Cervical Pathology Flashcards
1
Q
What are the 3 classic characteristics of progressive DJD?
A
- Fibrilation (roughening)
- Cartilage ulceration
- Scleorosis/Osteophytes
2
Q
What is the capsular pattern of the cervical spine?
A
SB and rotation> extension
3
Q
My patient came in complaining of “sand or noise in neck.” What are we thinking?
A
OA
4
Q
With OA, compression _______ pain and traction _______ pain
A
Compression increases
Traction decreases
5
Q
What are the 3 characteristics that are associated with destructive/ autoimmune changes with RA?
A
- Synovial Thickening
- Vascular Granulation
- Immunochemical (RF)
6
Q
Why is there atlantoaxial instability in ~83% of all cases of RA within 2 years?
A
Steroids
7
Q
In RA, traction ______ pain and compression ________ pain
A
Traction decreases
Compression increases
8
Q
True or false; spondylosis is associated with a capsular pattern
A
False
9
Q
With spondylosis, nerve tissue compromise occurs. In the case of myelopathy, it is the compression of the _______ secondary to _______.
A
Compression of the spinal cord secondary to stenosis
10
Q
With spondylosis, nerve tissue compromise occurs. In the case of radiculopathy, it is the compression of the _______ at the ________ secondary to _______.
A
Compression of the nerve root at the foramen secondary to osteophyte formation
11
Q
Spondylosis is most common in (men/ women) older than ____ years.
A
Men
45
12
Q
What are the grades of a cervical sprain?
A
1- laxity/ micro-tear
2- partial tear
3- full tear
13
Q
What are come common complaints associated with cervical sprains?
A
Pain Head ache Irritability Sore throat Numbness
14
Q
Cervical sprains that are from overload are ____ and ____ dependent
A
Force and time dependent
15
Q
What are the clinical signs of a cervical sprain?
A
◼ PPIVM’s/PAIVM’s excessive
◼ Loose/Empty/Abnormal end feel
16
Q
What are the classifications of cervical instability?
A
◼ Normal < 3mm ◼ Type 1: no displacement ◼ Type 2: 3-5mm ◼ Type 3: >5mm ◼ Type 4: Dislocation
17
Q
Which clinical tests assess cervical instability?
A
◼ Sharp-Purser Test
◼ Transverse Ligament Stress Test
18
Q
Which syndromes are associated with cervical instability?
A
Grisel
Ehlers- Danlos
19
Q
What are the clinical tests that assess cervical instability?
A
◼ PPIVM’s/PAIVM’s excessive
◼ Loose/Empty Abnormal end feel
20
Q
True or false; when treating a cervical strain, it is always best to massage away muscle spasms
A
False; they may be protective and this may cause instability
21
Q
In muscle strain injuries, formerly healthy tissues undergo __________ which results in its replacement with ______ ______ unless properly loaded as per Wolfe’s law
A
Microtears lead to scar tissue
22
Q
Cervical radiculopathy results in (upper/lower) motor neuron signs
A
Lower
23
Q
True or false; cervical radiculopathies are usually bilateral
A
False, unilateral
24
Q
Which tests assess for cervical radiculopathy?
A
◼ Spurling’s/Quadrant Test
◼ Myotomes/ Dermatomes/Reflexes
25
What is the clinical prediction rule for cervical radiculopathies?
◼ C-rotation <60° involved side
◼ Positive ULNT 1 (median nerve)
◼ Positive cervical distraction
◼ Positive Spurling’s Test(A)
>3= 95% CI
26
The greater occipital nerve is often compressed by which muscles?
◼ Semispinalis Capitis
◼ Upper Trapezius
◼ Obliquus Capitis Inferior
27
Entrapment of the greater occipital nerve is associated with which symptoms?
Headache, paresthesia, and pain into occiput, vertex, or eye orbit
28
How do you test for entrapment of the greater occipital nerve?
Manual Compression of
| suboccipital myofascia
29
Anterior scalene syndrome is the entrapment of ___________ by the _______ and _________. It is a form of _________ ________ ________.
Brachial plexus
By the anterior and middle scalene
It is a TOS
30
Anterior scalene syndrome is associated with which symptoms?
Paresthesia and pain into the upper extremity
31
Which clinical test us used to assess for anterior scalene syndrome?
Adson's test
32
What is a Jefferson's fracture?
C1 burst fracture due to trauma
33
What is a hangman's fracture?
C2 fracture of the pedicles due to hyper extension
34
What is an odontoid fracture? How is it assessed?
Hyper extension fracture of C1 or C2
| Assessed by open mouth x ray
35
What is a wedge fracture?
Vertebral body fracture secondary to hyper flexion
36
Average healing time for bone is approximately ...
