Cervical Spine Flashcards
Neck pain CPG: pathoanatomical features/differential diagnosis
A level - determine the potential for presence of serious pathology (infection, cancer, cardiac involvement, arterial insufficiency, upper cervical ligamentous insufficiency, unexplained cranial nerve dysfunction, fracture)
Neck pain CPG: imaging
A level - utilize guidelines and criteria to refer for imaging
Neck pain CPG: examination - outcome measures
A level -
NDI
PSFS
Neck pain CPG: examination - activity limitations and participation measures
F level - use easily reproducible activity limitation and participation restriction measures associated with patients neck pain.
Neck pain CPG: Examination - physical impairment measures
B level -
- neck pain with mobility deficits: c/s AROM, cervical flex rotation test, c/s and t/s segmental mobility test
- neck pain with HA: c/s AROM, cervical flex/rot test, upper c/s segmental mobility
- Neck pain with radiating pain: neurodynamic testing, spurlings, distraction test, valasalva test
- neck pain w movement coordination impairments: cranial cervical flexion and neck flexor muscle endurance
Neck pain CPG: Diagnosis/classification
C level -
Use ROM, presence of HA, history of trauma, referred or radiating pain to classify patient into one of 4 categories:
-neck pain with mobility deficits
-neck pain with movement coordination impairments (WAD)
-neck pain with HAs
-neck pain with radiating pain
Neck pain CPG: Interventions for neck pain with mobility deficits (Acute)
B level - thoracic manip, program of neck ROM exercises, scapulothoracic and UE strengthening
C level - c/s manip or mob
Neck pain CPG: Interventions for neck pain with mobility deficits (Subacute)
B level - neck and shoulder girdle endurance exercises
C level - thoracic manip and c/s manip or mob
Neck pain CPG: Interventions for neck pain with mobility deficits (Chronic)
B level - multimodal: t/s or c/s manip or mob, NM exercise, stretchingm strengthening, endurance, aerobic, cognitive affective elements, dry needling, laser, intermittent mechanical/manual traction
C level - provide neck, shoulder girdle, and trunk endurance exercise, pt ed to promote active lifestyle, address cognitive and affective factors
Neck pain CPG: interventions for neck pain with movement coordination impairments (acute)
B level - pt ed on: return to normal activities ASAP, minimize use of cervical collar, exercises to decrease pain and increase ROM.
Recovery in first 2-3mo
B level - multimodal intervention: manual plus exercise for pts who expect to experience a moderate to slow recovery with presistent impairments
C level - pts who are a low risk of progressing towards chronicity:
-1 session with advice, exercise instruction and education
-comprehensive exercise program. Strength and endurance.
-TENS
F level - monitor status and ID pts experiencing delayed recovery who may need more intensive rehab and early pain ed program
Neck pain CPG: interventions for neck pain with movement coordination impairments (chronic)
C level - pt ed on assurance, encouragement, prognosis, and pain management.
mobs with exercise program: c/s and t/s strength and endurance, flexibility, coordination
TENS
Neck pain CPG: interventions for neck pain with HAs (acute)
B level - supervised instruction in active mobility exercises
C level - self SNAG (C1-2 self natural apophyseal glide)
Neck pain CPG: interventions for neck pain with HAs (subacute)
B level - cervical manip and mobs
C level - C1-2 self SNAG
Neck pain CPG: interventions for neck pain with HAs (chronic)
B level - c/s or t/s manip or mobs, combined with shoulder girdle and neck stretching, strengthening, and endurance
Neck pain CPG: interventions for neck pain with radiating pain (acute)
C level - mobilizing and stabilizing exercises, laser, short-term use of c/s collar
