CERVICAL CONDITIONS

Question 1

enumerate the 7 conditions involving the cervical region:

Answer 1

1. cervical strain and sprain
2. cervical internal disk disruption
3. cervical spondylosis & stenosis
4. cervical joint pain
5. torticollis
6. cervical radiculopathy & radicular pain
7. whiplash injury

Question 2

classification of cervical strain and sprain

Answer 2

axial pain - is confined to one spot or region. It may be described a number of ways, such as sharp or dull, comes and goes, constant, or throbbing.

Question 3

definition of cervical strain and sprain

Answer 3

A cervical strain is a musculotendinous injury
produced by an overload injury resulting from
excessive forces imposed on the cervical
spine.

Cervical sprains are overstretching or tearing
of spinal ligaments.

Question 4

epidemiology of cervical strain and sprain

Answer 4

85% of neck pain results from acute, repetitive, or chronic neck injuries.

women are more affected; in the age range of 30-50 yo

Question 5

etiology of cervical strain and sprain

Answer 5

most common in motor vehicle accidents

most common cause of pain after non-catastrophic sports injuries

Question 6

pathophysiology of cervical strain and sprain

Answer 6

acceleration - deceleration injuries : a form of head injury caused by the head suddenly being placed into motion or abruptly stopped, as, for example, when the individual is in a car accident.

increased thoracic kyphosis and consequential cervical lordosis and extension, strain occurs in the Levator Scapulae, Superior Trapezius, SCM, Scalene and Suboccipital muscles.

increased thoracic kyphosis and consequential cervical lordosis and extension, strain occurs in the Levator Scapulae, Superior Trapezius, SCM, Scalene and Suboccipital muscles.

Question 7

clinical manifestations of cervical strain or sprain

Answer 7

Dull, sharp localized neck pain

Headache that is typically sharp/ dull localized to the cervical or shoulder girdle musculature

Neck fatigue

Muscle stiffness/ guarding

↓ Cervical ROM

Question 8

definition of cervical internal disk disruption

Answer 8

Indicates that an IV disk has lost its normal internal architecture but maintains a preserved external contour in the absence of nerve root compression

Question 9

classification of cervical internal disk disruption

Answer 9

axial pain - is confined to one spot or region. It may be described a number of ways, such as sharp or dull, comes and goes, constant, or throbbing.

Question 10

epidemiology of cervical internal disk disruption

Answer 10

20% - traumatically-induced CIDD

41% - suffering from CIDD & concomitant joint injury

Question 11

etiology of CIDD

Answer 11

End plate fractures due to excessive loads;
disc dislocation; loss of disk height; annular
fissue; ostephytosis; reactive end-plate
changes are markers of disk degeneration

Question 12

pathophysiology of CIDD

Answer 12

Stimulation of local mechanoreceptors and nociceptors and annular defect -> migration of nuclear material or inflammation mediators -> stimulate the outer annulus, dura mater, posterior longitudinal ligament, dorsal root ganglion or spinal nerve

Question 13

clinical manifestations of CIDD

Answer 13

Posterior neck pain, occipital and suboccipital pain, upper trapezius pain, inter- and periscapular pain, nonradicular arm pain, vertigo, tinnitus, ocular dysfunction, dysphagia, facial pain, and anterior chest pain

Question 14

clinical manifestation of CIDD

Answer 14

Posterior neck pain, occipital and suboccipital pain, upper trapezius pain, inter- and periscapular pain, nonradicular arm pain, vertigo, tinnitus, ocular dysfunction, dysphagia, facial pain, and anterior chest pain

Question 15

definition of cervical spondylosis & stenosis

Answer 15

Degenerative changes in the cervical spine are common with advancing age.

IV discs lose hydration and elasticity, leading to cracks and fissures.

Surrounding ligaments also lose their elastic properties.

spondylosis refers to degeneration of the spine, whereas stenosis specifically refers to the narrowing of the spinal canal that can happen as a part of spondylosis.

Question 16

classification of cervical spondylosis and stenosis

Answer 16

no classification for this condition

Question 17

epidemiology of cervical spodylosis and stenosis

Answer 17

prevalence of cervical spondylosis was 13.76%

female > males

Question 18

etiology of cervical sponylosis and stenosis

Answer 18

spondylosis - caused by the normal wear-and-tear of aging

stenosis - Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal.

Question 19

pathophysiology of cervical spondylosis and stenosis

Answer 19

Intervertebral disks lose hydration and elasticity with age, and these losses lead to cracks and fissures. The surrounding ligaments also lose their elastic properties and develop traction spurs. The disk subsequently collapses as a result of biomechanical incompetence, causing the annulus to bulge outward. As the disk space narrows, the annulus bulges, and the facets override. This change, in turn, increases motion at that spinal segment and further hastens the damage to the disk.

