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Orthopaedic Conditions > Cervical conditions > Flashcards

Cervical conditions Flashcards

1
Q

Causes of cervical strain

A

Rear ended car collision, sports trauma, receptive occupational injuries
Hx of overuse or trauma

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2
Q

Risk factors of cervical strain

A

Radiographic image used to rule out more severe injuries

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3
Q

Clinical presentation of cervical strain

A

Treat only as diagnosis of exclusion
Inspect neck for skin integrity, edema (swelling), ecchymosis (bruising), or asymmetry
Palpate tenderness- SPs –> paraspinal soft tissue
Assess ROM if Pt able to

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4
Q

Cervical strain DDX

A

Cervical sprain
Facet syndrome
Meniscoid entrapment

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5
Q

Physical findings of cervical strain

A

Palpable bogginess of posterior neck muscles, cervical tissue oedema (not pitting- application of pressure causes indentation), limited ROM

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6
Q

What is cervical strain

A

Whiplash
Result of sudden hyperextension followed by hyeprflexion of neck
Muscles and ligaments stretch beyond capacity = inflammation in local tissues

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7
Q

Associated symptoms of cervical strain

A

Persistent stiffness, trapezoidal pain, back pain, muscle spasm, headache
Symptoms begin acutely, hours after injury

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8
Q

Prognosis of cervical strain

A

Initially causes distress, minimal long term sequela (condition which is a consequence of previous injury)

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9
Q

Degeneration

A

Accumulated wear and tear that occurs over a long period of time

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10
Q

Degenerate age group

A

Elderly people

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11
Q

Risk factors for degeneration

A

Aging, hard manual labour, contact sports

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12
Q

Clinical presentation of degeneration

A

Neck pain/stiffness, inflexibility, limited ROM
Pt >50 years
Gradual onset
Crepitus
Morning stiffness
Dull achy P

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13
Q

Associated symptoms of degeneration

A

Numbness, tingling, potential weakness in neck, arms or shoulders because nerves in cervical region become irritated or pinched

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14
Q

Prognosis for degeneration

A

Treatment involves rest, pain medication, NSAIDs (non-steroid anti-inflammatory drugs), and physical therapy
Goal of physical is to increase flexibility, postural training and strengthen parapsinal muscles
Restoring flexibility prevents further repetitive microtrauma from poor movement patterns

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15
Q

Herniation

A

Tear or rupture of fibrocartilagneous material (annulus) that surrounds interverebral disc
Most common spinal levels- L4-5, L5-S1 (95-98% of all herniations)

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16
Q

Patho herniation

A

Secondary to disc degeneration (annulus fibrosis)
External protrusion of gelatinous nucleus pulposus through annular fibres potentially causing compression of spinal nerve segment (radiculopathy)
In addition to damage and comp, there is also potential chemical irritation from the release of inflammatory products and local oedema

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17
Q

Epidemiology of herniation

A

Traumatic events, many cases occur spontaneously

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18
Q

Herniation- age groups affected

A

Young adults

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19
Q

Herniation risk factors

A

High contact sports

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20
Q

Herniation clinical presentation

A

Can be mistaken for shoulder/forearm pathology (assess to rule out)
Complaints of weakness, numbness, and tingling in shoulder region down to fingers
Limited ROM
Bicep weakness, numbness in thumbs and index fingers
Symptoms vary dependent on which nerve roots
Unilateral symptoms, unless central herniation

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21
Q

Associated symptoms of herniation

A

Frequent headaches, pain originating in paraspinal muscles radiating down upper extremity

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22
Q

Prognosis of herniation

A

Should improve over time and symptoms become less intense following manual therapy

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23
Q

Stenosis

A

Narrowing of spaces in spine which can compress spinal cord

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24
Q

Age groups affected by sternosis

A

50+ due to osteoarthritic symptoms beginning leading to changes in spinal structures

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25
Q

Stenosis clinical presentation

A

Neck and arm pain
Vague nonspecific neurological symptoms
Upper extremity- Pt may feel clumsy/drop things
Lower- difficulty walking, imbalance
Bowel + bladder incontinence

26
Q

Stenosis prognosis

A

Nothing can be done to stop progression as due to daily wear and tear
Physical therapy, medication and injections aid treatment

27
Q

Cervical facet syndrome

A

Osteoarthritis of facet (degeneration)
Can be caused by whiplash
Non age group specific

28
Q

Risk factors of cervical facet syndrome

A

Sedentary jobs at computer (poor posture), history of trauma, degenerative disc disorder

29
Q

Clinical presentation of cervical facet syndrome

A

Unilateral pain, rarely radiating past shoulders
Pain with pressure on facet
Potential painful/limited extension and/or rotation

Inc P with ext (loading facets)

