Cervical conditions Flashcards
Causes of cervical strain
Rear ended car collision, sports trauma, receptive occupational injuries
Hx of overuse or trauma
Risk factors of cervical strain
Radiographic image used to rule out more severe injuries
Clinical presentation of cervical strain
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
Cervical strain DDX
Cervical sprain
Facet syndrome
Meniscoid entrapment
Physical findings of cervical strain
Palpable bogginess of posterior neck muscles, cervical tissue oedema (not pitting- application of pressure causes indentation), limited ROM
What is cervical strain
Whiplash
Result of sudden hyperextension followed by hyeprflexion of neck
Muscles and ligaments stretch beyond capacity = inflammation in local tissues
Associated symptoms of cervical strain
Persistent stiffness, trapezoidal pain, back pain, muscle spasm, headache
Symptoms begin acutely, hours after injury
Prognosis of cervical strain
Initially causes distress, minimal long term sequela (condition which is a consequence of previous injury)
Degeneration
Accumulated wear and tear that occurs over a long period of time
Degenerate age group
Elderly people
Risk factors for degeneration
Aging, hard manual labour, contact sports
Clinical presentation of degeneration
Neck pain/stiffness, inflexibility, limited ROM
Pt >50 years
Gradual onset
Crepitus
Morning stiffness
Dull achy P
Associated symptoms of degeneration
Numbness, tingling, potential weakness in neck, arms or shoulders because nerves in cervical region become irritated or pinched
Prognosis for degeneration
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
Herniation
Tear or rupture of fibrocartilagneous material (annulus) that surrounds interverebral disc
Most common spinal levels- L4-5, L5-S1 (95-98% of all herniations)
Patho herniation
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
Epidemiology of herniation
Traumatic events, many cases occur spontaneously
Herniation- age groups affected
Young adults
Herniation risk factors
High contact sports
Herniation clinical presentation
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
Associated symptoms of herniation
Frequent headaches, pain originating in paraspinal muscles radiating down upper extremity
Prognosis of herniation
Should improve over time and symptoms become less intense following manual therapy
Stenosis
Narrowing of spaces in spine which can compress spinal cord
Age groups affected by sternosis
50+ due to osteoarthritic symptoms beginning leading to changes in spinal structures
Stenosis clinical presentation
Neck and arm pain
Vague nonspecific neurological symptoms
Upper extremity- Pt may feel clumsy/drop things
Lower- difficulty walking, imbalance
Bowel + bladder incontinence
Stenosis prognosis
Nothing can be done to stop progression as due to daily wear and tear
Physical therapy, medication and injections aid treatment
Cervical facet syndrome
Osteoarthritis of facet (degeneration)
Can be caused by whiplash
Non age group specific
Risk factors of cervical facet syndrome
Sedentary jobs at computer (poor posture), history of trauma, degenerative disc disorder
Clinical presentation of cervical facet syndrome
Unilateral pain, rarely radiating past shoulders
Pain with pressure on facet
Potential painful/limited extension and/or rotation
Inc P with ext (loading facets)
Cervical artery dysfunction
Involves internal carotid and/or vertebral
5Ds, 3Ns
Clinical presentation of cervical artery dysfunction
Headache- unilateral and in frontotemporal or occipital region. May be described as constant, throbbing, or sharp
Facial numbness- ataxia (raised suspicion)
Trigger points
Discrete, focal, hyper irritable spots located in taut band of skeletal muscle
Epidemiology of trigger points
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
Group affected by trigger points
Sporty people/those who have contact stress on certain muscle group
Risk factors of trigger points
Factors causing chronic overuse or stress on muscles
Clinical presentation of trigger points
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)
Prognosis of trigger points
Dry needling, massage, acupuncture, etc all cause improvements over time
Acute disc prolapse
Slipped disc- do not use term in clinic
Nucleus pulposus bulges out of outer disc
Epidemiology of acute disc prolapse
Unguarded flexion and rotation
Local strain/injury
Risk factors of acute disc prolapse
X-ray shows narrowing of disc space, MRI confirms diagnosis
Clinical presentation of acute disc prolapse
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
Prognosis for acute disc prolapse
Heat and analgesics soothe
Chronic disc degeneration age groups
Degeneration fairly common from middle age onwards
40+
Chronic disc degeneration clinical presentation
Neck stiffness
Pain may radiate to occiput, scapula muscles and down one or both arms
Weakness, clumsiness
Tenderness in soft tissue
Limited ROM
Prognosis for chronic disc degeneration
During painful episodes- heat + massage, some benefit from restraining collar
Gentle passive manipulation + exercise eases
Reduction in discomfort but doesn’t necessarily improve
Pyogenic infection
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
Clinical presentation for pyogenic infection
Neck pain, often associated with muscle spasm and stiffness
Limited ROM
Prognosis for pyogenic infection
Early stage treatment through antibiotics= improvement
Tuberculosis
Infection localises intervertebral disc and anterior part of adjacent vertebral bodies
As Csp collapses into kyphosis, retropharyngeal abscess forms and points behind SCM
TB age groups
Usually children
Clinical presentation of TB
Neck pain and stiffness
If neglected retropharyngeal abscess may cause problems swallowing or swelling in posterior triangle
Tender and extremely restricted
Prognosis for TB
Antituberculosis drugs and immobilisation of neck for 6-18 months
Rheumatoid arthritis
Autoimmune inflammatory disease usually affecting women
Clinical presentation of rheumatoid arthritis
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
Ankylosing spondylitis
Type of arthritis which causes inflammation in joints and ligaments of spine
Ankylosing spondylitis causes
Genetic HLA B27
Instability Hx
Recurrent neck P
Clicking or clunking sensations
Instability clearing Qs
- H/As?
- Feeling like you need to hold your head up?
- Reluctance to move head?
- 5Ds, 3Ns, A
Instability causes
Age related changes
Trauma
Overuse injuries
Trauma (e.g., RTA)
Genertic conditions (e.g., Down syndrome)
Instability SSx
Inc RPOM
Spongy end feel
Instability DDX
Cervical sprain
OA
