Cervical Spinal Syndromes Flashcards
What is the classification approach based on?
Evidence when possible and experience/clinical expertise when evidence is not sufficient or not yet available
If a patient has recent onset of symptoms, no radicular symptoms in the upper quarter, restricted side to side ROM and no signs of nerve root compression which classification do they fit into?
What would the proposed interventions be for this classification?
Mobility
cervical/thoracic spine mobilization/manipulation and AROM exercises
If a patient has radicular/referred pain in the upper quarter, their symptoms either peripheralize or centralize with movement, they do have signs of nerve compression, and may have diagnosis of cervical radiculopathy, which classification do they fit into?
What is the proposed intervention?
Centralization
mechanical/manual cervical traction and repeated movements to centralize symptoms
If a patient has low pain and disability scores, their symptoms last a long time, there are no signs of nerve compression, and there is no centralization/peripheralization which classification do they fit into?
What are the proposed interventions?
Conditioning and increase exercise tolerance
Strength and endurance exercise for cervical spine muscles as well as aerobic training
If a patient has high pain and disability test scores, very recent onset of symptoms, symptoms caused by trauma, referred pain or radiating symptoms to upper quarter and has poor tolerance for examination or most interventions which classification do they fit into?
What are the proposed interventions?
Pain control
gentle AROM within pain tolerance, ROM exercises for adjacent regions, modalities as needed, and activity modification to control pain
If a patient presents with a unilateral headache with onset preceded by neck pain, headache pain triggered by neck movement or positions or headache pain elicited by pressure on posterior neck which classification do they fit into?
What are the proposed interventions?
Reduce headache
cervical spine manipulations/mobilization, neck and upper quarter muscular strengthening, and postural education
What is the formula for clinically evaluating patients complaining of pain or dysfunction of the neck, head, shoulder, or upper extremity?
A-know normal and be able to recognize deviation from the norm
B-be able to reproduce THE pain by reproducing the abnormal position or movement
C-understand the mechanism by which THE pain is caused
True or False: Bone is the most common pain origination site in the upper C spine.
False, soft tissue causes the majority of symptoms
What are the common sites of muscular pain from tension in the C spine?
base of skull which is the attachment site for the upper trapezius muscles and suboccipitals but may occur within muscle belly from either acute or sustained contractions
Which type of contraction leads to “ischemic” muscular pain and why?
Which type of contraction can lead to increased internal pressure leading to inflammation and “myositis”?
Sustained contractions due to loss of oxygen as well as accumulated irritating metabolites
Acute muscle contraction
True or False: Pain from the IVD is commonly distributed in broad areas with ill-defined margins
True
What five structures can cause pain from within the vertebral canal in the upper C spine?
-Vertebral artery within Transverse foramen
What are 3 common syndromes of the upper C spine?
Cervical headaches
Rheumatoid Arthritis
Acute Wry neck/joint locking
What are the 3 parts of the spinal nucleus of the trigeminal nerve?
Pars oralis
Pars interpolaris
pars caudalis
True or False: the trigeminocervical nucleus does not transmit nociceptive information and so it cannot be a pain generator for the head or neck
False, the trigeminocervical nucleus primarily is involved in transmission of nociceptive information, therefor it can be seen as the pain center for the entire head and upper neck
True or False: While pathology and cause of trigger points is poorly understood, their capacity to produce referred pain into the head is well documented
True
True or False: All cervical muscle are reportedly capable of producing headaches
False, only the muscles innervated by C1-C3 are reportedly able to produce headaches
Which transitional zone in the C spine is considered a particularly vulnerable area in cervical trauma?
What syndrome effects this area and is proving to be more common in the general population?
C2-C3 joint
C3 Dorsal ramus syndrome
What usually causes occipital neuralagia?
arthritis of the upper cervical spine mayu cause compression of the greater occipital nerve which causes headaches
Which level of the C spine is most frequently injured in ‘whiplash’ trauma?
What is a post-traumatic headache a sign of as far as injury to the C spine?
C5-C6
A sign of upper C spine injury concomitant w/ any more obvious lower C lesion
Which populations are at a greater risk of Rheumatoid arthritis?
females and mid-life (40-50 y.o) patients
what is the major feature of RA?
