CERVICAL SPINE MT #1 Flashcards by ROGER ALONSO

Cervical Spine–Introduction X 19

List of conditions discussed herein:

1) Sprain/strain
2) Fracture
3) Dislocation
4) Herniations
5) MFPS
6) Radiculopathy
7) Myelopathy
8) Degenerative disease
9) Infection
10) Discitis

KNOW

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Cervical Spine–Introduction X 19

11) Muscle spasm
12) “Postural syndrome”
13) Referred pain
MI, carotidynia, throat, ear, teeth, etc…
14) Lymphadenopathy
15) Meningitis
16) Tumor/malignancy
17) Angina
18) Temporomandibular joint syndrome/dysfunction
19) Thoracic outlet syndrome

KNOW

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Cervical Spine–Introduction

RED FLAGS– requiring caution, films or referral:

1) Severe trauma
2) ______ ______ trauma with loss of consciousness
3) Nuchal rigidity
4) A NEW, severe headache, or “the worst one I’ve ever had”
5) Associated _______ or _________
6) Associated cranial nerve or CNS signs/symptoms
7) History of cancer, RA or Down syndrome
8) Alcoholism or drug abuse
9) Known immunocompromise

Direct head

dysphaGIA—Difficulty with SWALLOWING is the sensation that food is stuck in the throat, or from the neck down to just above the abdomen behind the breastbone (sternum).

dysphaSIA—-language disorder marked by deficiency in the generation of SPEECH, and sometimes also in its comprehension, due to brain disease or damage.

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Cervical Spine–Introduction

The patient has neck pain, and has been in an accident.What possible problems should you be considering?

1) Sprain/strain injury
2) Fracture
3) Dislocation
4) _______________

Disc herniation

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Cervical Spine–Introduction

What are some possible injuries for a patient whose head has been forced into FLEXION?

A.  Sprain/strain of posterior muscles/ligaments
B.  Dislocation of \_\_\_\_\_\_\_\_\_
C.  \_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
D.  Fractures:
1) Spinous avulsion fractures  (Clay shoveler’s)
2) Wedge of body
3) Burst
4) Teardrop

facets

Disc herniation

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Cervical Spine–Introduction

What are some possible injuries for a patient whose head has been forced into EXTENSION?

A. _______/_________ of anterior structures
B. Fractures
1) Compression fracture of facets
2) Teardrop fracture (anteroinferior body C2)
3) Hangman’s fracture (bilateral pedicle fracture C2)

Sprain/strain

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Cervical Spine–Introduction

What are some possible neural injuries for a patient whose head has been forced into LATERAL FLEXION?

A. ____________ nerve root compression
B.____________ brachial plexus stretch injury
C. Facet fracture

Ipsilateral

Contralateral

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Cervical Spine–Introduction

What would cause pain, NUMBNESS, or WEAKNESS in the UPPER extremity?

1--Disc lesion
2--Nerve root \_\_\_\_\_\_\_\_\_\_\_\_
  A.  weakness or numbness
3--Referred pain
4--Ill-defined, diffuse pattern of pain/numbness
5--Myelopathy 
6--Brachial plexus damage
  A.   Numbness/tingling resolved in minutes: “\_\_\_\_\_\_\_/\_\_\_\_\_\_\_”
7--Double crush syndrome

entrapment

burner/stinger

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Cervical Spine–Introduction

What would cause a patient to be unable to move his/her head in a particular direction?

1—________________
A. “I just woke up with it”, the dreaded “crick in the neck”, etc.

2—___________
A. Gradual onset over years; older patient

3—Fracture/dislocation
A. Recent trauma

4—______________
A. Symptoms of fever/infection, severe pain on flexion

Torticollis

Osteoarthritis

Meningitis

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Cervical Spine–Introduction

What about chronic pain and/or stiffness?
1—Osteoarthritis
2—_________syndrome
A. Forward head posture (anterior head carriage) or other sustained posture
4—Subluxation
A. Local pain with specific movement

Postural

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Cervical Spine–Introduction–Cervical Sprain/Strain

1—Whiplash/Acceleration-deceleration Injury
2—SIDE IMPACT
3—FRONT END IMPACT
4–REAR END IMPACT

KNOW EXAMPLES

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Cervical Spine–Introduction–Cervical Sprain/Strain

Cervical Sprain/Strain

1---3 Grades- mild, moderate, severe
2---Local pain
3---Palpable spasm and tenderness
4---Decreased and painful \_\_\_\_\_\_\_
5---Distraction test, Shoulder depression test
6---Negative neurological tests
A...--May develop TOS type syndromes

ROM

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Cervical Spine–Introduction–Cervical Sprain/Strain

Torticollis

The Latin word tortus means ‘______.’ Collum (collar) means ‘neck.’Torticollis simply means TWISTED NECK. It can have many different causes.

