
F - these beliefs will result in altered movement patterns and reduced physical activity
Nerve roots exit
above the named level
which neurological sequelae of impingement will you get with sensory/motor changes
radiculopathy: nerve root
which neurological sequelae of impingement will you get with UMN signs
Myelopathy
Which nerve keeps us alive
phrenic (C345) to the diaphragm
Tracheobronchial conditions
inflammation, infection (viral, bacterial), tumor
Potential symptoms of tracheobronchial conditions
referred neck pain, dyspnea, dysphagia, persistent cough, fever, chills, hemoptysis
Conditions referring to the neck
tumors, infection, cardiovascular pain, gastrointestinal, Lyme disease, RA, ankylosing spondylitis, fibromyalgia,Klippel-Feil syndrome, Hypo/hyperthyroidism
This syndrome is a congenital fusion of cervical vertebrae. Mutation in genes GDF6 and GDF3
Klippel-Feil Syndrome
Briefly look over conditions referring to the neck
yaaa
____ of patients with neck pain will go on to develop chronic symptoms
44%
_____ of general pop who experience neck pain at some time will report neck pain 1-5 years later
50-85%
Age and male were _____associated with PT use
negatively
Lower ed level, having workers comp and litigation were ____ associated with PT use
positively
compared to centralization exercicises, traction, and neural mobilizations; cervical manual therapy with exercise has ____ evidence of success
stronger
classification for recent onset of symptoms and no radic
Mobility (manual therapy and exercise)
classification for radic, symptoms below elbow
centralization
classification for no radic, chronic symptoms
Exercise and condtioning
classification for primary complaint of headache, specifically cervicogenic
Headaches (manual therapy and neck flexor/scapular strengthening)
classification for acute and traumatic mechanism
pain control (gentle ROM and activity)
staging the patient is based on the level of
acuity
acuteness is determined by
the nature of the presenting symptoms and the goals for treatment
Goal of stage 1 acuity
decrease severity
goal of stage 2 acuity
address relative impairments
goal of stage 3 acuity
return to work/sport
Decision rule developed for radiographs of the c spine following trauma
canadian cervical spine rule
what is the canadian cervical spine rule looking to detect
any fracture, dislocation, or ligamentous instability demonstrated by dx imaging
Pt is older than 65 or dangerous mechanism or paresthesias in extremities after a traumatic incident (MVA, fall, collision). Do we send for Radiography according to Canadian C-spine rule
YES
According to the CCS rule, after establishing that there is no high risk factor that mandates radiographs, what are the low-risk factors that allow for a safe assessment of ROM?
Simple rear-end MVC, sitting position in the emergency department, ambulatory at any time, delayed onset of neck pain, absence of midline cervical spine tenderness
If the patient passes the low risk factor that allows safe assessment of ROM in the CCS rule, how many degrees to the left and right are required to not get radiography
45 in each direction
Signs/symptoms of upper cervical instability
suboccipital (C2) pain, bilateral UE/LE paresthesias, clumsiness/loss of balance, nystagmus, headaches, blurred vision
UMN signs
Hyperreflexia, spasticity, abnormal gait, clumsiness, babinski’s sign.
Causes of atlantoaxial instability
congenital bony malformation, downs, inflammatory conditions, trauma, chronic coritcosteroid use
_____ of patients with RA have cervical involvement
50% (destruction of dens, transverse lig, or both
which inflammatory conditions do we worry about for atlantoaxial instability
RA, psoriatic arthritis, anklyosing spondylitis, osteomyelitis
