Cervical spine Flashcards
What jobs does the c-spine do?
- Position of head for vision and balance
- Needed for rapid motion
- Protects “vital tubes”
- Use of sensory organs
Which bones are in the upper cervical spine? Lower?
Upper: occiput, atlas, axis
Lower: C3-7
What is the annual incidence of c-spine pain?
10-20%
T/F: Chronic neck pain is the 2nd most common cause of disability
F: Chronic neck pain is the 4th most common cause of disability, 21st in burden of disability
T/F: Cervical pain is more common in women than men
True
T/F: Cervical pain peaks at age 70y +
F: Peak at 35-49y
List some risk factors for neck pain
Cycling, smoking, hx of neck pain, depression, job strain, low social support, heavy labor workers, desk workers, sedentary work, repetitive work, work with neck flexed, work with arms above shoulder height
T/F: Most cases of neck pain have a specific pathoanatomic cause
False
List non-MSK causes of neck pain
infection, tumor, cardiac, endocrine, GI, neuro, pulmonary, systemic disease
What would you ask when taking a c-spine pain history?
Demographics, employment/ work, current condition, medical care, functional status, social history, medical hx, family hx, onset, trauma?
C-Spine exam
Neuro sx, b/b, weight loss/ night pain/ fever, dizziness/ fainting, HA, TMJ, facial pain, pulmonary sx, effect of cough/ sneeze on pain, cardiac sx, sleeping, posture, litigation
List the score categories for the NDI
0-4 No disability 5-14 Mild 15-24 Mod 25-34 Severe 35+ Complete *Multiply score by 2 to get %*
How is the NDI performed?
Self-reported questionnaire
What is the FABQ and how is it scored?
It is a self-reported questionnaire that measures fear avoidance beliefs for PA (5 items) and work (11 items). Ea item is scored from 0-6. Higher score means higher fear.
What are the signs of radiculopathy due to neurological impingement?
Nerve root impingement: sensory/ motor changes
What are the signs of myelopathy due to neurological impingement?
Spinal cord impingement: UMN signs/ sx (weakness, spasticity, + Babinski, increased DTRs, clumsy, abnormal gait)
Which nerve rootsinnervate the phrenic nerve to the diaphragm?
C3-4-5
Neck sx of tracheobronchial conditions?
inflammation, infection, tumor
Sx that may be referred to neck:
Pain, dyspnea (labored breathing), dysphasia (difficulty swallowing), persistent cough, fever/ chills, hemoptysis
What are sx of cervical tumors?
Neck pain, sore throat, dysphagia, growing mass, UMN signs (if spinal cord involvement)
What is a pancoasts tumor and what are the sx?
Lung cancer in upper lobe that invades brachial plexus; extra pulmonary sx: shoulder pain, cough, chest pain
List two types of infection in the c-spine
Osteomyelitis (neck pain, stiffness, fever; discitis (neck pain, stiffness, fever, disc space narrowing, myelo- or radicular signs in later stages
What are 3 CV conditions that can refer to the neck?
Acute myocardial infarction, acute coronary insufficiency, carotodynia
1 GI condition that can refer to neck and its sx:
Esophageal conditions (infection, tumor, varices); dysphagia, ant neck pain
What % of its with neck pain develop chronic sx?
44%
What are + associations with PT use for neck pain?
Older age, female, lower education, workers comp, being in litigation
What % of PT cases are neck cases?
~27%
What are the guideline recommendations for neck pain?
NDI, cervical mob/ mania with exercise, thoracic coord, strengthening, endurance, neural mobs, traction, education
What are the 5 categories for neck pain?
Mobility Centralization Exercise & Conditioning Headaches Pain Control
How does mobility present?
Recent onset of sx
No radicular sx
How does centralization present?
Radicular sx
Sx distal to elbow
How does exercise & condition present?
No radicular sx
Chronic sx
How does headaches present?
Primary c/o HA
Cervicogenic HA
How does pain control present?
Acute onset of sx
Trauma
What is the tx for mobility?
MT + exercise
What is the tx for centralization?
Activities to promote centralization
What is the tx for exercise and conditioning?
Conditioning/ strengthening exercises
What is the tx for HA?
MT, neck flexor/ scap strengthening
What is the tx for pain control?
Gentle ROM and activity
What is the name of the screening for red flags developed by George et al, JOSPT 2015?
Optimal Screening for Prediction of referral Outcome (OSPRO). 23 item screening tool identified 100% of positive responders
Why is avoidance response such big deal in c-spine pain?
Psychosocial factors predictive of prolonged disability at 12 months
What are the 5 categories of cervical intervention?
Thoracic mania Cervical manual ICTraction DNF/ CCF Exercise
What is the job of the canadian c-spine rules?
decision rule for detection of any fracture, dislocation, or ligamentous instability demonstrated by diagnostic imaging. High sensitivity (You can trust a negative)
What are the 2 cervical ligaments you need to clear?
Alar, transverse
What are 3 causes of AA instability?
ligamentous/ bony/ muscular support. (Can be due to congenital bony malformation, down’s, inflammation, trauma, chronic corticosteroid use)
What are s/s of upper cervical instability?
Suboccipital pain, B UE/ LE paresthesias, clumsiness, loss of balance, nystagmus, HA, blurred vision, UMN signs (hyperreflexia, spasticity, abnormal gait, clumsy, + Babinski)
What % of pts with RA have cervical involvement?
50%
What are the 5 factors for cervical myelopathy?
- Age >45 y
- Hoffmann
- Inverted Supinator
- Babinski
- Gait abnormality
3 upper cervical ligament tests in pt with dens fx presenting with HA
- Sharp Purser
- Alar ligament
- Transverse ligament aka anterior shear test
