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Manual II > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

What are the 3 classic characteristics of progressive DJD?

A
  • Fibrilation (roughening)
  • Cartilage ulceration
  • Scleorosis/Osteophytes
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2
Q

What is the capsular pattern of the cervical spine?

A

SB and rotation> extension

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3
Q

My patient came in complaining of “sand or noise in neck.” What are we thinking?

A

OA

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4
Q

With OA, compression _______ pain and traction _______ pain

A

Compression increases

Traction decreases

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5
Q

What are the 3 characteristics that are associated with destructive/ autoimmune changes with RA?

A
  • Synovial Thickening
  • Vascular Granulation
  • Immunochemical (RF)
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6
Q

Why is there atlantoaxial instability in ~83% of all cases of RA within 2 years?

A

Steroids

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7
Q

In RA, traction ______ pain and compression ________ pain

A

Traction decreases

Compression increases

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8
Q

True or false; spondylosis is associated with a capsular pattern

A

False

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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

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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

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11
Q

Spondylosis is most common in (men/ women) older than ____ years.

A

Men

45

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12
Q

What are the grades of a cervical sprain?

A

1- laxity/ micro-tear
2- partial tear
3- full tear

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13
Q

What are come common complaints associated with cervical sprains?

A 
Pain
Head ache
Irritability 
Sore throat
Numbness
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14
Q

Cervical sprains that are from overload are ____ and ____ dependent

A

Force and time dependent

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15
Q

What are the clinical signs of a cervical sprain?

A

◼ PPIVM’s/PAIVM’s excessive

◼ Loose/Empty/Abnormal end feel

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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
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17
Q

Which clinical tests assess cervical instability?

A

◼ Sharp-Purser Test

◼ Transverse Ligament Stress Test

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18
Q

Which syndromes are associated with cervical instability?

A

Grisel

Ehlers- Danlos

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19
Q

What are the clinical tests that assess cervical instability?

A

◼ PPIVM’s/PAIVM’s excessive

◼ Loose/Empty Abnormal end feel

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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

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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

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22
Q

Cervical radiculopathy results in (upper/lower) motor neuron signs

A

Lower

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23
Q

True or false; cervical radiculopathies are usually bilateral

A

False, unilateral

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24
Q

Which tests assess for cervical radiculopathy?

A

◼ Spurling’s/Quadrant Test

◼ Myotomes/ Dermatomes/Reflexes

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25
Q

What is the clinical prediction rule for cervical radiculopathies?

A

◼ C-rotation <60° involved side
◼ Positive ULNT 1 (median nerve)
◼ Positive cervical distraction
◼ Positive Spurling’s Test(A)

> 3= 95% CI

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26
Q

The greater occipital nerve is often compressed by which muscles?

A

◼ Semispinalis Capitis
◼ Upper Trapezius
◼ Obliquus Capitis Inferior

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27
Q

Entrapment of the greater occipital nerve is associated with which symptoms?

A

Headache, paresthesia, and pain into occiput, vertex, or eye orbit

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28
Q

How do you test for entrapment of the greater occipital nerve?

A

Manual Compression of

suboccipital myofascia

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29
Q

Anterior scalene syndrome is the entrapment of ___________ by the _______ and _________. It is a form of _________ ________ ________.

A

Brachial plexus
By the anterior and middle scalene
It is a TOS

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30
Q

Anterior scalene syndrome is associated with which symptoms?

A

Paresthesia and pain into the upper extremity

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31
Q

Which clinical test us used to assess for anterior scalene syndrome?

A

Adson’s test

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32
Q

What is a Jefferson’s fracture?

A

C1 burst fracture due to trauma

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33
Q

What is a hangman’s fracture?

A

C2 fracture of the pedicles due to hyper extension

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34
Q

What is an odontoid fracture? How is it assessed?

A

Hyper extension fracture of C1 or C2

Assessed by open mouth x ray

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35
Q

What is a wedge fracture?

A

Vertebral body fracture secondary to hyper flexion

36
Q

Average healing time for bone is approximately …

A

10 weeks

37
Q

What is Klippel- Feil syndrome?

A

◼ Congenital cervical fusion
◼ Asymmetric scapular
descent

38
Q

What is odontoid hypoplasia?

A

◼ Absence/diminished dens

◼ Posterior atlas migration

39
Q

What are McKenzie’s 3 syndromes?

A

⦿ Postural Syndrome
⦿ Dysfunction Syndrome
⦿ Derangement Syndrome

40
Q

What are the 4 risk factors associated with McKenzie’s syndromes?

A

◼ Individual lifestyle
◼ Physical
◼ Biomechanical
◼ Psychosocial

41
Q

What is the McKenzie treatment philosophy?

A 
◼ Self treatment
◼ Repeated movements
◼ Progression of Forces
◼ ↓ Peripheralization
◼ ↑ Centralization
42
Q

What is postural syndrome?

A

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
Q

The head weighs …

A

8-12 lbs

44
Q

Every inch the head is forward adds _____lbs

A

10

45
Q

What are the adverse effects associated with forward head posture?

A 
◼ Muscle strain
◼ Nerve compression
◼ Diminished lung capacity 30%
◼ Thoracic kyphosis
◼ Elevates/retrudes mandible
◼ Spinal motion dysfunctions
46
Q

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

A

Muscle balance

Muscle imbalance

47
Q

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.

A

biomechanical

neuromuscular imbalance

48
Q

What is dysfunction syndrome?

A

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
Q

What is the clinical prediction rule for dysfunction syndrome?