30
Q

Cervical artery dysfunction

A

Involves internal carotid and/or vertebral
5Ds, 3Ns

31
Q

Clinical presentation of cervical artery dysfunction

A

Headache- unilateral and in frontotemporal or occipital region. May be described as constant, throbbing, or sharp
Facial numbness- ataxia (raised suspicion)

32
Q

Trigger points

A

Discrete, focal, hyper irritable spots located in taut band of skeletal muscle

33
Q

Epidemiology of trigger points

A

Acute trauma or repetitive micro trauma
Lack of exercise, prolonged poor posture, vitamin deficiency, sleep disturbance
Occupational or recreational activities that produce repetitive strain on specific muscle group

34
Q

Group affected by trigger points

A

Sporty people/those who have contact stress on certain muscle group

35
Q

Risk factors of trigger points

A

Factors causing chronic overuse or stress on muscles

36
Q

Clinical presentation of trigger points

A

Regional persistent pain –> limited ROM
Tension headaches, tinnitus
Pain in shoulders
Pain in quads, calves, limited ROM in knee/ankle
Active TPs cause pain at rest, tender to palpation, with referred pain (differentiation of tender points)

37
Q

Prognosis of trigger points

A

Dry needling, massage, acupuncture, etc all cause improvements over time

38
Q

Acute disc prolapse

A

Slipped disc- do not use term in clinic
Nucleus pulposus bulges out of outer disc

39
Q

Epidemiology of acute disc prolapse

A

Unguarded flexion and rotation
Local strain/injury

40
Q

Risk factors of acute disc prolapse

A

X-ray shows narrowing of disc space, MRI confirms diagnosis

41
Q

Clinical presentation of acute disc prolapse

A

Potential pressure on posterior longitudinal ligament = pain and stiffness, referred pain to upper arm/scapular region
Pain and parasthesia in one upper limb, radiating to outer elbow, back of wrist and to index/middle finger
Neck may title forwards/sideways

42
Q

Prognosis for acute disc prolapse

A

Heat and analgesics soothe

43
Q

Chronic disc degeneration age groups

A

Degeneration fairly common from middle age onwards
40+

44
Q

Chronic disc degeneration clinical presentation

A

Neck stiffness
Pain may radiate to occiput, scapula muscles and down one or both arms
Weakness, clumsiness
Tenderness in soft tissue
Limited ROM

45
Q

Prognosis for chronic disc degeneration

A

During painful episodes- heat + massage, some benefit from restraining collar
Gentle passive manipulation + exercise eases
Reduction in discomfort but doesn’t necessarily improve

46
Q

Pyogenic infection

A

Bacteria reaches spine via blood stream, initially deconstruct changes are made to disc space and adjacent parts of vertebral bodies
Abscess formation, pus may extend into spinal cord/soft tissue

47
Q

Clinical presentation for pyogenic infection

A

Neck pain, often associated with muscle spasm and stiffness
Limited ROM

48
Q

Prognosis for pyogenic infection

A

Early stage treatment through antibiotics= improvement

49
Q

Tuberculosis

A

Infection localises intervertebral disc and anterior part of adjacent vertebral bodies
As Csp collapses into kyphosis, retropharyngeal abscess forms and points behind SCM

50
Q

TB age groups

A

Usually children

51
Q

Clinical presentation of TB

A

Neck pain and stiffness
If neglected retropharyngeal abscess may cause problems swallowing or swelling in posterior triangle
Tender and extremely restricted

52
Q

Prognosis for TB

A

Antituberculosis drugs and immobilisation of neck for 6-18 months

53
Q

Rheumatoid arthritis

A

Autoimmune inflammatory disease usually affecting women

54
Q

Clinical presentation of rheumatoid arthritis

A

Neck pain
Restricted ROM
Root compression symptoms may be present in upper limb
May be symptoms of vertebrobasiler insufficiency (limited blood flow to posterior part of brain): vertigo, tinnitus, visual disturbance

55
Q

Ankylosing spondylitis

A

Type of arthritis which causes inflammation in joints and ligaments of spine

56
Q

Ankylosing spondylitis causes

A

Genetic HLA B27

57
Q

Instability Hx

A

Recurrent neck P
Clicking or clunking sensations

58
Q

Instability clearing Qs

A
  • H/As?
  • Feeling like you need to hold your head up?
  • Reluctance to move head?
  • 5Ds, 3Ns, A
59
Q

Instability causes

A

Age related changes
Trauma
Overuse injuries
Trauma (e.g., RTA)
Genertic conditions (e.g., Down syndrome)

60
Q

Instability SSx

A

Inc RPOM
Spongy end feel

61
Q

Instability DDX

A

Cervical sprain
OA

62
Q
A

Orthopaedic Conditions (11 decks)

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