Cervical Pathology Flashcards
Suboccipital VBI can be cause by… (4)
congenital
OA subluxation
Trauma
Prolonged position
Transverse VBI can be caused by…(5)
athlerosclerosis/embolism
osteophyte compression
disc herniation
congenital
tumor
Osteal VBI can be caused by…(4)
post-surgical compression
apical lung tumor
sympathetic n compression
athlerosclerosis/embolism
Common causes of VBI… (4)
trauma, whiplash (blood supply to brain and cranial nerves become compromised)
congenital (unequal vertebral a. size)
manipulation with rotation thrust
intrinsic (athlerosclerosis, embolism, tumor)
Extracranial VBI distribution…
ipsilateral posterior neck
Clinical presentation of Non-ischemic (local) VBI
ipsilateral posterior neck pain and occipital HA
C2-6 cervical n root impairment (rare)
clinical presentation of ischemic VBI
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)
What are the 5 typical cardinal signs of VBI
drop attacks, lip/peri-oral paresthesia or anesthesia, lateral nystagmus, bilateral or quadrilateral limb paresthesia, ataxia
Horners syndrome (5) signs
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)
Cause of wellenburg’s syndrom
(VBI pathology)
VBI to lateral medullary
wellenburg’s syndrome signs
dizziness, nystagmus, hemilateral paresthesia CL CN and long tract signs, ataxia, horner’s, +/- on lower CNS signs
what are the 3 tests for VBI
-de klyne’s, minimized deklyne’s, progressive deklynes
-hautant’s test (sitting)
-underburg test (standing)
What side are you blocking/testing with R rotation and extension during VBI testing?
occluding same side, testing opposite
3 examples Spinal cord pathologies…
neurofibroma, meningitis, stenosis (osteophytes, cervical disc, lig flavum)
3 causes for n root radicular pain…
disc compression, foramina compression, traction injuries
CPG recommendations (2017) to rule in / out cervical radiculopathy
rule in: (+) spurling, distraction, valsalva
rule out: (-) ULTT
clinical presentation of fracture
sudden onset of severe pain
sudden loss of function
immediate torticollis or fixed flexion
feeling instability
feeling locking
no ROM
extremely anxious about moving
what is a hangmans fracture
pars interarticularis of C2
what is a jefferson fracture
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
what is the most commonly missed fracture?
dens
what is grisel’s?
Grisel syndrome is a condition of uncertain etiology characterized by a non-traumatic rotary atlantoaxial subluxation associated with a head and neck infection.
Ligament injury examples
CV ligs – trauma, grisel’s, RA/AS, downs syndrome, long term steroid use
lig flavum buckling
lig sprain
muscle pathology examples
tears–SCM, longus colli
infant/adult torticollis
trigger points
hypertonicity (facilitated segment/CNS involvment)
S & S cervical HNP
none
severe pain
extensive referral
radicular pain
severe limitation of motion and function
radiculopathy
what is a rim lesion and what causes them?
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
referral patterns of cervical discs C4-7
4: base of neck level with clavicle
5: superior angle of scapula
6: mid scapula
7: inferior angle of scapula
imaging choice to detect disc protrusion/herniation vs foraminal stenosis
MRI
CT
Z joint pathologies…
trauma arthritis
degenerative arthritis (osteophytes, casular fibrosis, instability)
Systemic arthritis
subluxation
Benign HA examples
c spine impairment
tension
psychogenic overlay
fatigue
depression
trauma
serious HA examples
CVA, tumor, VBI, intracranial bleed, life threatening trauma
possible sources of cervicogenic HA
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
C1 structures that can cause cervicogenic HA
AO joint
Suboccipital m
C2 structures that can cause cervicogenic HA
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
C3 structures that can cause cervicogenic HA
c2-3 z joint / disc
semispinalis/spenius, MF
what is convergence hypothesis
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)
cervicogenic HA (ICHD) description…
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)
what are the tests for cervicogenic HA
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)
diagnostic criteria for cervical tension type HA
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
diagnostic criteria for cervical tension type HA
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
common findings for cervical tension type HA
myofacial trigger points
upper trap, SCM, temporalis
reduced neck mobility
forward head
migraine S & S
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
cluster HA S&S
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
Occipital neuralgia S&S
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
trigeminal or glossopharyngeal neuralgia
stabbing/electric shock like pain in parts of face
caused by MS or trigeminal n compression from a swollen blood vessel or tumor
caused of cervicogenic dizziness
dysfunction of upper cervical joint receptors or muscles
flexion ext whiplash
cervicogenic dizziness physiologic mechanism
vasomotor changes due to irritation of cervical sympathetic chain
VBI/vascular compression
Altered proprioceptive input from upper cervical spine
tests for cerv. dizziness
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
Poor sitting posture leads to…
forward head
rounded shoulders
shortened cervical extensors
neck pain, cervicogenic HA and dizziness