Synovitis
What is synovitis?
When joints membrane becomes inflamed
What is the effect of rheumatoid arthritis on the C spine?
- loosening effect on ligaments of Atlanto-axial koint
- synovitis of facet joints
- muscular aches
- fatigue
What are the treatment considerations with patients suffering from RA?
- know treatment contra-indications and precautions-never manipulate
- encourage gentle movement and AROM exercises during periods of remission
- provide support (soft collar), heat and other pain relieving modalities during acute inflammatory epidsodes
- be aware of various treatment meds such as NSAIDS, steroids, gold injections, etc.
When does acute Wry neck usually manifest?
What is wry neck also known as?
when rising in the morning
Torticullis
What ROM limitations are common with wry neck patients?
Painful/limited movement of head TOWARDS side of pain (usually no limit going away from pain or in neck flexion)
may have limits to full elevation of painful-side arm
What are 3 possible mechanisms for acute wry neck?
- Meniscoid villus-impacted synovial inclusiona
- periarticular congestion/localized irritability without inclusion
- slow shift of cervical disc substance
What are the two types of “Wry Neck”?
describe each.
Type 1-Facet
- onset is sudden and to a particular movement - onset on waking, during the night or any time of day - pain is unilateral and does not spread - easily relieved in one treatment
Type II- Disc
- onset is commonly in the morning - pain is unilateral but spreads to yoke area and to scapula/outer/posterior arm, sometimes as far as the elbow - can be badly provoked by localized mobs/manips - requires sustained traction in flexion - takes longer to relieve
What does cervical joint locking imply is the cause of pain?
What is the typical patient look like who has cervical joint locking?
What is treatment usually directed towards?
facet joint is cause of pain (impaction of synovial fold or joint capsule itself)
young athletic patient with no previous neck injury
treatment directed towards “gapping” or “opening” the affected facet joint to allow release of impacted synovium
True or false: Cervical spondylosis is a lower cervical spine problem because of it’s dependance upon disc degeneration as the “starter”
True
Which direction will cervical disc protrusions usually occur in? why?
laterally because of the width and strength of the posterior longitudinal ligament
What are the expected subjective findings for a patient with cervical spondylosis?
- pain locally in lower cervical spine or radiating down into one or both upper extremities
- if advanced problem-may have radiculopathy or myelopathy
- stiffness is a common complaint
- movement and posture as aggravating factors
What are the expected objective findings for a patient with cervical spondylosis?
- lower cervical spine at fault-flexion/extension limited movements
- flexion may be more painfully limited because of disc
- quadrant may be positive if referred pain-radiculopathy
- upper limb tension test
- x-rays will show degenerative changes
What treatments are common with cervical spondylosis?
- treatment very much depends on symptoms grouping (severity)
- modalities for pain relief (heat, ultrasound, etc.)
- mobilization of stiff segments
- exercises and posture correction to control/prevent further exacerbation
What are the characteristics of Cervical Syndrome?
- non-specific neck pain
- symptoms in neck itself or may have radiation to mid scapula, should or arm
- all cervical syndromes arise from lower cervical spine
- self limiting disorder, especially in those aged under 30, which spontaneously resolves
- high recurrences makes it more continuous than episodic
- if left untreated (uneducated) it progresses to brachial neuralgia
What are the three subgroups of Cervical Syndrome?
Postural
Dysfunction
Derangement
What are characteristics of Brachial Neuralgia?
- cervical radiculopathy where pain is in distribution of a specific nerve root as a result of compressive pathology
- seldom short lived with symptoms lasting up to 16 weeks before natural resolution
- often preceded by episodic neck pain
- symptoms may develop slowly or suddenly
- generally involves C5-C7 segments
Is brachial neuralgia more common in the C4-C5 disc or C7-T1 disc?
C7-T1 (25% compared to 4%)
What are common mechanisms of injury for brachial neuralgia?
What does recovery usually depend on?
frequent heavy lifting, smoking, vibrating equipment, and riding in cars
degree of radiation of symptoms (centralization phenomenon)
What are the McKenzie Treatment Principles for C spine?
Preference for patient self treatment
Progression of application of force
- Static patient generated forces - dynamic patient generated forces - therapist generated forces
Clinical application of centralization phenomenon
