Cervical Pathology Flashcards
non-specific mechanical neck pain
most commonly given Dx
can involve any innervated structure (muscle, ligament, disc, synovial joint capsule)
non radicular in nature
Muscle strain
levator scapulae, trapezius, rhomboids, SCM, scalenes, and erector spinae
MOI: acute, whiplash
Comp: localized pain, point tenderness, spasm, stiffness
ADL: active movements
N: none
ROM, S: decreased strength and pain with active contraction
decreased AROM due to pain or weakness, decreased passive ROM due to pain
Dx: MMT
Tx: decrease pain, TE to restore function
Torticollis (Wryneck)
draws head into position of ipsilateral lateral flexion and or contralateral rotation
caused by spasm of SCM
Comp: stiffness, pain with attempt to align head to midline
Tx: pain management, manual therapy
Trigger Points
palpably tight/stiff nodule or adhesion in the musculature
Commonly involved: trapezius, levator scapulae, scalenes, SCM
MOI: acute, overuse, poor posture, or psychological stress
Comp: localized sharp pain with referral pattern
ROM&S: may be decreased due to pain
Dx: physical exam, injection
Tx: massage, myofascial release, trigger point release, cupping, IASTM, dry needling,injection TE
Cervicogenic headaches
often chronic and recurrent
typically presents as unilateral pain that starts in the neck and is initiated by neck movement
Accompanied by decreased cervical ROM
caused by any structure innervated by C1-C3 spinal nerves
MOI: trauma, whiplash, chronic muscle spasm
Dx: MRI or CT to dx underlying conditions
Tx: TE, manipulation, injection
Zygapophseal (facet ) joint sprain
facet joint capsule
MOI: acute or overuse
Comp: pain located just off the midline, can refer to occiput, posterior shoulder, parascapular region
ADL: extension
N: none
ROM & S: pain with extension, rotation, lateral flexion, axial load
often hypertonic musculature and paraspinal tenderness
Dx: diagnostic injection therapy; imaging unreliable
Tx: NSAIDs, TE, spinal manipulation, traction, injection, radiofrequency ablation of medial branch
Facet joint syndrome/ osteoarthritis
facet joint or joint capsule
MOI: overuse
Comp: dull aching neck pain, paravertebral or posterolateral pain, worse in morning improves with repetitive motion
N: none
ROM: pain with extension, rotation, axial load
Dx: imagining shows joint space narrowing osteophyte formation, hypertrophy of the articular process, cysts, subarticular bone erosion
Tx: medication, TE, injection, radiofrequency of medial branch
Cervical instability
Alar ligament
alar ligament
connects foramen magnum of occiput to dens of C2
limits lateral flexion and rotation
Transverse ligament
runs horizontally from one lateral mass to the other posterior to the dens
has a thinner vertical portion running from occiput to body of C2
prevents anterior translation of C1 on C2
Upper cervical instability
atlanto-occipital or altanto-axial can contribute to cervicogenic headaches and segmental degeneration (osteoarthritis)
MOI: trauma, whiplash, long term postural, rhematoid arthritis
Comp: stiffness, diffuse pain, headaches, frequent need for manipulation
N: myotomes and dermatomes may be affected
Ligamentous Sprains
Anterior longitudinal ligament
Posterior longitudinal ligament
Intertransverse ligament
poserior ligamentous complex
Dx: MRI, vertebral body translation on x-ray
Posterior ligamentous complex
ligamentum flavum
interspinous ligament
supraspinous ligament
Whiplash associated disorders
rapid acceleration-deceleration mechanism of energy transfer to the neck
can involve facet joint/capsules, ligaments, vertebral arteries, musculature, discs
MOI: trauma, MVA
SX: onset usually within 2 hours
Whiplash force classification
Quebec task force
0: no complaints
1: neck pain, stiffness, or tenderness; no physical signs
II: neck complaint and musculoskeletal sign (decreased ROM and point tenderness)
III: neck complaint and neurological signs
IV: neck complaint and fracture or dislocation
Jefferson fracture
burst fx of C1, rarely results in spinal cord damage unless displacement is severe
Hangman’s fracture
through pedicle or pars of C2
Spinous process fx can occur from
hyperflexion (avulsion)
