Cervical spine Flashcards
What are the 2 causes of a cervical strain/sprain?
- Forced mvmt past end range
- Violent high velocity mvmt
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
Cervical strain/sprain
What are the 6 indications to get a cervical spine radiograph for non-trauma related?
- >50y/o w/ new sxs
- Constitutional sxs (F, weight loss, etc)
- mod-severe neck pain >6wks
- Infectious risk (IVDU, etc)
- h/o malignancy
What are the 5 components of the Nexus criteria?
(no cervical x-rays needed in traumatic injury)
- Posterior midline tenderness
- No altered consciousness
- No abnormal neuro
- No intoxication
- No painful distracting injuries
What are the 2 criteria used to determine if x-rays are NOT needed in a traumatic c-spine injury?
- Nexus Criteria
- Canadian C-spine rule
What are the 3 C-spine views?
- A/P
- Lateral
- Odontoid
What test is used to eval for a cervical strain/sprain? Should it be pos or neg?
- Spurlings (tests for radicular pain)
- Should be NEG
Which C-spine levels are routinely checked during a neuro exam (MC to be injured)
C5-T1
What is the Spurling’s test used to help dx (2)?
Cervical disc herniation
Cervical Spondylosis
(radicular pain)
Which condition?
- Cervical pain/stiffness 12-24hrs after injury
- Pain peaks day 3-5
- dramatic ROM loss greatest w/ flexion and extension
“Whiplash”
Whiplash:
- Pain w/ axial loading?
- Nml or abnl neuro exam?
- Pain w/ axial loading? NO
- Nml or abnl neuro exam? NML
What condition?
Whiplash
(straightening from mm. spasm)
How do you tx Strain/Sprain/Whiplash? (6)
- Soft cervical collar
- NSAIDs/Tylenol
- Muscle relaxers (Cyclobenzapine, Metaxalone)
- Cervical pillow
- Heat/ice
- PT
What are the 2 causes of Cervical Facet Dysfunction?
- Prolonged positional stress
- Traumatic injury
What is cervical Facet Dysfunction?
Shift in vertebral alignment–> “locking” of facet joint
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
Cervical Facet Dysfunction
How do you tx Cervical Facet Dysfunction? (3)
- Analgesics
- Muscle relaxers
- Early referral to PT/DC/DO
What is the main complication of Cervical manipulation/
Cerebral artery occlusion/dissection
What are the 4 sxs of cerebral artery occlusion/dissection (complication of cervical manipulation)
- Cervical/suboccipital pain
- Dizziness
- N/V
- Vision loss
What is cervical radiculopathy?
Neurogenic pain in the distribution of cervical roots
+/- numbness and tingling
What are the 2 causes of cervical radiculopathy and what age groups are they MC in?
- Cervical disc bulge/herniation (young and old)
- Cervical foraminal narrowing (old)
Abrupt onset of cervical radiculopathy indicates what as the cause?
disc bulge/herniation
What is the hallmark sx of cervical radiculopathy?
Cervical radicular pain increased w/:
- rotation, lateral flexion and extension to involved side
What is the name of the test used to test for cervical radiculopathy?
Will this test be pos or neg?
Positive spurlings
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
In young adults, are you more likely to see abrupt or gradual onset of cervical radiculopathy?
abrupt
Which of the following views allows you to optimally see the (cervical) foramen?
The oblique view
What are the 5 x-ray views used when evaluating for cervical radiculopathy?
- A/P
- Lateral
- Odontoid
- R/L obliques
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)
What is conservative tx for Cervical radiculopathy? (5)
- NSAIDs
- Steroids (Prednisone)
- Acetaminophen
- PT (cervical traction, postural education)
- OT
Which condition?
- Degenerative dz
- Osteophytes
- Ligamentum flavum thickening
- Disk space narrowing
- Vertebral subluxation
Cervical spondylosis
What cervical levels is Cervical Spondylosis MC at?
- C5-C6
- C6-C7
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 facet joints
Cervical Spondylosis
Is there TTP to the affected area in a cervical sprain/strain and whiplash?
yes
What is the main concern for cervial spondylosis?
Myelopathy
- Weak hands/atrophy of hand musculature
- Leg weakness
- unsteady gait
- Bladder/bowel dysfunction
- hyper-reflexia
- Lhermittes sign
- sensory impairment
Myelopathy (Cervical Spondylosis)
Which condition has Lhermitte’s sign (electric shock down back w/ neck flexion)
Myelopathy (Cervical Spondylosis)
What condition?
Cervical Spondylosis
What condition?
Cervical Spondylosis
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)
Should you prescribe narcotics for Cervical Spondylosis?
NO
