Cervical Spine Flashcards
Cervical Disc SE
¥ Central/bilateral, suprascapular fossa, medial scapular
¥ increased pain sustained F (?E) dec non weight bearing
¥ unusual, sustained activity of neck, strain with arms eg lifting
Symptoms not immediate; more next day – always ask about activities the day prior to pain onset
¥ May have presentation in Tx and/or Lx
¥ Medial scapula pain may arise from Cx or Tx
Cervical Disc OE
¥ Forward head posture+/- ‘list’ (deviation of head) away from ‘painful’ side
¥ ?all movements limited by pain
¥ Limited E+post. glide –> symptoms
¥ central thickening
depression C4, prominent C5
central PA’s: C4 mobile, C5 stiff (one level is depressed and the other prominent)
¥ Tx PAIVM’s: tick tick *
¥ Neurolog. ?*
* always check to negate/confirm hypothesis
Cervical Disc Management
Irritable: ¥ Collar, analgesics ¥ NSAID’s ¥ bed rest ¥ Cx traction ¥ electrotherapy
Non-irritable: ¥ Central PA’s into R (resistance) ¥ Posture correction ¥ Muscle balance ¥ Self-Rx-mobility, mm length and strength/endurance
Cervical PIV SE
¥ Local, bilateral not central ? Med. scap
¥ inc on stretch movements eg F, LF, rot away OR compression movements eg E, LF, rot toward
¥ Quick unguarded movement –> immediate symptoms –> improve rapidly (Very aware of pain when problem first presents)
Pain – uni/bilateral not central – always screen central to support/negate
Cervical PIV OE
¥ ?Nil deformity – no list/antalgic gait
¥ Peri-articular- inc symptoms F, LF away, rot away, from side of symptoms*
¥ Intra-articular- inc symptoms E, LF toward, rot toward side of symptoms*
¥ Lateral interlaminar thickening
¥ Unilat PA’s stiff, p
¥ Neurolog ?
¥ Very stiff at level
* stretching (flexion) = pain – periarticular pattern
* compressive (Extension) = pain – intraarticular pattern
Cervical PIV Management
Acute: ¥ Gentle passive mobs: ¥ unilat PA’s, lateral glide, rot away ¥ Cx traction ¥ Electrotherapy, collar ¥ ROM exs
Chronic:
¥ strong EOR mobs (get patient to Lat-Rot or Ext and work very EOR mobs), self Rx
Wry Neck SE
Cause unknown - ?? joint capsule pinch
• limited ROM with pain
¥ LOCKED JOINT-underlying disc or PIV joint dysfunction
¥ Both acute, recent onset, patient scared-can’t move neck! LIST (Deviation)
Present quickly; Bx=Hx
Wry Neck OE
Limited examination-correction of list to P1
Wry Neck Treatment
¥ Disc vs PIV–>Rx
¥ Disc-mobs, traction, relax. techs, soft tissue
¥ PIV-manipulate, traction, relax. Tech
Usually respond well to mobs
Cervical nerve root SE
Severe
¥ Dermatome for n. root
¥ severe, lancinating, stabbing, constant
¥ p&n’s, numb
¥ distal worse
¥ Heavy, sustained, repet. activity ?lift, E,
¥ start central spread /worsen, distal p&n
Chronic
¥ “Nuisance” pain
¥ deep, patchy within dermatome+/- p&n’s
¥ Needs considerable activity to agg.
¥ Residual, recurrent
Not necessarily associated with particular incident
Cervical nerve root OE
- P&N’s can be in different areas to symptoms
- p is usually worse distally – symptoms can start proximally and progress distally; proximal pain can disappear
Severe
¥ Very uncomfortable
¥ list in anti-tension (tilt towards p as it compresses)
¥ correct to P1symptoms-latency (wait 20-30secs)
¥ inc with E, LF, rot t/w (narrows IV foramen)
¥ Neurol- dec sensation
dec reflex, mm weak
¥ Neural-positive, latent
Chronic ¥ Vigorous P/E reqd. ¥ Full ROM, EOR pain ¥ May need sustained, combined to distal Sx ¥ Neurol-mild signs ¥ Neural-strong tests, sensitise Palp, PAIVM-thickening, stiff
Cervical nerve root Management
Severe
¥ Cx traction-low kg, progress time 5’-30’
¥ Neural mobs-gentle, remote, antitension
¥ collar
¥ Advice-rest
¥ Electrotherapy
¥ Later passive mobs
Chronic
¥ Vigorous Rx
¥ Lots of Rx eg jt mobs+manips+neural mobs+traction+mobilising exs
¥ Home advice: posture correction, self mobs, ergonomics, endurance exs
*traction usually preferred Rx
Cervical Postural SE
¥ widespread diffuse ache with uni-bilat spread
¥ inc sustained posture
dec mov’ts, non-weight bearing
¥pre-disposing ill –> rest –> dec mm control;
Increase pace, hrs, activities
usually due to mm imbalance – unbalanced length-tension relationship
Cervical Postural OE
¥ Forward head posture, Tx kyphosis ¥ Full ROM, pain free ¥ Mm imbalance tight-suboccipital E, upper traps, levator scapulae weak-short neck Fx/long neck Ex ¥ Palp-tender over area ¥ PAIVM’s: tick tick ¥ Neurol: tick tick
Cervical Postural Treatment
¥ Explain-mechanism, active role
¥ Advice-rest, regular curve reversal
¥ Home exs: stretches for tight mm; endurance exs. for weak mm
¥ Passive mobs for joint/neural signs
Cervical Instability SE
¥ Arcs, twinges on movement and especially return
¥ inc trivial mech. stress; sustained postures;
dec nwb-but too long will aggravate
¥ persistent neck ache
recurrent short term relief with Rx-often directed at joints, muscle length etc
Cervical Instability OE
¥ Forward head posture
¥ E: excess mid Cx movement –> p++ and p on return
¥ Other Cx: tick tick
¥ Generalised mobile jts (vertebrae hinges at level of unstable jt in ext/level has too much mov’t)
¥ Mm-all groups weak esp deep Cx Flexors
¥ Palp-thickened C4/5, depressed C4, prominent C5
PAIVM’s PA: C4 mobile, soft endfeel, deep p+
PA C567=stiff
Cervical Instability Management
Early:
¥ pain relief with gentle mobs for mobile C4 and/or collar
¥ Stronger mobilisation to dec stiff levels
Later:
¥ Stability-endurance exs eg deep Cx flexors, intersegmental mm control
Fusion surgery ( if exercises don’t work), inject joints
¥ Prophylaxis-modify work/recreation to limit strain unstable jt
¥ Increase mm strength to make up for ligament laxity
Whiplash SE
¥ Wide range of symptoms-head, neck, upper limb, numb, paraesthesia, D, H/A, Weak
¥ Spectrum of minor to major incl. # vertebra
Vehicle-rear end-head catapulted into E then F
Whiplash OE
¥ Wide range to reflect structures/mechanisms involved:
-disc
-PIV
-Ligs
-Mm-sternomastoid, post neck, prevertebral
oesophagus, pharynx
-brain, TMJ, vertebral body
Whiplash Management
¥ Early-refer GP, thorough S/E, P/E, concise records
¥ Soft tissue t/t-ice, electrotherapy, ROM exs, hold relax, collar
Later-passive mobs, continuous traction, stabilising/endurance exs
