Cervical II Flashcards
Whiplash
. #1 reason for patients to present w/ neck pain
. Hyper-extension injury w/ secondary hyper-flexion injury then occur as head snaps back onto the thorax
. Ant. Longitudinal ligament or cervical mm. May be stretched or torn
. Light weight, tall people at higher risk
. 50% patients w. Whiplash still have symptoms after 1 yr
. Soft tissue, muscle energy, indirect techniques work
Carotid aa.
. Bifurcate into internal and external carotid
. Carotid sinus contains nerve receptors for baroregulation
. Occlusion of carotid aa. Can precipitate rapid dec. in bp
Wallenberg test
. Screens for vertebral a. Insufficiency
. Pt supine, cradle head and neck w/ hands
. Introduce extension of cervical spine and rotation of neck in both directions
. Pos test: dizziness, nausea, syncope, dysarthria, dysphagia, hearing or vision issues, or paresis caused by reduction of blood flow to vertebral a.
Cervical spine imaging
. High index of suspicion for obtaining imaging
. Acute neck pain in people over 60 or under 15 should be considered for X-ray
. Patients w/ blunt trauma, high speed MVAm and sports-related injuries
. Don’t want to miss fracture, tumor, spinal cord compromise
Cervical spinal nerves
. Exit spine through neural foramina
. Largest at C2 and smallest at c7
. Cervical flexion inc. neural foramina diameter, extension dec. it
Cervical disc disease
. Disc protrusion/herniation compress cervical n. Root below it
leading to radiculopathy
. Do not do HVLA at that level
Cervical intradiscal pressure
. Lowest in supine w/ head supported
. Greatest in cervical hyper-extension
Post. Longitudinal ligament
. Cervical lordosis maintained
. Runs from C2 to sacrum
. Weaker than ant. Longitudinal ligament
. Presents risk for disc herniation esp. in lower cervical region
Cervical raiduclopathy
. Cause pain, weakness, numbness, or parenthesias
. Usually follow specific nerve root pattern
. Most common cervical nerve root herniation is C6-7 disc affecting C7 nerve root
. Produces a reflex x hange in interscapular area that can lead to recalcitrant upper back pain and arm symptoms
. Look for sensory loss, motor weakness, or loss of DTR
. Symptoms can be intermittent and not produce a neurologic deficit
Spurling’s test
. Tests for cervical n. Root compression
. Sidebend, extend, compress (in stages)
. Pos. Test: reproduces radioulnar symptoms
. 93% specific
. 30% sensitive
Intrascapular pain can be referred from the ___
Neck
Cervical spinal stenosis
. Narrowing spaces w/in spinal column form OA can put pressure on nerve roots or spinal cord
. May be asymptomatic but worsens over time
. Symptoms: pain, numbness, mm. Weakness, difficulty walking
Cervical sympathetics
.arises from intermediolateral cell columns of spinal cord
. N. Fibers travel via white rami
. Cervical sympathetics come from T1-4
. 3 fused ganglia innervates area
. Only postganglionic fibers present in cervical region
T/F treat thoracic before cervical
T
Motion of typical cervical vertebrae
. Rotation/sidebending motions to same side alway even if in neutral in C2-6
. C7 follows thoracic mechanics due to its facet joints resembling T1
Steps to cervical diagnosis
. Motion test rotation
. Motion test lat. translation
. Add flexion, extension, retests
Cervical motion pattern exceptions
. Tight muscles may pull SB and rotation to opposite sides, treat tight mm. First then retest joint motion
. Advanced joint/disc disease can lead to segmental instability and collapse of column so dysfunction can occur in any direction
Guidelines for OMM treatment
. Rule out urgent condition
. Dec. muscle tension in neck and upper back
. Cervical and thoracic soft tissue is essential
. Treat fascia, thoracic, ribs, and shoulder girdle
. Use least invasive techniques when possible
. Consider patient’s ability to response
. Primary goal: maximize function not resolve all pain
Benefits of cervical manipulation
. Inc. ROM, dec. pain, improved activities of daily living, shortened disability time
. Secondary benefits: reduced reliance on meds, improved postural efficiency
. May dec. need and cost for PT and prevent injections or surgery
. Good for patients w/ acute neck pain and headache
.
HVLA absolute contraindications
. Fractures in area . Osteoporosis in area . Bone metastasis in area . Severe RA lead to unstable atlantoaxial joint . Down syndrome for laxity in ligaments . Osteomyelitis
HVLA relative contraindication
. Acute whiplash
. Herniated nucleus pulposus/radiculopathy
. Vertebral a. Ischemia
. Hyper-mobile patients
. Dizziness, nausea, nystagmus w/ cervical extension/rotation
Arterial insufficiency
. Combo of extension, rotation, and SB can compromise vertebral a. In some at risk patients
. If any concerns in history/exam stop
. Monitor patient during treatment and reassess after
Type of patients at high risk for vertebral a. Adverse event
. Morbidly obese patients . Older arthritic patients . Young hypermobile patients . Patient’s w/ necks over 18 inches in diameter . Patient’s w/ asthma