10 weeks
37
What is Klippel- Feil syndrome?
◼ Congenital cervical fusion
◼ Asymmetric scapular
descent
38
What is odontoid hypoplasia?
◼ Absence/diminished dens
| ◼ Posterior atlas migration
39
What are McKenzie's 3 syndromes?
⦿ Postural Syndrome
⦿ Dysfunction Syndrome
⦿ Derangement Syndrome
40
What are the 4 risk factors associated with McKenzie's syndromes?
◼ Individual lifestyle
◼ Physical
◼ Biomechanical
◼ Psychosocial
41
What is the McKenzie treatment philosophy?
```
◼ Self treatment
◼ Repeated movements
◼ Progression of Forces
◼ ↓ Peripheralization
◼ ↑ Centralization
```
42
What is postural syndrome?
Pain caused by mechanical deformation of soft tissue from prolonged positioning
```
◼ Least frequent in clinic
◼ No underlying pathology
◼ Usually more youthful
◼ Local/intermittent symptoms
◼ No pain with movement
◼ No loss of movement
```
43
The head weighs ...
8-12 lbs
44
Every inch the head is forward adds _____lbs
10
45
What are the adverse effects associated with forward head posture?
```
◼ Muscle strain
◼ Nerve compression
◼ Diminished lung capacity 30%
◼ Thoracic kyphosis
◼ Elevates/retrudes mandible
◼ Spinal motion dysfunctions
```
46
Normal amounts of opposing force between muscles are necessary to keep the bones centered in the joint during motion; this would be
considered ____________.
On the other hand, _________ occurs when opposing muscles provide different directions of tension due to tightness and/or weakness
Muscle balance
| Muscle imbalance
47
There are also two recognized causes of
muscle imbalance.
The first is a ___________ cause from repeated movements in one direction or sustained postures.
The second cause is a __________ due to the predisposition of certain muscle groups to be either tight or weak.
biomechanical
| neuromuscular imbalance
48
What is dysfunction syndrome?
Pain caused by mechanical deformation of soft tissue due to structural impairment
```
◼ 2nd most frequent in clinic
◼ Prior injury, inflammation, or current degenerative process
◼ Tissue shortening/adaptation
• Facet Syndrome/FRS/ERS
◼ Usually over 30 years of age
◼ Local/intermittent symptoms
◼ Pain toward available end range
◼ Loss of movement
```
49
What is the clinical prediction rule for dysfunction syndrome?
1. Initial NDI <11.5
2. Bilateral pattern of involvement
3. Not performing sedentary work .5 hrs/day
4. Feels better when moving neck
5. Does not feel worse with neck extension
6. Diagnosis of spondylosis without radiculopathy
>4
50
What is derangement syndrome?
Pain caused by internal intervertebral disc displacement
```
◼ Most frequent in clinic
◼ Insidious or progressive
◼ Tissue shortening/adaptation
• Facet Syndrome/FRS/ERS
◼ Usually 20 to 55 years of age
◼ Local/peripheral pain
◼ Constant/intermittent symptoms
◼ Pain influenced by loading
◼ Loss of movement
◼ Neural ingrowth with chronicity
◼ May include deformity
```
51
A type 1 derangement
Central across C5-C7; no scap/sh pain; no deformity
52
A type 2 derangement
Central across C5-C7; possible scap/sh pain with deformity
Flat or flattened cervical spine
53
A type 3 derangement
Unilateral across C3-C7; possible scap/sh pain; no deformity
54
A type 4 derangement
Unilateral across C5-C7; possible scap/sh pain with deformity
Torticollis
55
A type 5 derangement
Unilateral across C5-C7; possible scap/sh pain; pain below elbow; no deformity
56
A type 6 derangement
Unilateral across C5-C7; possible scap/sh pain; pain below elbow with deformity
Flat or flattened cervical spine OR torticollis
57
A type 7 derangement
Symmetric/Asymmetric across C4-C6; pain referred to neck
| either anterior/anterolateral; cervical flexion is obstructed
58
All derangements are across C5-C7 except...
Type 3: C3-C7
| Type 7: C4- C6
59
What is spinal cord compression?
◼ Central disc derangement
◼ Stenosis
- inward canal closure secondary to spondylosis
60
What are the sings and symptoms of spinal cord compression?
```
◼ Usually over age of 50
◼ Hunched posture
◼ Decreased coordination/balance
◼ Bilateral numbness/tingling
◼ Myelopathy Hand
```
61
What are the clinical tests for spinal cord compression?
Hoffman
Babinski
Hyper reflexia
UMN things
62
What are the whiplash associated disorders ?
