CERVICAL CONDITIONS Flashcards
enumerate the 7 conditions involving the cervical region:
- cervical strain and sprain
- cervical internal disk disruption
- cervical spondylosis & stenosis
- cervical joint pain
- torticollis
- cervical radiculopathy & radicular pain
- whiplash injury
classification of cervical strain and sprain
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.
definition of cervical strain and sprain
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.
epidemiology of cervical strain and sprain
85% of neck pain results from acute, repetitive, or chronic neck injuries.
women are more affected; in the age range of 30-50 yo
etiology of cervical strain and sprain
most common in motor vehicle accidents
most common cause of pain after non-catastrophic sports injuries
pathophysiology of cervical strain and sprain
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.
clinical manifestations of cervical strain or sprain
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
definition of cervical internal disk disruption
Indicates that an IV disk has lost its normal internal architecture but maintains a preserved external contour in the absence of nerve root compression
classification of cervical internal disk disruption
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.
epidemiology of cervical internal disk disruption
20% - traumatically-induced CIDD
41% - suffering from CIDD & concomitant joint injury
etiology of CIDD
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
pathophysiology of CIDD
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
clinical manifestations of CIDD
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
clinical manifestation of CIDD
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
definition of cervical spondylosis & stenosis
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.
classification of cervical spondylosis and stenosis
no classification for this condition
epidemiology of cervical spodylosis and stenosis
prevalence of cervical spondylosis was 13.76%
female > males
etiology of cervical sponylosis and stenosis
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.
pathophysiology of cervical spondylosis and stenosis
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.
clinical manifestation of cervical spondylosis and stenosis
Neck pain LOM Tenderness at posterior aspect of neck (+) neurological signs (+) Spurling’s/Foraminal Compression Tests (+) Lhermitt’s sign
definition for cervical joint pain
Most commonly occurs in association with a symptomatic intervertebral disk at the same level
classification for cervical joint pain
no classifications
epidemiology for cervical joint pain
58-88% complain of headaches
50-53% c/o posterior headaches after whiplash injury
etiology of cervical joint pain
Traumatic, non-traumatic
cervical zygapophyseal joint pain affects usually one joint and can be due to spondylosis or improper biomechanics
pathophysiology of cervical joint pain
Zygapophyseal join fractures, intra-articular hemorrhage and capsular tears
clinical manifestation for cervical joint pain
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
definition of torticollis
Wry neck or cervical scoliosis
Persistent involuntary contractions of the muscles in one side of the body
classification for torticollis
none
epidemiology of torticollis
4/1000 births
75% involving on the right side
etiology of torticollis
Congenital
a. faulty fetal position
b. direct trauma on the muscle
c. nerve injury
Muscle imbalance due to existing conditions
pathophysiology of torticollis
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.
clinical manifestations of torticollis
Head is slightly flexed and drawn towards the
contracted side with the face rotated over the
shoulder
definition of cervical radiculopathy & radicular pain
cervical radicular pain defined as pain
involving the shoulder girdle and distally,
manifested as pain in the upper limb
classification of cervical radiculopathy and radicular pain
none
epidemiology of cervical radiculopathy and radicular pain
Peak incidence at ages 50-54
55yo< due to acute disc herniation
55yo> due to degenerative changes
etiology of cervical radiculopathy and radicular pain
due to disc herniation, stenosis,osteophytes,
swelling with trauma, spondylosis
pathophysiology of cervical radiculopathy and radicular pain
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
clinical manifestations of cervical radiculopathy and radicular pain
Muscle weakness in the Unilat UE (myotome)
Paresthesia in the Unilat UE ( dermatome)
Hyporeflexia
aggravated by side flexion, rotation, extension and relieved by distraction
definition of whiplash injury
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.
classification for whiplash injury
none
epidemiology of whiplash injury
The prevalence of whiplash injuries was 7.7% and 9.6% in men and women, respectively.
etiology of whiplash injury
commonly caused by rear-end car accidents
pathophysiology of whiplash injury
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
clinical manifestations of whiplash injury
neck pain headaches shoulder girdle pain upper limb paresthesia weakness dizziness visual disturbances tinnitus
GENERAL complications for CERVICAL CONDITIONS
Long-term complications that may develop from cervical injuries include chronic pain, headaches, depression, permanent loss of cervical ROM, and disability.
GENERAL diagnosis for CERVICAL CONDITIONS
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
general DDX
cervical radiculopathy vs brachial plexus lesion
cervical myelopathy vs cervical radiculopathy
general prognosis for cervical conditions
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.
gen healthcare management for CERVICAL CONDITIONS
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).
GENERAL other healthcare management for CERVICAL CONDITIONS
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
special tests
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
