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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
Q

Name 6 signs of a red flags for headache

A

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
Q

What is acute torticolis/wry neck?

A

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
Q

What are the subjective features of acute torticolis/wry neck

A

More common in children than adults
Affects females more than males
Unguarded movement which causes sharp unilateral neck pain and muscle spasm

28
Q

What are the objective findings typical with acute torticolis/wry neck?

A

Restricted ROM in C-spine
Avoiding movements towards symptoms
Often holding neck in lateral flexion away from pain
Muscle spasm sometimes present

29
Q

What are the key impairments of acute torticolis/wry neck? (2)

A

Pain

Restricted ROM

30
Q

Name and describe 3 other type of acute torticolis/wry neck.

A

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
Q

How would you manage a patient with acute torticolis/wry neck?

A

Symptom control: NSAIDs, Analgesics, heat, ice.
Build capacity: ROM exercises away from pain, PAIVMs in easing position
Exercise: non-weightbearing

32
Q

What is whiplash disorder (how does it occur)?

A

Hyperextension and hyperflexion of the cervical spine following impact (sport/road traffic accident)

33
Q

What anatomical structures does whiplash disorder typically affect? (4)

A

Zygapophyseal joints, intervertebral discs, vertebral bodies, nerve tissue

34
Q

What are the subjective features i.e. symptoms (pain etc) of whiplash? (7-14)

A

Pain in neck, head, shoulders, thoracic, interscapular, arm, lumbar region
Headache, dizziness, loss of balance, visual disturbances, paresthesia, anaesthesia & weakness

35
Q

What are the objective features of whiplash?

A

Loss of cervical ROM, muscle spasm, possible sensory changes, reduced function, signs of distress

36
Q

Key impairments with whiplash disorder?

A

Pain, reduced ROM of C- and T- spine, reduced function

37
Q

How would you manage a patient with whiplash disorder?

A

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
Q

What is the pathology of OA of the cervical spine?

A
  • 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
Q

What are the objective findings with an OA C-spine patient? (3)

A

Reduced ROM, areas of hypomobility, possible sensory, motor & reflex changes if nerve is affected

40
Q

What is the clinical presentation of an OA patient (history-wise)? (who typically gets OA)

A

Occupations which load the joints in a repetitive and sustained manner increase risk
OA changes affect 90% of people >40

41
Q

What are some of the subjective features of C-spine OA?

A

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
Q

How would you manage a patient with C-spine OA?

A

Advice/education: pacing
Symptom control: pain management -analgesia, heat
Build capacity: restore movement of C-spine, Strengthening cervical spine muscles (flexors and extensors)

43
Q

What is non-specific neck pain?

A

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
Q

What are the subjective features of non-specific neck pain?

A

Related to movement, postures/activities

45
Q

What are the objective features of non-specific neck pain?

A

Restricted ROM, muscles spasm, tenderness on palpation, asymmetry

46
Q

How would you manage non-specific neck pain?

A

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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