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UQ MSK PT > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

Suboccipital VBI can be cause by… (4)

A

congenital
OA subluxation
Trauma
Prolonged position

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2
Q

Transverse VBI can be caused by…(5)

A

athlerosclerosis/embolism
osteophyte compression
disc herniation
congenital
tumor

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3
Q

Osteal VBI can be caused by…(4)

A

post-surgical compression
apical lung tumor
sympathetic n compression
athlerosclerosis/embolism

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4
Q

Common causes of VBI… (4)

A

trauma, whiplash (blood supply to brain and cranial nerves become compromised)

congenital (unequal vertebral a. size)

manipulation with rotation thrust

intrinsic (athlerosclerosis, embolism, tumor)

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5
Q

Extracranial VBI distribution…

A

ipsilateral posterior neck

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6
Q

Clinical presentation of Non-ischemic (local) VBI

A

ipsilateral posterior neck pain and occipital HA
C2-6 cervical n root impairment (rare)

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7
Q

clinical presentation of ischemic VBI

A

hind brain transient ischemic event (dizziness, diplopia, dysphagia, drop attacks, nausea, nystagmus, facial numbness, ataxia, vomiting, hoarseness, loss of short term memory, hypotonia/weakness, anhidrosis, perioral dysethesia, photophobia, papillary changes, clumsiness & agitation)
Hind brain stroke (wellenberg’s syndrome)

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8
Q

What are the 5 typical cardinal signs of VBI

A

drop attacks, lip/peri-oral paresthesia or anesthesia, lateral nystagmus, bilateral or quadrilateral limb paresthesia, ataxia

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9
Q

Horners syndrome (5) signs

A

miosis (contraction of pupil)
Ptosis (droopy eye)
enophthalmos (recession eye ball)
anhydrosis (decreased sweating)
facial flushing (paralysis of cervical sympathetic n trunk due to lack of proper blood flow to VBI system)

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10
Q

Cause of wellenburg’s syndrom

A

(VBI pathology)
VBI to lateral medullary

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11
Q

wellenburg’s syndrome signs

A

dizziness, nystagmus, hemilateral paresthesia CL CN and long tract signs, ataxia, horner’s, +/- on lower CNS signs

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12
Q

what are the 3 tests for VBI

A

-de klyne’s, minimized deklyne’s, progressive deklynes
-hautant’s test (sitting)
-underburg test (standing)

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13
Q

What side are you blocking/testing with R rotation and extension during VBI testing?

A

occluding same side, testing opposite

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14
Q

3 examples Spinal cord pathologies…

A

neurofibroma, meningitis, stenosis (osteophytes, cervical disc, lig flavum)

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15
Q

3 causes for n root radicular pain…

A

disc compression, foramina compression, traction injuries

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16
Q

CPG recommendations (2017) to rule in / out cervical radiculopathy

A

rule in: (+) spurling, distraction, valsalva
rule out: (-) ULTT

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17
Q

clinical presentation of fracture

A

sudden onset of severe pain
sudden loss of function
immediate torticollis or fixed flexion
feeling instability
feeling locking
no ROM
extremely anxious about moving

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18
Q

what is a hangmans fracture

A

pars interarticularis of C2

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19
Q

what is a jefferson fracture

A

a burst fracture of the atlas
It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two-part fractures have also been described

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20
Q

what is the most commonly missed fracture?

A

dens

21
Q

what is grisel’s?

A

Grisel syndrome is a condition of uncertain etiology characterized by a non-traumatic rotary atlantoaxial subluxation associated with a head and neck infection.

22
Q

Ligament injury examples

A

CV ligs – trauma, grisel’s, RA/AS, downs syndrome, long term steroid use

lig flavum buckling

lig sprain

23
Q

muscle pathology examples

A

tears–SCM, longus colli
infant/adult torticollis
trigger points
hypertonicity (facilitated segment/CNS involvment)

24
Q

S & S cervical HNP

A

none
severe pain
extensive referral
radicular pain
severe limitation of motion and function
radiculopathy

25
Q

what is a rim lesion and what causes them?

