Cervical Spine Flashcards
Define radiculopathy
Compression/inflammation leading to demyelination and axonal damage causing reduced impulse conduction along the nerve. Loss of function in reflexes, power and sensation
What is somatic referred pain?
The convergence of nociceptive afferents on 2nd order neurons in the spinal cord that also serves the lower limb.
A dull aching, gnawing, difficult to localise pain.
Has an inconsistent, non-dermatomal pattern
What is radicular pain?
Lacinating, shocking, electric feeling in a thin band. Caused by compression/inflammation leading to ectopic discharges from the dorsal root or its ganglion
What 2 pathologies in the spine cause radiculopathy?
Disc herniation, forminal encroachment of spinal nerve due to degenerative changes
What are the 3 Ns (red flags)?
Nystagmus (involuntary rhythmic side-to-side, up and down or circular motion of the eyes) nausea, neurological symptoms
What are the 5 Ds (red flags)?
Dizziness, drop attacks (loss of power/consciousness), diplopia (seeing double), dysphagia (problems swallowing), dysarthria (problems speaking)
What is the clinical presentation of radiculopathy (history)?
Common in 40-50s
Neck and arm pain (usually unilateral) with a combination of sensory/motor changes
What are the subjective features of radiculopathy?
Paraesthesia (pins and needles). Pain beyond the shoulder. Arm pain worse than neck pain
What are the objective features of radiculopathy?
Sensory loss, motor loss or reflex changes in the affected nerve root distribution, positive neurodynamic assessment
What are the impairments associated with radiculopathy?
Cervical ROM, neurointegrity, neural provocation
What are the 2 ways to manage radiculopathy?
Conservatively (90%), surgically (10%)
What would come under advice/education for management of radiculopathy?
Distinction between radiculopathy and radicular pain, reassurance, pacing, activity modification
What would come under symptom control for radiculopathy?
Analgesics
What are the 4 ways to conservatively manage radiculpathy?
Advice/education, symptom control, build capacity, return to function
How would you build capacity in someone with radiculopathy?
ROM, manual therapy, lateral glides, neurodynamic glides, strengthening flexors/extensors
What is involved in return to function with radiculopathy?
Functional ROM, strengthening in functional positions, achieve patients functional goals
What is a cervicogenic headache?
A headache that is due to cervical pathology. Originates from the upper 3 levels of the cervical spine
What kind of investigations would you use to diagnose a cervicogenic headache?
Cervical spine x-ray/MRI
What are the subjective features of a cervicogenic headache?
Non throbbing/lacinating, starts in neck, migraine/tension headache (50%)
What are the objective findings of a cervicogenic headache?
Cervical spine movements or sustained neck position leading to headaches. Restriction in neck motion, palpation of cervical spine on symptomatic side causes a headache
What’s the clinical presentation (history) for a cervicogenic headache? I.e. where is the pain and what sex is it most common in?
Female > male
With moderate-severe unilateral neck pain
What advice/education would you give to a patient with cervicogenic headache?
Ergonomic advice
How would you control symptoms of cervicogenic headache in a patient?
PAIVMs & SNAGs at symptomatic level
Pain relief-analgesics
How would you manage a patient with a cervicogenic headache?
Address loss of cervical ROM: manual therapy (PAIVMs) for pain or ROM
Exercises: craniocervical flexors/extensors, ROM exercises
Name 6 signs of a red flags for headache
Headache that is;
Subacute and progressively worsening
Severe with sudden onset
Severe with nausea & vomiting
Associated with neurological signs or changes in consciousness
Temporal headache
Not associated with identifiable aetiology
What is acute torticolis/wry neck?
Unilateral neck pain caused by disc or intra-articular entrapment of menscoid or synovial tissue
Discogenic wry neck has a more gradual onset and affects the lower C-spine
Occurs between C2-4 most commonly
What are the subjective features of acute torticolis/wry neck
More common in children than adults
Affects females more than males
Unguarded movement which causes sharp unilateral neck pain and muscle spasm
What are the objective findings typical with acute torticolis/wry neck?