Question 20

clinical manifestation of cervical spondylosis and stenosis

Answer 20

Neck pain 
LOM 
Tenderness at posterior aspect of neck 
(+) neurological signs 
(+) Spurling’s/Foraminal Compression Tests 
(+) Lhermitt’s sign

Question 21

definition for cervical joint pain

Answer 21

Most commonly occurs in association with a symptomatic intervertebral disk at the same level

Question 22

classification for cervical joint pain

Answer 22

no classifications

Question 23

epidemiology for cervical joint pain

Answer 23

58-88% complain of headaches

50-53% c/o posterior headaches after whiplash injury

Question 24

etiology of cervical joint pain

Answer 24

Traumatic, non-traumatic

cervical zygapophyseal joint pain affects usually one joint and can be due to spondylosis or improper biomechanics

Question 25

pathophysiology of cervical joint pain

Answer 25

Zygapophyseal join fractures, intra-articular hemorrhage and capsular tears

Question 26

clinical manifestation for cervical joint pain

Answer 26

Unilateral paramidline neck pain is more painful than any associated headaches Pain from the cervical zygapophyseal joints c1-2 AND c2-3 = Occiput c3-4 AND c4-5 = Posterior neck c5-c6 = Supraspinatus fossa of the scapula c6-7 = Scapula c1-2, C2-3, C3-4 AND c4-5 = FACE c3-4, c4-5. AND c5-6 = HEAD

Question 27

definition of torticollis

Answer 27

Wry neck or cervical scoliosis Persistent involuntary contractions of the muscles in one side of the body

Question 28

classification for torticollis

Answer 28

none

Question 29

epidemiology of torticollis

Answer 29

4/1000 births 75% involving on the right side

Question 30

etiology of torticollis

Answer 30

Congenital a. faulty fetal position b. direct trauma on the muscle c. nerve injury Muscle imbalance due to existing conditions

Question 31

pathophysiology of torticollis

Answer 31

congenital - caused by local trauma to the soft tissues of the neck just before or during delivery. acquired - can be the result of blunt trauma to head and neck, or from simply sleeping in an awkward position.

Question 32

clinical manifestations of torticollis

Answer 32

Head is slightly flexed and drawn towards the contracted side with the face rotated over the shoulder

Question 33

definition of cervical radiculopathy & radicular pain

Answer 33

cervical radicular pain defined as pain involving the shoulder girdle and distally, manifested as pain in the upper limb

Question 34

classification of cervical radiculopathy and radicular pain

Answer 34

none

Question 35

epidemiology of cervical radiculopathy and radicular pain

Answer 35

Peak incidence at ages 50-54 55yo< due to acute disc herniation 55yo> due to degenerative changes

Question 36

etiology of cervical radiculopathy and radicular pain

Answer 36

due to disc herniation, stenosis,osteophytes, | swelling with trauma, spondylosis

Question 37

pathophysiology of cervical radiculopathy and radicular pain

Answer 37

Cervical IV disc herniation inflammatory response and pressure gradient-> radicular pain degenerative changes-> ligamentous hypertrophy, hyperostosis, disk degeneration, facet joint arthropathy, ostephytes, cysts-> stenosis and Impingement radiculopathy

Question 38

clinical manifestations of cervical radiculopathy and radicular pain

Answer 38

Muscle weakness in the Unilat UE (myotome) Paresthesia in the Unilat UE ( dermatome) Hyporeflexia aggravated by side flexion, rotation, extension and relieved by distraction

Question 39

definition of whiplash injury

Answer 39

Whiplash is a neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip. Whiplash is commonly caused by rear-end car accidents. But whiplash can also result from sports accidents, physical abuse and other types of traumas, such as a fall.

Question 40

classification for whiplash injury

Answer 40

none

Question 41

epidemiology of whiplash injury

Answer 41

The prevalence of whiplash injuries was 7.7% and 9.6% in men and women, respectively.

Question 42

etiology of whiplash injury

Answer 42

commonly caused by rear-end car accidents

Question 43

pathophysiology of whiplash injury

Answer 43

Passive movement of the neck, muscular control and stabilize the cervical spine does not react quickly enough to prevent injurious forces from occurring across the cervical functional spinal units

Question 44

clinical manifestations of whiplash injury

Answer 44

``` neck pain headaches shoulder girdle pain upper limb paresthesia weakness dizziness visual disturbances tinnitus ```

Question 45

GENERAL complications for CERVICAL CONDITIONS

Answer 45

Long-term complications that may develop from cervical injuries include chronic pain, headaches, depression, permanent loss of cervical ROM, and disability.

Question 46

GENERAL diagnosis for CERVICAL CONDITIONS

Answer 46

CT scan: for bony conditions Myelography: disc conditions Discography: for the disc Electrodiagnostic evaluation: NCV (Nerve conduction velocity, EMG) for cervical neve root and peripheral function

Question 47

general DDX

Answer 47

cervical radiculopathy vs brachial plexus lesion cervical myelopathy vs cervical radiculopathy

Question 48

general prognosis for cervical conditions

Answer 48

cervical conditions worsen with age, due to aging, there are anatomical and physiological changes in the body which may lead to worsening of the condition. prognosis also differs if the pt is involving him or herself in engaging in interventions or exercises that help alleviate or perhaps slow down disease progression.

Question 49

gen healthcare management for CERVICAL CONDITIONS

Answer 49

medical - not much medical intervention if condition can be controlled through medication. pharmacological - use of nsaids, oral steroids, muscle relaxants, opioids, and antidepressants may be observed so as to control or alleviate symptoms of these conditions. surgical - as for surgical management, cervical implants may be placed in these patients. Cervical implants are devices surgeons use to decompress and stabilize the neck. These devices are implanted either from the front (anterior) of the spine, or from the back (posterior).

Question 50

GENERAL other healthcare management for CERVICAL CONDITIONS

Answer 50

physiatrist - helps give an individual the power to make major changes in their life, and to help target the exact issues relating to their mental or behavioral health challenges. speech pathology - needed in patients with speech impairments due to cervical conditions

Question 51

special tests

Answer 51

Spurling test-test for foraminal encroachment on an inflamed cervical nerve root Lhermittes- indicative of spinal cord pathology as well as herniated cervical disc Adson’s maneuver- with neurovascular compromise secondary to TOS