A

Rim lesions are those injuries that occur around the edge of the disc, at the rim.

associated with small osteophytes formation

not related to natural aging–most likely due to trauma to the disc

26
Q

referral patterns of cervical discs C4-7

A

4: base of neck level with clavicle
5: superior angle of scapula
6: mid scapula
7: inferior angle of scapula

27
Q

imaging choice to detect disc protrusion/herniation vs foraminal stenosis

A

MRI
CT

28
Q

Z joint pathologies…

A

trauma arthritis
degenerative arthritis (osteophytes, casular fibrosis, instability)
Systemic arthritis
subluxation

29
Q

Benign HA examples

A

c spine impairment
tension
psychogenic overlay
fatigue
depression
trauma

30
Q

serious HA examples

A

CVA, tumor, VBI, intracranial bleed, life threatening trauma

31
Q

possible sources of cervicogenic HA

A

structures innervated by C1-3 spinal nerves
upper cervical synovial joints and muscles **
C2-3 disc
vertebral and internal carotid a
dura of upper spinal cord and posterior cranial fossa

32
Q

C1 structures that can cause cervicogenic HA

A

AO joint

Suboccipital m

33
Q

C2 structures that can cause cervicogenic HA

A

median/lateral AA
transverse AA and alar lig, tectoral membrain\
prevertebral m, SCM, traps, semispinalis/splenius m
upper SC, post cranial fossa
vertebral a, carotid a

34
Q

C3 structures that can cause cervicogenic HA

A

c2-3 z joint / disc

semispinalis/spenius, MF

35
Q

what is convergence hypothesis

A

HA perceived in the forehead is the congervence btwn trigeminal n and cervical afferents

HA percieved in occiput congervence btwn cervcical and other cervical afferents (greater occipital n–c2, lesser occipital n–c3, greater auricular n–c2-3)

36
Q

cervicogenic HA (ICHD) description…

A

Unilateral HA without side shift
HA starts in upper neck or occiput region, spreading to the oculo-fronto-temporal area

mod to severe, non-throbbing, non lancinating pain

pain triggered by neck movements or sustained awk positions

reduced ROM c spine

pain elicited by external pressure on upper cervical joints (C0-3)

37
Q

what are the tests for cervicogenic HA

A

Cervical flexion rotation test–upper cer joint dysfunction, HA reproduction, decreased rotation in end-range flexion ( «40 degrees, cut off score 32 degrees using CROM)
PAVIM central PA glides (reduced motion at C0-3)

38
Q

diagnostic criteria for cervical tension type HA

A

bilat location for 15 days to 3 months
pressing or tightening (non pulsating pain)
mild to mod pain NPRS < 7/10
lack of aggrevation during PA

39
Q

diagnostic criteria for cervical tension type HA

A

bilat location for 15 days to 3 months
pressing or tightening (non pulsating pain)
mild to mod pain NPRS < 7/10
lack of aggravation during PA
NO photophobia, phonophobia, vomiting, nausea during HA

40
Q

common findings for cervical tension type HA

A

myofacial trigger points
upper trap, SCM, temporalis

reduced neck mobility

forward head

41
Q

migraine S & S

A

unilateral pulsating lasting 4-72 hrs
mod to severe HA, nausea, vomiting, photophobia, phonophobia

associated with hormone level; common in women

may or may not have aura

42
Q

cluster HA S&S

A

unilat, aorund one eye or side of face from neck to temples
severe sudden burning sharp, ofthen involving stuffy nose and swollen eyes

occurs repeatedly at same time 2-3 hrs after asleep every day for several weeks then goes away

43
Q

Occipital neuralgia S&S

A

greater and lesser n irritation
unilateral, piercing, throbbing, electric shock like chronic pain

caused by trauma, pinching nerves by muscles, osteophytes/tumors, gout, diabetes, vasculitis

44
Q

trigeminal or glossopharyngeal neuralgia

A

stabbing/electric shock like pain in parts of face
caused by MS or trigeminal n compression from a swollen blood vessel or tumor

45
Q

caused of cervicogenic dizziness

A

dysfunction of upper cervical joint receptors or muscles
flexion ext whiplash

46
Q

cervicogenic dizziness physiologic mechanism

A

vasomotor changes due to irritation of cervical sympathetic chain
VBI/vascular compression
Altered proprioceptive input from upper cervical spine

47
Q

tests for cerv. dizziness

A

rule out: VBI. vestibular function, upper cervical instability (alar/transverse)

Cerv Dizziness: Positive cervical neck torsion test, pos smooth pursuit neck torsion test (especially post trauma), positive cervical relocation tests (joint pos errors), other MSK impairments

48
Q

Poor sitting posture leads to…

A

forward head
rounded shoulders
shortened cervical extensors
neck pain, cervicogenic HA and dizziness

UQ MSK PT (4 decks)

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