Cervical Condition

Question 1

TOS

Answer 1

Compresion of the nerves, arteries and veins in the lower neck and upper chest, Often causes pain in the arm, neck and shoulders

A symptomatic compression of the neurovascular bundle at the thoracic outlet which has three main compression sites the Interscalene triangle, Costoclavicular space and Retro Pectoralis space.

It can be classed as neurogenic which is the most common, venous or arterial (neurogenic = brachial plexus compromise)

It can be caused by previous head, neck or upper extremity trauma, through anatomical defects or by steroid use causing an overdevelopment of the muscles leading to compression

It affects 0.3 – 2% of the general population with a typical age range of 25-40 and it has female to male ratio of 4 to 1

Its symptoms are dependent on the type and can be mild to disabling, they include paraesthesia, discoloration, aching pain in the neck and shoulders aswell as numbness and tingling or cold arms and hands.

Question 2

Degenerative Disc disease –

Answer 2

• Is an age wear and tear on the disc which causes a Breakdown of the Extracellular matrix and therefore fail to bear the daily loadings on the spine
• They can manifest as Disc protrusion, extrusion, sequestration
• They occur most commonly in the lowest 3 cervicals
• Female=Male
• Common after 35 y/o
• With certain occupations predisposing it such as plasterers and decorators or jobs with a lot of repetitive neck motion and overhead work.
• Its symptoms include head, neck and shoulder pain and can also include radicular symptoms and neurological signs such as muscle weakness and altered sensations

Question 3

Cervical Radiculopathy

Answer 3

Cervical radiculopathy is a condition in which a nerve in the neck is compressed or irritated, causing pain, numbness, or weakness in the shoulder and arm

occurs when the spinal nerves exiting the cervical spine (nerve roots) are compressed or irritated

• Often called a pinched nerve, is the damage of nerve roots in the cervical spine caused by a compression
• It is most common at C7 and C6
• With men being affected slightly more than females
• Its age range is 40-60 and is most prevalent in people 50-54 yoa
• Its symptoms can be described as burning or sharp pain stemming from the neck and travelling to other parts of the body connected to the damaged root. Muscle weakness or weakened reflexes.

Question 4

Cervical myelopathy

Answer 4

-This is a degenerative condition caused by a more internal compression of the spinal cord

-It has an age range of 40-60 y/o

-More common in Men with a 3: 1 ratio

-Symptoms include: Neck pain, stiffness and reduced ROM, numbness or tingling in the arms and hands as well as hyperreflexia and clonus.

This compression can result from degenerative changes such as cervical spondylosis, disc herniation, spinal stenosis, or trauma. The compression leads to impaired function and damage to the spinal cord, resulting in neurological deficits

Question 5

Cluster of Wainner

Answer 5

The Cluster of Wainner is the best cluster to rule in/out cervical radiculopathy

It involves the ULTT (median nerve), Cervical rotation test, Distraction test and Spurlings test,

Go into details for each test

If 3 out of 4 tests are positive it indicates a 65% chance of radiculopathy and if 4 out of 4 tests are positive it indicates a 90% chance of cervical radiculopathy. If the ULTT is negative the chance of cergical radiculopathy is at 3%

Question 6

S&S Cerbical Radiculopathy Vs myelopathy

Answer 6

Signs and symptoms:

Cervical myelopathy:

• Gait disturbances, such as difficulty with balance and coordination (spastic gait).
• Sensory changes, including numbness, tingling, or weakness in the hands and arms.
• Motor dysfunction, such as weakness in the hands and arms, fine motor skill deterioration, and difficulty with gripping objects.
• Bladder or bowel dysfunction in severe cases.

Cervical radiculopathy:

• Pain radiating from the neck into the shoulder, arm, or hand, following a specific dermatomal distribution corresponding to the affected nerve root.
• Numbness or tingling in the arm, hand, or fingers.
• Muscle weakness in the arm or hand, particularly with specific movements or activities.
• Reflex changes, such as diminished or exaggerated reflexes in the affected limb.

Question 7

Whiplash

Answer 7

Whiplash - Neck injury caused by forceful, extension and flexion movements.

Quebec grade classification

Grade 0: No Neck Complaints or physical pain

Grade 1: Neck Complaints, No Physical Signs

Grade 2: Neck Complaints and Musculoskeletal Signs

Grade 3: Neck Complaints and Neurological Signs

Grade 4: Neck Complaints and Fracture or Dislocation

Question 8

Torticollis

Answer 8

Torticollis - Contracted state of the cervical muscles (SCM) producing a twisting of the neck and an unnatural position of the head.

Congenital muscular torticollis - Often occurs due to birth trauma or abnormal positioning in the uterus leading to a contracture of the SCM, Most commonly affects infants but improves with manual cervical stretching.

Acquired torticollis - Can result from various factors, including trauma, muscle spasm, infection, inflammation, or injury to the cervical spine or surrounding structures. Onset can occur at any age and may be sudden or gradual. Symptoms may include pain, stiffness, and limited range of motion in the neck, with the head tilted or rotated to one side.