Cervical Pain Classification Systems

Question 1

What percentage of the population will have neck pain at some time in their lives?

Answer 1

22-70%

Question 2

What percentage of patients with neck pain will develop chronic symptoms?

Answer 2

about 30%

Question 3

What percentage of patients seen in outpatient PT are those with neck pain?

Answer 3

25%

Question 4

What are the top two levels of cervical radiculopathy?

Answer 4

C6-C7 (C7 radiculopathy) = 45-60%

C5-C6 (C6 radiculopathy) = 20-25%

Question 5

Describe Grades I-IV of the Bone and Joint Neck Pain Classification.

Answer 5

Grade I: Neck pain with no signs of major pathology, no problems with ADL.

Grade II: Neck pain with no signs of major pathology, but interference with ADL.

Grade III: Neck pain with neuro signs of nerve compression

Grade IV: Neck pain with signs of major pathology

Question 6

What is nociceptive pain?

Answer 6

localized pain to area of tissue injury within normal tissue healing time

Question 7

What is neuropathic pain?

Answer 7

pain accompanied by signs or symptoms of neurological dysfunction, such as paresthesias or numbness

Question 8

What is nociplastic (central sensitization) pain?

Answer 8

diffuse, widespread pain, fatigue, sleep dysfunction, and enhanced sensitivity

Question 9

Describe the following McKenzie Cervical Pain Classifications:

Derangement

Articular Dysfunction

Contractile Dysfunction

Postural Syndrome

Other

Answer 9

• Derangement – lasting decrease of symptoms in response to repeated movements
• Articular Dysfunction – intermittent pain produced at a restricted end-range
• Contractile Dysfunction – intermittent pain produced by musculotendinous unit
• Postural Syndrome – only produced by sustained loading
• Other – chronic pain syndrome, inflammatory, mechanically inconclusive, mechanically unresponsive radiculopathy, post-surgery, spinal stenosis, trauma

Question 10

Describe/List the AOPT Cervical Spine Classification based on ICF.

Answer 10

(1) Neck pain with limited motion
(2) Headaches related to neck pain
(3) Neck pain associated with whiplash/movement coordination (stability)
(4) Neck and nerve-related pain into the arm/radicular pain

Question 11

What is the Cloward Sign?

Answer 11

Where cervical pain is referred, based on cervical level, to the thoracic spine when degenerative changes are present

Question 12

Describe Cervical Myofascial Pain.

Answer 12

Pain that is in the area of a muscle and fascia (local or referred) that can be worse with repetitive tasks or postural positions, local or referred, ache or sharp

Question 13

What can cause Cervical Myofascial Pain?

Answer 13

trauma, overuse, stress, or postural mechanics

Question 14

Describe Cervicogenic Headache.

Answer 14

A headache of the cervical region that is:

(1) unilateral, starting posterior head and neck and migrates to the front (can also have ipsilateral arm discomfort)
(2) bilateral with aggravation of neck positions and specific occupations

Question 15

What could be the cause of cervicogenic headache?

Answer 15

The exact etiology unknown, but may result from convergence of sensory input from upper cervical spine into trigeminal spinal nucleus

Input can come from upper cervical facets, upper cervical muscles, C2-3 discs, vertebral internal carotid arteries, dura mater of upper SC, or posterior cranial fossa