Cervical Spinal Syndromes

Question 1

What is the classification approach based on?

Answer 1

Evidence when possible and experience/clinical expertise when evidence is not sufficient or not yet available

Question 2

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?

Answer 2

Mobility

cervical/thoracic spine mobilization/manipulation and AROM exercises

Question 3

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?

Answer 3

Centralization

mechanical/manual cervical traction and repeated movements to centralize symptoms

Question 4

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?

Answer 4

Conditioning and increase exercise tolerance

Strength and endurance exercise for cervical spine muscles as well as aerobic training

Question 5

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?

Answer 5

Pain control

gentle AROM within pain tolerance, ROM exercises for adjacent regions, modalities as needed, and activity modification to control pain

Question 6

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?

Answer 6

Reduce headache

cervical spine manipulations/mobilization, neck and upper quarter muscular strengthening, and postural education

Question 7

What is the formula for clinically evaluating patients complaining of pain or dysfunction of the neck, head, shoulder, or upper extremity?

Answer 7

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

Question 8

True or False: Bone is the most common pain origination site in the upper C spine.

Answer 8

False, soft tissue causes the majority of symptoms

Question 9

What are the common sites of muscular pain from tension in the C spine?

Answer 9

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

Question 10

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”?

Answer 10

Sustained contractions due to loss of oxygen as well as accumulated irritating metabolites

Acute muscle contraction

Question 11

True or False: Pain from the IVD is commonly distributed in broad areas with ill-defined margins

Answer 11

True

Question 12

What five structures can cause pain from within the vertebral canal in the upper C spine?

Answer 12

-Vertebral artery within Transverse foramen

Question 13

What are 3 common syndromes of the upper C spine?

Answer 13

Cervical headaches
Rheumatoid Arthritis
Acute Wry neck/joint locking

Question 14

What are the 3 parts of the spinal nucleus of the trigeminal nerve?

Answer 14

Pars oralis
Pars interpolaris
pars caudalis

Question 15

True or False: the trigeminocervical nucleus does not transmit nociceptive information and so it cannot be a pain generator for the head or neck

Answer 15

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

Question 16

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

Answer 16

True

Question 17

True or False: All cervical muscle are reportedly capable of producing headaches

Answer 17

False, only the muscles innervated by C1-C3 are reportedly able to produce headaches

Question 18

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?

Answer 18

C2-C3 joint

C3 Dorsal ramus syndrome

Question 19

What usually causes occipital neuralagia?

Answer 19

arthritis of the upper cervical spine mayu cause compression of the greater occipital nerve which causes headaches

Question 20

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?

Answer 20

C5-C6

A sign of upper C spine injury concomitant w/ any more obvious lower C lesion

Question 21

Which populations are at a greater risk of Rheumatoid arthritis?

Answer 21

females and mid-life (40-50 y.o) patients

Question 22

what is the major feature of RA?

Answer 22

Synovitis

Question 23

What is synovitis?

Answer 23

When joints membrane becomes inflamed

Question 24

What is the effect of rheumatoid arthritis on the C spine?

Answer 24

• loosening effect on ligaments of Atlanto-axial koint
• synovitis of facet joints
• muscular aches
• fatigue

Question 25

What are the treatment considerations with patients suffering from RA?

Answer 25

- 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.

Question 26

When does acute Wry neck usually manifest? What is wry neck also known as?

Answer 26

when rising in the morning Torticullis

Question 27

What ROM limitations are common with wry neck patients?

Answer 27

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

Question 28

What are 3 possible mechanisms for acute wry neck?

Answer 28

- Meniscoid villus-impacted synovial inclusiona - periarticular congestion/localized irritability without inclusion - slow shift of cervical disc substance

Question 29

What are the two types of "Wry Neck"? | describe each.

Answer 29

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

Question 30

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?

Answer 30

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

Question 31

True or false: Cervical spondylosis is a lower cervical spine problem because of it's dependance upon disc degeneration as the "starter"

Answer 31

True

Question 32

Which direction will cervical disc protrusions usually occur in? why?

Answer 32

laterally because of the width and strength of the posterior longitudinal ligament

Question 33

What are the expected subjective findings for a patient with cervical spondylosis?

Answer 33

- 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

Question 34

What are the expected objective findings for a patient with cervical spondylosis?

Answer 34

- 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

Question 35

What treatments are common with cervical spondylosis?

Answer 35

- 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

Question 36

What are the characteristics of Cervical Syndrome?

Answer 36

- 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

Question 37

What are the three subgroups of Cervical Syndrome?

Answer 37

Postural Dysfunction Derangement

Question 38

What are characteristics of Brachial Neuralgia?

Answer 38

- 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

Question 39

Is brachial neuralgia more common in the C4-C5 disc or C7-T1 disc?

Answer 39

C7-T1 (25% compared to 4%)

Question 40

What are common mechanisms of injury for brachial neuralgia? What does recovery usually depend on?

Answer 40

frequent heavy lifting, smoking, vibrating equipment, and riding in cars degree of radiation of symptoms (centralization phenomenon)

Question 41

What are the McKenzie Treatment Principles for C spine?

Answer 41

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