Blurred vision due to retinopathy
PTSD
Disturbed sensory and motor function
63
What is the QTF and what is its classification?
Quebec task force
```
0- no pain no orthopedic presentation
1- pain, no ortho presentation
2- pan and ortho presentation
3- pain, ortho and neuro
4- pain and fracture or dislocation
```
64
What are the signs and symptoms of a whiplash injury?
```
◼ Pain/headaches
◼ Dizziness/balance
◼ Visual disturbance
◼ Numbness/weakness
◼ ↓Cognition/ concentration
```
65
Which clinical tests assess whiplash injuries?
◼ PPIVM’s/PAIVM’s
◼ Resisted muscle action
◼ Traction painful
◼ Neuro screen
66
What is a cluster head ache?
Idiopathic, unilateral head ache often associated with C2-C3
The pain jumps around
Often accompanied by watery eyes and runny nose
67
What causes a rebound headache?
Too much OTC headache medicines
| System desensitization
68
What is a post traumatic headache?
Due to trauma and minor stress and strain
69
What are cervicogenic headaches?
```
◼ Structural precipitation
• Neck movement
• Compression
• Motion limitation
◼ Pain is moderate/severe
◼ Varied duration
```
>5x/monthly
Unilateral or bilateral
15-20% all chronic headaches
70
What are the clinical tests used to detect cervicogenic headaches?
◼ PPIVM’s/PAIVM’s
◼ Resist muscle action
◼ Cervical Flexion Rotation Test
71
Which muscle is must associated with cervicogenic headaches?
Rectum capitis posterior minor
72
What are the signs and symptoms associated with migraines?
```
Fatigue
Change in mood
Red eye
Alodinea
GI upset
```
73
What is an episodic tension type headache and how do you test for it?
```
◼ 1 episode a month
◼ 30 minutes to 7 days
◼ Bilateral
◼ Pressing/tightening
◼ Pain mild/moderate
◼ No Nausea/vomiting
◼ Either phono- or photophobic
```
Clinical Tests
◼ Manual pressure
74
What is a chronic tension type headache and how do you test for it?
```
◼ 3-15 episodes a month
◼ Lasts hours continuous
◼ Bilateral
◼ Pressing/tightening
◼ Pain mild/moderate
◼ Mild nausea/vomiting
◼ Either phono- or photophobic
```
Clinical Tests
◼ Manual Pressure
75
What is the most common reason for people 65 and older to see their doctor?
Dizziness
76
What are the 3 most common types of dizziness?
◼ Type 1:
vertigo/oscillopsia/impulsion
◼ Type 2: pre-syncope
◼ Type 3: disequilibrium
77
What are the 3 sub classifications of type 1 dizziness?
⦿ Vertigo
◼ Spinning sensation
⦿ Oscillopsia
◼ Oscillation of object in visual field
⦿ Impulsion
◼ Sensation of being hurled or pulled in space
78
What are the causes of type 1 dizziness?
```
⦿ Causes
◼ Vestibular Disease
• BPPV, Meniere’s, etc.
◼ CN VIII pathology
◼ Cerebellar lesions
◼ Central Vestibular Disorders
• MS
```
79
What is BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)?
⦿ Most common peripheral vestibular disorder
◼ Idiopathic BPPV (6th decade)
◼ Non-idiopathic: trauma, inner ear degeneration
⦿ 2 Pathological Theories:
◼ Canalithiasis: endolymph in semicircular canals (Epley)
◼ Cupulolithiasis: sedimentous material (Semont)
80
What are the signs and symptoms for BPPV?
◼ Horizontal-rotary nystagmus
| ◼ At least 30-60 second duration when head to affected side
81
What is dizziness type 2?
```
Pre-syncope
◼ Light-headed
◼ Nausea
◼ Faintness
◼ Giddiness
```
82
What are the clinical signs and symptoms associated with dizziness type 2?
```
◼ Dizziness
◼ Drop Attacks
◼ Diplopia
◼ Dysarthria
◼ Dysphagia
◼ Nausea
◼ Numbness
◼ Nystagmus
◼ Ataxia
```
83
What are the causes of pre-syncope?
```
◼ Vasovagal
◼ Cardiovascular
◼ Cervical Arterial Dys. (CAD)
◼ Postural Hypotension
◼ Subclavian Steal Syndrome
```
84
What is type 3 dizziness?
Disequilibrium
◼ “off-balance”
◼ Frequent falls
85
What causes type 3 dizziness?
◼ Visual impairment
◼ Somatosensory
• Myelopathy/ Polyneuropathy
◼ Cervicogenic
• Peripheral sensory afferents
• Body rotation/march
◼ Basal Ganglia
• Parkinsonism
