Cervical Spine Flashcards
Factors used to determine the need for radiographs after acute head/neck injury secondary to the risk of fracture?
(Canadian C-spine rules)
High Risk Factors Present?
- Age > 65
- Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
- Paresthesias in extremities.
* If yes to any of these: x-ray. If no, continue
Low Risk Factors that allow safe assessment of range of motion?
1. Simple rear-end motor accident
2. Normal sitting posture in emergency department
3. Ambulatory at any time since injury
4. Delayed onset of neck pain and absence of midline tenderness.
If any low risk factors, x-ray
Is the patient able to actively rotate the neck > 45 degrees to the right and the left?
If no, x-ray
Sn=1
Do you order imaging for neck pain w mobility deficits?
No with the absence of red flags.
Do you order imaging for neck pain with radiating pain, normal x-ray and (+) neurologic signs/symptoms?
Order MRI
Do you order imaging for neck pain with mvmnt coordination impairment?
No if there’s (-) neurological sxs, (-)XR, (-)evidence of spondylosis
Nexus II CT scan s/p head injury indicated if:
1) evidence of significant skull fx
2) scalp hematoma
3) neurologic deficit
4) altered level of alertness
5) abnormal behavior
6) Coagulopathy (clotting disorder)
7) Persistent vomiting
8) Age 65 or older
Interventions for: Neck pain with mobility deficits
Acute
B: Thoracic manipulation, program of neck ROM exercises, scapulothoracic and upper extremity strengthening.
C:May provide cervical manipulation and/or mobilization
Interventions for: Neck pain with mobility deficits
Subacute
B: neck and shoulder girdle endurance exercises
C: Thoracic manipulation and cervical manipulation and/or mobilization
Interventions for: Neck pain with mobility deficits
Chronic
B: Multimodal approach:
- Thoracic manipulation and cervical manipulation and/or mobilization
- mixed exercises for cervical/scapulothoracic regions:NM exercises (coordination, proprioception, postural training), stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements.
C: Neck, shoulder girdle and trunk endurance exercise and counseling strategies that promote an active lifestyle and address cognitive and affective factors
Interventions for: Neck pain with movement coordination impairments (including WAD)
(acute)
B:
- eduction to return to normal, non-provocative pre accident activities ASAP, minimize cervical collar use, perform postural and mobility exercises to decrease pain and increase ROM
- Reassurance that recovery is expected to occur in first 2-3 months
B:
-multimodal approach including: manual mobilization techniques plus exercise (strengthening, endurance, flexibility, postural, coordination, aerobic and functional exercises) for those expected to experience a moderate to slow recovery with persistent impairments.
C:
- For pts whose condition is perceived to be at low risk of progressing towards chronicity:
- single session consisting of early advice, exercise instruction and education
- comprehensive exercise program (including strength and/or endurance with/without coordination exercises)
- TENS
Interventions for: Neck pain with movement coordination impairments (including WAD)
chronic
C:
- pt education and advise focusing on assurance, encouragement, prognosis and pain management
- mobilization combined with an individualized, progressive submaximal exercise program including cervicothoracic strengthening, endurance, flexibility and coordination using the principles of cognitive behavioral therapy
- TENS
Interventions for: Neck pain with headaches
acute
B:
-supervised instruction in active mobility exercise
C:
-C1-C2 self sustained natural apophyseal glide (self-SNAG) exercise
Interventions for: Neck pain with headaches
subacute
B:
-cervical manipulation and mobilization
C:
-C1-C2 self SNAG exercise
Interventions for: Neck pain with headaches
chronic
B:
-cervical or cervicalthoracic manipulation or mobilizations combined with shoulder girdle and neck stretching, strengthening and endurance exercises.
Interventions for: Neck pain with radiating pain
acute
C:
-mobilizing and stabilizing exercises, laser and short term use of a cervical collar
Interventions for: Neck pain with radiating pain
Chronic
B:
- mechanical intermittent cervical traction, combined with other interventions such as stretching and strengthening exercises plus cervical and thoracic mobilization/manipulation
- education and counseling to encourage participation in occupational and exercise activities.