Restricted ROM in C-spine
Avoiding movements towards symptoms
Often holding neck in lateral flexion away from pain
Muscle spasm sometimes present
What are the key impairments of acute torticolis/wry neck? (2)
Pain
Restricted ROM
Name and describe 3 other type of acute torticolis/wry neck.
Congenital - affecting young boys, contracture of the sternocleidomastoid due to a tumour or ischaemia of the muscle
Traumatic - follows subluxation of the C1/2 joints, often in children
Spasmodic – rare but due to focal dystonia
How would you manage a patient with acute torticolis/wry neck?
Symptom control: NSAIDs, Analgesics, heat, ice.
Build capacity: ROM exercises away from pain, PAIVMs in easing position
Exercise: non-weightbearing
What is whiplash disorder (how does it occur)?
Hyperextension and hyperflexion of the cervical spine following impact (sport/road traffic accident)
What anatomical structures does whiplash disorder typically affect? (4)
Zygapophyseal joints, intervertebral discs, vertebral bodies, nerve tissue
What are the subjective features i.e. symptoms (pain etc) of whiplash? (7-14)
Pain in neck, head, shoulders, thoracic, interscapular, arm, lumbar region
Headache, dizziness, loss of balance, visual disturbances, paresthesia, anaesthesia & weakness
What are the objective features of whiplash?
Loss of cervical ROM, muscle spasm, possible sensory changes, reduced function, signs of distress
Key impairments with whiplash disorder?
Pain, reduced ROM of C- and T- spine, reduced function
How would you manage a patient with whiplash disorder?
Advice/education: pacing, reassurance, encourage gradual movement
Symptom control: analgesia, manual therapy kept to a minimum
Build capacity: restore movement of C-spine, strengthen C-spine muscles
Return to function: returning patient to work and sports/activities, monitor mood/anxiety, consider referral to wider MDT to a pain specialist
What is the pathology of OA of the cervical spine?
- Affects facet joints leading to cartilage thinning, fibrillation of cartilage, fibrillation & hypertrophy of the subchondral bone (which is the layer of bone just below the cartilage in a joint).
- Most common in cervio-thoracic junction
- Facet joints cannot withstand load which causes overloading of the subchondral bone
- Inflammatory mediators will fire nociceptors in the joint capsule and synovium of the joint
What are the objective findings with an OA C-spine patient? (3)
Reduced ROM, areas of hypomobility, possible sensory, motor & reflex changes if nerve is affected
What is the clinical presentation of an OA patient (history-wise)? (who typically gets OA)
Occupations which load the joints in a repetitive and sustained manner increase risk
OA changes affect 90% of people >40
What are some of the subjective features of C-spine OA?
Stiffness, pain in neck with possible referral into head/shoulders, gradual worsening, possible radicular pain (due to osteophytes encroaching into intervertebral foramen causing impingement and irritation to nerve roots
How would you manage a patient with C-spine OA?
Advice/education: pacing
Symptom control: pain management -analgesia, heat
Build capacity: restore movement of C-spine, Strengthening cervical spine muscles (flexors and extensors)
What is non-specific neck pain?
Due to neck pain of postural and mechanical origin
Risk factors: duration of sitting, job demand ergonomics
Affects 2/3 people in their lifetime
Insidious in onset
What are the subjective features of non-specific neck pain?
Related to movement, postures/activities
What are the objective features of non-specific neck pain?
Restricted ROM, muscles spasm, tenderness on palpation, asymmetry
How would you manage non-specific neck pain?
Advice/education: pacing, prognosis is generally good, postural advice
Symptom control: pain management - analgesia/heat, ergonomic assessment
Build capacity: restore ROM of C-spine, strengthen C-spine flexors & extensors as per assessment
Return to function: encourage a quick, graded return to work