A
  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
Q

What is derangement syndrome?

A

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
Q

A type 1 derangement

A

Central across C5-C7; no scap/sh pain; no deformity

52
Q

A type 2 derangement

A

Central across C5-C7; possible scap/sh pain with deformity

Flat or flattened cervical spine

53
Q

A type 3 derangement

A

Unilateral across C3-C7; possible scap/sh pain; no deformity

54
Q

A type 4 derangement

A

Unilateral across C5-C7; possible scap/sh pain with deformity

Torticollis

55
Q

A type 5 derangement

A

Unilateral across C5-C7; possible scap/sh pain; pain below elbow; no deformity

56
Q

A type 6 derangement

A

Unilateral across C5-C7; possible scap/sh pain; pain below elbow with deformity

Flat or flattened cervical spine OR torticollis

57
Q

A type 7 derangement

A

Symmetric/Asymmetric across C4-C6; pain referred to neck

either anterior/anterolateral; cervical flexion is obstructed

58
Q

All derangements are across C5-C7 except…

A

Type 3: C3-C7

Type 7: C4- C6

59
Q

What is spinal cord compression?

A

◼ Central disc derangement
◼ Stenosis
- inward canal closure secondary to spondylosis

60
Q

What are the sings and symptoms of spinal cord compression?

A 
◼ Usually over age of 50
◼ Hunched posture
◼ Decreased coordination/balance
◼ Bilateral numbness/tingling
◼ Myelopathy Hand
61
Q

What are the clinical tests for spinal cord compression?

A

Hoffman
Babinski
Hyper reflexia

UMN things

62
Q

What are the whiplash associated disorders ?

A

Blurred vision due to retinopathy
PTSD
Disturbed sensory and motor function

63
Q

What is the QTF and what is its classification?

A

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
Q

What are the signs and symptoms of a whiplash injury?

A 
◼ Pain/headaches
◼ Dizziness/balance
◼ Visual disturbance
◼ Numbness/weakness
◼ ↓Cognition/ concentration
65
Q

Which clinical tests assess whiplash injuries?

A

◼ PPIVM’s/PAIVM’s
◼ Resisted muscle action
◼ Traction painful
◼ Neuro screen

66
Q

What is a cluster head ache?

A

Idiopathic, unilateral head ache often associated with C2-C3
The pain jumps around
Often accompanied by watery eyes and runny nose

67
Q

What causes a rebound headache?

A

Too much OTC headache medicines

System desensitization

68
Q

What is a post traumatic headache?

A

Due to trauma and minor stress and strain

69
Q

What are cervicogenic headaches?

A 
◼ Structural precipitation
• Neck movement 
• Compression 
• Motion limitation
◼ Pain is moderate/severe
◼ Varied duration

> 5x/monthly
Unilateral or bilateral
15-20% all chronic headaches

70
Q

What are the clinical tests used to detect cervicogenic headaches?

A

◼ PPIVM’s/PAIVM’s
◼ Resist muscle action
◼ Cervical Flexion Rotation Test

71
Q

Which muscle is must associated with cervicogenic headaches?

A

Rectum capitis posterior minor

72
Q

What are the signs and symptoms associated with migraines?

A 
Fatigue
Change in mood
Red eye
Alodinea 
GI upset
73
Q

What is an episodic tension type headache and how do you test for it?

A 
◼ 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
Q

What is a chronic tension type headache and how do you test for it?

A 
◼ 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
Q

What is the most common reason for people 65 and older to see their doctor?

A

Dizziness

76
Q

What are the 3 most common types of dizziness?

A

◼ Type 1:
vertigo/oscillopsia/impulsion
◼ Type 2: pre-syncope
◼ Type 3: disequilibrium

77
Q

What are the 3 sub classifications of type 1 dizziness?

A

⦿ Vertigo
◼ Spinning sensation

⦿ Oscillopsia
◼ Oscillation of object in visual field

⦿ Impulsion
◼ Sensation of being hurled or pulled in space

78
Q

What are the causes of type 1 dizziness?

A 
⦿ Causes
◼ Vestibular Disease
• BPPV, Meniere’s, etc. 
◼ CN VIII pathology 
◼ Cerebellar lesions 
◼ Central Vestibular Disorders
• MS
79
Q

What is BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)?

A

⦿ 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
Q

What are the signs and symptoms for BPPV?

A

◼ Horizontal-rotary nystagmus

◼ At least 30-60 second duration when head to affected side

81
Q

What is dizziness type 2?

A 
Pre-syncope
◼ Light-headed
◼ Nausea
◼ Faintness
◼ Giddiness
82
Q

What are the clinical signs and symptoms associated with dizziness type 2?

A 
◼ Dizziness 
◼ Drop Attacks 
◼ Diplopia 
◼ Dysarthria 
◼ Dysphagia 
◼ Nausea 
◼ Numbness 
◼ Nystagmus 
◼ Ataxia
83
Q

What are the causes of pre-syncope?

A 
◼ Vasovagal
◼ Cardiovascular
◼ Cervical Arterial Dys. (CAD)
◼ Postural Hypotension
◼ Subclavian Steal Syndrome
84
Q

What is type 3 dizziness?

A

Disequilibrium
◼ “off-balance”
◼ Frequent falls

85
Q

What causes type 3 dizziness?

A

◼ Visual impairment

◼ Somatosensory
• Myelopathy/ Polyneuropathy

◼ Cervicogenic
• Peripheral sensory afferents
• Body rotation/march

◼ Basal Ganglia
• Parkinsonism

Manual II (11 decks)

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