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Thoracic and Cervical Quiz > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

non-specific mechanical neck pain

A

most commonly given Dx

can involve any innervated structure (muscle, ligament, disc, synovial joint capsule)
non radicular in nature

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2
Q

Muscle strain

A

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

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3
Q

Torticollis (Wryneck)

A

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

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4
Q

Trigger Points

A

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

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5
Q

Cervicogenic headaches

A

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

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6
Q

Zygapophseal (facet ) joint sprain

A

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

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7
Q

Facet joint syndrome/ osteoarthritis

A

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

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8
Q

Cervical instability

A

Alar ligament

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9
Q

alar ligament

A

connects foramen magnum of occiput to dens of C2

limits lateral flexion and rotation

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10
Q

Transverse ligament

A

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

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11
Q

Upper cervical instability

A

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

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12
Q

Ligamentous Sprains

A

Anterior longitudinal ligament
Posterior longitudinal ligament
Intertransverse ligament
poserior ligamentous complex

Dx: MRI, vertebral body translation on x-ray

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13
Q

Posterior ligamentous complex

A

ligamentum flavum
interspinous ligament
supraspinous ligament

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14
Q

Whiplash associated disorders

A

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

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15
Q

Whiplash force classification

A

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

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16
Q

Jefferson fracture

A

burst fx of C1, rarely results in spinal cord damage unless displacement is severe

17
Q

Hangman’s fracture

A

through pedicle or pars of C2

18
Q

Spinous process fx can occur from

A

hyperflexion (avulsion)

hyperextension (contact or push-off fx) mechanism

19
Q

Burst fractur below

A

C3 commonly cause spinal cord pathology

20
Q

Spinal cord injury above C3

A

fatal

respiratory muscle function lost

21
Q

Fractures

A

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

22
Q

Cervical stenosis

A

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)

23
Q

Disc herniation

A

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

24
Q

Cervical spondylosis

A

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

25
Q

Thoracic outlet syndrome

A

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

26
Q

costoclavicular space between

A

first rib and clavicle

hypertrophy of subclavius or change in angulation of the bony structures

27
Q

Thoracic Outlet Syndrome

A

brachial plexus, subclavian artery, anterior and middle scalenes, pec minor, subclavius, first rib, clavicle

28
Q

TOS

A

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

29
Q

Brachial Plexus Injury (Stinger)

A

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

30
Q

Forward head posture

A

C: pain in involved musculature
ROM&S: decreased strength in involved musculature
Dx: Occiput to wall distance (OWD)
Tx: TE, postural re-education

31
Q

cervical myelopathy

A

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

Thoracic and Cervical Quiz (5 decks)

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