Cervical Flashcards
3 predictors of poor outcomes after neck surgery
- workers comp
- dermatomal sensory loss
- use of weak narcotics prior to sx
Canadian C-spine rule
algorithm
- Did you have high risk fracture episode (fall > 3 ft or fall > 5 steps?) If yes,
do you - Have any tingling into either UE? if yes-xray. If no,
- are you older than 65? If yes, x-ray, if no did you
- Have low risk factor (that allows for safe ROM)
- simple MVA? can you sit up in the ER? walk after the trauma? no cervical midline tenderness? - Can you rotate > 45 degrees? No-xray needed. If no x-ray
cruciform ligament
made up of transverse lig and longitudinal ligament
- supports dens C2 on C1
c/s outcome measures
NDI
Patient specific Functional Scale
Cranial cervical flexion test
supine with biofeedback under c/s
- perform chin tucks at 22,25,26,28 and 30 mm/hg and hold for 10s at each pressure
- (-) test if you can sustain 26-30 mm/hg x10” with no SCM or superficial mm compensation
- (+) test if < 26 mmhg for 10 s, compensates with superficial mm
Neck flexor endurance test
Normal: hold 38.95s
Abnormal: with neck pain 24.1 seconds
thoracic manip for neck pain
C evidence
A evidence neck pain
Exam; NDI: 7% (think c/s has 7 vertebrae) ; PSFS (>2)
Interventions
- manips
- coordination,strength,endurance therex
- patient ed and counseling
Traction and nerve mobs
level B evidence
Signs of a stroke
think FAST
- Facial droop- ask person to smile
- Arms- can pt raise both arms up or does one arm shift downward
- Speech- can pt repeat a simple phrase? slurred or not making sense?
- Time- call 911 immediately!
Contraindications to manual therapy at neck
- Worsening neuro function (multi level root pathology)
- unremitting severe pain
- recent trauma
- UMN signs
- spinal cord damage
Contraindications to cervical manipulation
ACUTE soft tissue, ACUTE fracture
- dislocation, ligamentous rupture, RA, AS, osteoporosis, vascular disease, anticoagulation therapy, instability, tumor, infection, acute myelopathy
CPR for cervical myelopathy
- Age > 45
- (+) gait deviations (ataxic gait, wide BOS)
- (+) Hoffman
- (+) Babinski
- (+) inverse supinatior
3 or more = 94% post test probability
Manual tx for myelopathy
- stay away from c/s manips! (contra)
- but can manip upper/mid thoracic spine and intermittent cervical traction
- saw improvements in strength
CPR for cervical radiculopathy
- (+) ULTT A (median nerve)
- (+) Spurlings
- (+) distraction
- Rot < 60 degrees to involved side
3/4: 6.1 LR
4/4: 30.3 LR
CPR for cervical manipulation
- (+) opinion that manip will help
- Acute, symptoms < 38 days
- ROM rotation with > 10 degrees difference side to side
- pain with PA to middle c/s
Tx for cervical radiculopathy
MULTIMODAL
- Manual therapy
- Cervical traction
- DNF exercise
CPR for cervical traction
- Age > 55
- (+) distraction test (30#)
- (+) peripheralization with p/a C4-C7
- (+) ULTT A
- (+) Shoulder abd test
3/5 LR 4.81
4/5 LR 23
Cervical Traction parameters
Position neck at 24 degrees of flexion
15 min, intermittent 1 min pull, 20” rest
- initial pull force 10-12# (weight of head, 10% BW), increase throughout session (max pull 35-40#)
DIFFERENT THAN LUMBAR
Lumbar
QIW, 12 min, 40-60% BW force
Thoracic outlet tx
conservative: stretch what’s tight
- mobilize tight structures (1st rib, spine)
- Lengthen shortened muscles: scalenes, LS, Pec minor
- teach diaphragmatic breathing
- Neural gliding techniques
Tests:
Cervical rotation Lateral Flexion test
- contralateral rotation, ipsilateral lateral flexion
(+) if you cant laterally flex ( C7 TP blocked by elevated first rib)
Whiplash MOI
MVA- coup-contracoup
- s shaped spinal curve
- upper cervical flexion, lower cervical extension
facet capsulses can be stretched, pinched or torn
Clinical predictor on acute–> chronic neck pain following whiplash
- NDI > 15
- Tampa scale for kinesiophobia > 41
5-6% development to chronic if NO to both above
up to 83% development of chronic pain if YES to both above
Cervicogenic headache treatment
- strengthen deep neck flexors
- self SNAGS
- manual therapy (mobs or manip)
Cervicogenic headache dx
- limited cervical ext ROM
- pain with palpation to c3/c4
- weakness in deep neck flexors with CC cervical flexion test
Neck pain with radiating pain treatment
Acute
- nerve mobs and traction (B)
- mobilizing/stabilizing (C)
- cervical collar (C)
- stretching, thoracic mob/manip (C)
Chronic (B)
- intermittent traction
- stretching
- strengthening
- C/S, and T/S manips
- education
Neck pain with mobility deficits tx
Acute
- cervical AROM (B)
- thoracic manips (B)
- scapulothoracic strengthening (B)
- cervical mobs (C)
Subacute
- neck/shoulder endurance therex (B)
- throacic/cervical mob/manip (C)
Chronic (multimodal)
- cervical/thoracic manip (B)
- strengthening/stretching, endurance training, cognitive affectiev elements (B)
- neck/shoulder/trunk endurace therex (C)
- pt ed (C)
Neck pain with movement coordination (motor control) therex
Most commonly due to sprain/strain of c/s
Acute
- active exercise protocol, pt ed to return to pre-accident activities, postural/mobility exercises to decrease pain and increase ROM (B)
- mobs and exercise (B)
CPR to know who responds well with cervical radic
Age < 55
non dominant arm affected
looking down does not increase symptoms
Multimodal approach used ( manual, traction and exercise DNF)
Risk factors for pancoast tumor
- men > 50
- Hx of smoking
- pain in shoulder along vertebral border of scap
- can progress to pain down the arm into ulnar nerve distribution
Can demonstrate
- horners syndrome
- wheezing
Septic arthristis (AC jt)
- chest pain localized to SC jt
- hx of IV drug use, diabetes, trauma, infection, fever
- Tender SC jt, swelling at SC jt
Subarachnoid hemorrhagic/ischemic stroke
- elevated BP, severe headache
- hx HTN, altered mental status, vertigo, vomiting
Difference between neck with mobility and movement coordination
neckpain with mobility= more ACUTE < 12 weeks
neckpain with movement coordination- more CHRONIC
Signs of neck pain with mobility issues
- loss of cervical AROM
- limited flexion rotation test
- hypomobility in cervical/thoracic spine
Signs of neck pain with radiating pain
- (+) spurlings
- (+) distraction
- (+) ULTT A
- Valsalva
Signs of neck pain with movement coordination
Including whiplash
- (+) cervical neck flexor endurance test
- (+) craniocervical flexion test
Signs of neck pain with headaches
- upper cervical ROM
- (+) flexion rotation test
- upper cervical mobility
