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MSK - Upper Quadrant > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

Define radiculopathy

A

Compression/inflammation leading to demyelination and axonal damage causing reduced impulse conduction along the nerve. Loss of function in reflexes, power and sensation

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2
Q

What is somatic referred pain?

A

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

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3
Q

What is radicular pain?

A

Lacinating, shocking, electric feeling in a thin band. Caused by compression/inflammation leading to ectopic discharges from the dorsal root or its ganglion

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4
Q

What 2 pathologies in the spine cause radiculopathy?

A

Disc herniation, forminal encroachment of spinal nerve due to degenerative changes

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5
Q

What are the 3 Ns (red flags)?

A

Nystagmus (involuntary rhythmic side-to-side, up and down or circular motion of the eyes) nausea, neurological symptoms

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6
Q

What are the 5 Ds (red flags)?

A

Dizziness, drop attacks (loss of power/consciousness), diplopia (seeing double), dysphagia (problems swallowing), dysarthria (problems speaking)

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7
Q

What is the clinical presentation of radiculopathy (history)?

A

Common in 40-50s

Neck and arm pain (usually unilateral) with a combination of sensory/motor changes

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8
Q

What are the subjective features of radiculopathy?

A

Paraesthesia (pins and needles). Pain beyond the shoulder. Arm pain worse than neck pain

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9
Q

What are the objective features of radiculopathy?

A

Sensory loss, motor loss or reflex changes in the affected nerve root distribution, positive neurodynamic assessment

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10
Q

What are the impairments associated with radiculopathy?

A

Cervical ROM, neurointegrity, neural provocation

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11
Q

What are the 2 ways to manage radiculopathy?

A

Conservatively (90%), surgically (10%)

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12
Q

What would come under advice/education for management of radiculopathy?

A

Distinction between radiculopathy and radicular pain, reassurance, pacing, activity modification

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13
Q

What would come under symptom control for radiculopathy?

A

Analgesics

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14
Q

What are the 4 ways to conservatively manage radiculpathy?

A

Advice/education, symptom control, build capacity, return to function

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15
Q

How would you build capacity in someone with radiculopathy?

A

ROM, manual therapy, lateral glides, neurodynamic glides, strengthening flexors/extensors

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16
Q

What is involved in return to function with radiculopathy?

A

Functional ROM, strengthening in functional positions, achieve patients functional goals

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17
Q

What is a cervicogenic headache?

A

A headache that is due to cervical pathology. Originates from the upper 3 levels of the cervical spine

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18
Q

What kind of investigations would you use to diagnose a cervicogenic headache?

A

Cervical spine x-ray/MRI

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19
Q

What are the subjective features of a cervicogenic headache?

A

Non throbbing/lacinating, starts in neck, migraine/tension headache (50%)

20
Q

What are the objective findings of a cervicogenic headache?

A

Cervical spine movements or sustained neck position leading to headaches. Restriction in neck motion, palpation of cervical spine on symptomatic side causes a headache

21
Q

What’s the clinical presentation (history) for a cervicogenic headache? I.e. where is the pain and what sex is it most common in?

A

Female > male

With moderate-severe unilateral neck pain

22
Q

What advice/education would you give to a patient with cervicogenic headache?

A

Ergonomic advice

23
Q

How would you control symptoms of cervicogenic headache in a patient?

A

PAIVMs & SNAGs at symptomatic level

Pain relief-analgesics

24
Q

How would you manage a patient with a cervicogenic headache?

A

Address loss of cervical ROM: manual therapy (PAIVMs) for pain or ROM
Exercises: craniocervical flexors/extensors, ROM exercises

25
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
26
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
27
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
28
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
29
What are the key impairments of acute torticolis/wry neck? (2)
Pain | Restricted ROM
30
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
31
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
32
What is whiplash disorder (how does it occur)?
Hyperextension and hyperflexion of the cervical spine following impact (sport/road traffic accident)
33
What anatomical structures does whiplash disorder typically affect? (4)
Zygapophyseal joints, intervertebral discs, vertebral bodies, nerve tissue
34
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
35
What are the objective features of whiplash?
Loss of cervical ROM, muscle spasm, possible sensory changes, reduced function, signs of distress
36
Key impairments with whiplash disorder?
Pain, reduced ROM of C- and T- spine, reduced function
37
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
38
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
39
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
40
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
41
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
42
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)
43
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
44
What are the subjective features of non-specific neck pain?
Related to movement, postures/activities
45
What are the objective features of non-specific neck pain?
Restricted ROM, muscles spasm, tenderness on palpation, asymmetry
46
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

MSK - Upper Quadrant (4 decks)

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