hyperextension (contact or push-off fx) mechanism
Burst fractur below
C3 commonly cause spinal cord pathology
Spinal cord injury above C3
fatal
respiratory muscle function lost
Fractures
MOI: axial compressive load, rapid flexion (seatbelt), whiplash
Comp: loss of function, pain
ROM should not be performed if suspected
Neuro: motor, sensory, reflexes can all suffer deficits
Dx: x-ray, CT
Tx: cervical collar, traction, surgical stabilization
Cervical stenosis
central canal, lateral recess, foramen, nerve root
MOI: overuse, degenerative
Comp: neck and or arm pain, radiculopathy into arm/hand, heaviness or weakness of UE, paresthesia or numbness in shoulder, arm or hand; uniateral or bilateral
ADL: fine motor control of hands.fingers
N: dermatome, myotome, reflexes affected
Dx: imaging to measure foraminal space, x-ray, CT, MRI
Tx: TE, pain medication, injection, surgery (decompression or fusion)
Disc herniation
usually occur lower from C4-C7
annulus fibrosis, nucleus pulpsis, spinal nerve root
MOI: acute (compression, flexion, extension) or overuse
Comp: sharp pain with extension, radiating pain into arm/hand or parascapular region
may exhibit flat neck posture or splinting away from side of injury
ROM: decreased flexion, extension, lateral flexion, or rotation due to pain
N: peripheral weakness, paresthesia, diminished reflexes
Dx: MRI, CT
Tx: TE, traction, steroid injection, surgery
prognosis usually good with conservative tx, substantial improvements in 4-6 months
Cervical spondylosis
non-specific term for degeneration of the discs and or bony structures; disc degeneration, degenerative arthritis, and or spinal stenosis
S: vertebral bodies, facet joints and or disc
Comp: neck, occiput or posterior shoulder pain; stiffness after prolonged inactivity (upon waking in the morning)
Most cases asymptomatic
Affects on sensation, strength, neurologic exam: all affected
Dx: x-ray, MRI, CT
Tx: ice, heat, NSAIDs, TE, injection, surgery
usually responds well to conservative treatment and activity modification
Thoracic outlet syndrome
compression of brachial plexus and subclavian artery in one or three locations
Interscalene triangle where brachial plexus and subclavian artery exit into the upper extremity
marked by anterior scalene (anteriorly) middle scalene (posteriorly) and first rib (inferiorly)
hypertrophy or tightness of musculature
occasional presence of cervical rib
costoclavicular space between
first rib and clavicle
hypertrophy of subclavius or change in angulation of the bony structures
Thoracic Outlet Syndrome
brachial plexus, subclavian artery, anterior and middle scalenes, pec minor, subclavius, first rib, clavicle
TOS
MOI: overuse, secondary to previous trauma, postural deviations (rounded and depressed shoulders)
Comp: pain (neck, shoulder, chest, arm), numbness, tingling, weakness or heaviness of hand/ arm
ADL: overhead arm activity; sx worsened by shoulder abduction/ER and head rotation
N: myotomes, dermatomes, or reflexes
Dx: physical exam, x-ray, MRI, nerve conduction
Tx: manual therapy, TE, 1st rib mobilization/manipulation, NSAIDS, oral steriods, surgery
Brachial Plexus Injury (Stinger)
Mechanical deformation of C5-T1 nerve roots
MOI: traction or compression
rotation, lateral flexion, and compression or extension causes compression/impingement; direct impact to base of the neck; forced contralateral lateral flexion with ipsilateral depression of the shoulder causes traction
S/S: sharp burning pain radiating into arm, temp weakness or decreased function, usually subsides within minutes
N: persists for days or months
usually involve cervical spine; r/o c-spine
Forward head posture
C: pain in involved musculature
ROM&S: decreased strength in involved musculature
Dx: Occiput to wall distance (OWD)
Tx: TE, postural re-education
cervical myelopathy
non specific pathology of the spinal cord causing disruption of nerve signal transmission
MOI: acute trauma, spondylosis, disc herniation, infection, tumor
Comp: neck pain, numbness and paresthesia in distal extremities, atrophy on intrinsic hand muscles, bladder dysfunction
ADL: difficulty with fine motor movements, gait
N: myotomes and dermatomes affected, decreased or absent reflexes
