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MJ- F3 E2: MSK/Rheum > Cervical spine > Flashcards

Cervical spine Flashcards

1
Q

What are the 2 causes of a cervical strain/sprain?

A
  1. Forced mvmt past end range
  2. Violent high velocity mvmt
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2
Q

What is the clinical presentation of what:

  • Non-radicular, non-focal neck pain anywhere from base of skullto cervicothoracic junction
  • c/o neck spasm and limited ROM
  • +/- cervicogenic HA
A

Cervical strain/sprain

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3
Q

What are the 6 indications to get a cervical spine radiograph for non-trauma related?

A
  1. >50y/o w/ new sxs
  2. Constitutional sxs (F, weight loss, etc)
  3. mod-severe neck pain >6wks
  4. Infectious risk (IVDU, etc)
  5. h/o malignancy
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4
Q

What are the 5 components of the Nexus criteria?

(no cervical x-rays needed in traumatic injury)

A
  1. Posterior midline tenderness
  2. No altered consciousness
  3. No abnormal neuro
  4. No intoxication
  5. No painful distracting injuries
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5
Q

What are the 2 criteria used to determine if x-rays are NOT needed in a traumatic c-spine injury?

A
  1. Nexus Criteria
  2. Canadian C-spine rule
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6
Q

What are the 3 C-spine views?

A
  1. A/P
  2. Lateral
  3. Odontoid
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7
Q

What test is used to eval for a cervical strain/sprain? Should it be pos or neg?

A
  • Spurlings (tests for radicular pain)
  • Should be NEG
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8
Q

Which C-spine levels are routinely checked during a neuro exam (MC to be injured)

A

C5-T1

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9
Q

What is the Spurling’s test used to help dx (2)?

A

Cervical disc herniation

Cervical Spondylosis

(radicular pain)

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10
Q

Which condition?

  • Cervical pain/stiffness 12-24hrs after injury
  • Pain peaks day 3-5
  • dramatic ROM loss greatest w/ flexion and extension
A

“Whiplash”

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11
Q

Whiplash:

  • Pain w/ axial loading?
  • Nml or abnl neuro exam?
A
  • Pain w/ axial loading? NO
  • Nml or abnl neuro exam? NML
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12
Q

What condition?

A

Whiplash

(straightening from mm. spasm)

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13
Q

How do you tx Strain/Sprain/Whiplash? (6)

A
  • Soft cervical collar
  • NSAIDs/Tylenol
  • Muscle relaxers (Cyclobenzapine, Metaxalone)
  • Cervical pillow
  • Heat/ice
  • PT
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14
Q

What are the 2 causes of Cervical Facet Dysfunction?

A
  1. Prolonged positional stress
  2. Traumatic injury
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15
Q

What is cervical Facet Dysfunction?

A

Shift in vertebral alignment–> “locking” of facet joint

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16
Q

Clinical presentation?

  • Insidious onset
  • Unilateral–> sharp in C-spine, Achey in referral zone
  • Focal facet TTP
  • ROM limitations:
    • ipsilateral- sharp pain increases w/ extension
    • Contralateral–> tightness
A

Cervical Facet Dysfunction

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17
Q

How do you tx Cervical Facet Dysfunction? (3)

A
  • Analgesics
  • Muscle relaxers
  • Early referral to PT/DC/DO
18
Q

What is the main complication of Cervical manipulation/

A

Cerebral artery occlusion/dissection

19
Q

What are the 4 sxs of cerebral artery occlusion/dissection (complication of cervical manipulation)

A
  1. Cervical/suboccipital pain
  2. Dizziness
  3. N/V
  4. Vision loss
20
Q

What is cervical radiculopathy?

A

Neurogenic pain in the distribution of cervical roots

+/- numbness and tingling

21
Q

What are the 2 causes of cervical radiculopathy and what age groups are they MC in?

A
  1. Cervical disc bulge/herniation (young and old)
  2. Cervical foraminal narrowing (old)
22
Q

Abrupt onset of cervical radiculopathy indicates what as the cause?

A

disc bulge/herniation

23
Q

What is the hallmark sx of cervical radiculopathy?

A

Cervical radicular pain increased w/:

  • rotation, lateral flexion and extension to involved side
24
Q

What is the name of the test used to test for cervical radiculopathy?

Will this test be pos or neg?

A

Positive spurlings

25
Why are serial neuro exams important in the case of disc bulge/herniation as the cause of cervical radiculopathy?
neuro deficits might not present initially
26
In young adults, are you more likely to see abrupt or gradual onset of cervical radiculopathy?
abrupt
27
Which of the following views allows you to optimally see the (cervical) foramen?
The oblique view
28
What are the 5 x-ray views used when evaluating for cervical radiculopathy?
* A/P * Lateral * Odontoid * R/L obliques
29
How do you tx Cervical Radiculopathy? (7)
* **NSAIDs** * **Steroids** (Prednisone) * **Acetaminophen** * **PT** (cervical traction, postural education) * **OT** * +/- Neuro/PMR consult (persistent/worsening pain despite conserv. tx)--\> epidural injections * +/- surgical consult (failure w/ conservative care)
30
31
What is conservative tx for Cervical radiculopathy? (5)
* **NSAIDs** * **Steroids** (Prednisone) * **Acetaminophen** * **PT** (cervical traction, postural education) * **OT**
32
Which condition? * Degenerative dz * **Osteophytes** * **Ligamentum flavum thickening** * Disk **space narrowing** * **Vertebral** **subluxation**
Cervical spondylosis
33
What cervical levels is Cervical Spondylosis MC at?
* C5-C6 * C6-C7
34
Clinical presentation of what? * **Progressive** ROM loss/stiffness * Pain not well localized * **Deep, aching** neck and shoulder pain * Cervical crepitus * Focal/defuse **TTP** along **spinous processes** and f**acet joints**
Cervical Spondylosis
35
Is there TTP to the affected area in a cervical sprain/strain and whiplash?
yes
36
What is the main concern for cervial spondylosis?
Myelopathy
37
* Weak hands/**atrophy of han**d musculature * Leg weakness * unsteady gait * **Bladder/bowel dysfunction** * hyper-reflexia * **_Lhermittes sign_** * sensory impairment
Myelopathy (Cervical Spondylosis)
38
Which condition has **Lhermitte's sign** (electric shock down back w/ neck flexion)
Myelopathy (Cervical Spondylosis)
39
What condition?
Cervical Spondylosis
40
What condition?
Cervical Spondylosis
41
How do you tx Cervical Spondylosis? (8)
* NSAIDs * **Duloxetine** * **Amitryptyline** (if prob w/ sleep) * **Gabapentin** * Cervical pillow * Cervical traction * PT * Surgical fixation (if fail above)
42
Should you prescribe narcotics for Cervical Spondylosis?
**_NO_**

MJ- F3 E2: MSK/Rheum (7 decks)

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