1–Congenital is often from birth trauma
A. Fibrosis of sternal head of SCM
B. 90% respond to stretching in first year of life
2—Spasmodic (CNS disorder)
A. Repeated muscular spasms “_____ _______”
3—Acquired
A. Trauma & spasms
4—Restriction is limited to one side
5–______ spasm-head in rotation and flexion

twisted

cervical dystonia
**Cervical dystonia is characterized by excessive pulling of the muscles of the neck and shoulder. The excessive pulling causes the head to turn or tilt involuntarily. Most commonly, the head turns to one side or the other. Tilting sideways, or to the back or front may also occur. Often, the turning and tilting movements are accompanied by jerky or wobbly movements known as tremor. Also common is soreness of the muscles of the neck and shoulders.—-he cause of cervical dystonia is unknown.

SCM

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Cervical Spine–Introduction–Cervical Sprain/Strain

Torticollis Exam Findings

1—-Decreased active and passive ______
2—-______ spasm and trigger points

ROM

SCM

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Cervical Spine–Introduction–Cervical Sprain/Strain

Facet Syndrome

1—Minor to moderate traumatic onset of neck and arm pain (___-___________)
A. Can be insidious
2—-Painful extension with ____________
3—Insidious or traumatic

non-dermatomal

rotation

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Facet Syndrome Exam Findings

1—All orthopedic maneuvers involving _________ observed to be positive
2—Trigger points
3—Maybe facetal __________ on x-ray

compression

degeneration

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Spinal Stenosis

1—Central (< ___ mm) or foraminal

2—Foraminal stenosis may be _______or__________

3—May affect more than ______ _________

unilateral or bilateral

one level

Cervical Myelopathy

1—-_________ symptoms of arm pain, clumsiness, difficulty walking, spastic weakness, paresthesia, hoarseness, vertigo, bowel/bladder dysfunction

2—Secondary to any space-occupying lesion (SOL)

3—Central canal stenosis can be measured on plain film radiography (

Bilateral

MRI

Cervical Myelopathy Exam Findings

1—Signs of LMN, UMN, cerebellum, and/or PC disease

2—All _____ potentially decreased

3—Bilateral spastic paresis UE, later LE

4—_______________ superficial reflexes

ROM

Decreased

Pathogenesis—Cervical Spondylosis

1—-Primary – etiology =___________

2—-Secondary – results from overt trauma, microtrauma dysfunction

3—–Due to limited room in the ____ for exiting nerve roots, subluxation & osteophyte formation in POSTERIOR joints readily compress the roots
a. Especially after ANY injury with associated soft tissue ____________.

unknown

IVF

swelling.

Incidence—Cervical Spondylosis

1—-Primarily affects the C__/C__& C__/C__ vertebral segments

2—-Present in 60% of those over _____ YEARS OLD

C5 & C6

C6 &C7

Clinical Features of Cervical Spondylosis x 6

1---Stiffness &amp; achiness
2---Usually \_\_\_\_\_\_\_\_\_\_
3---May have \_\_\_\_\_\_\_\_\_\_\_\_\_\_
4---May have pain down the spine between the \_\_\_\_\_\_\_
5---May have radicular symptoms
6---Dx primarily by x-ray

**look for “SPUR OF BONE”
& NARROWING OF DISC as well. (slide 32)

unilateral

paresthesias

scapula

Degenerative Changes of Cervical Spondylosis x 4

1—________________ (esp off the joints of Luschka)
2—Loss of disc ____________
3—IVF encroachment
4—Sclerosis

Osteophytes

height

Degenerative Changes of Cervical Spondylosis
via CLINICAL CHANGES X 4

1—-If upper extremity symptoms, then possibly could be the primary complaint.

2—Spondylitic Myelopathy a.k.a ________ _________

a. Direct cord compression or ischemia = __________
- -Gait disturbances
- -Paresthesias
- -Weakness
- -Clumsiness

Spondylosis Deformans

myelopathy

Degenerative Changes of Cervical Spondylosis via CLINICAL CHANGES X 4 3---Difficulty swallowing = ___________ off anterior aspect of vertebral bodies 4---_________ may create transient, partial or complete occlusion of the vertebral arteries ***CMT contraindication

osteophytes Osteophytes

Management of Cervical Spondylosis 1---Spondylitic myelopathy, vascular compromise, and/or esophageal compromise = co-management 2---VBAI or spondylitic myelopathy = __________ to CMT 3---Acute elderly pt. = ____-______ techniques

contraindications non-force

Cervical Disc Herniation x 9 1---WITH or WITHOUT nerve root compression 2---Classification (Jomin et al.) *Class 1 – __________ syndrome – c/s pain and stiffness only **Class 2 – ________ ___________ syndrome – mixed c/s and neuro signs ***Class 3 – _________ syndrome – purely radicular signs ****Class 4 – ______ ________syndrome – cord signs and symptoms

Cervical Neurological radicular Radicular Spinal cord

Cervical Disc Herniation x 9 3---Decreased posterior lateral herniations (posterior longitudinal ligament--PLL-- is THICKER in c/s) 4---Before age 40 more likely a _________ (HNP), after age 40 more likely ___________ (DDD) 5---COMMON levels – C4-C7 (usually 4th decade, C6 & C7 most common) 6---Etiology – most frequently, secondary to _________ 7---Clinical Sx- Neck and arm PAIN * ** Valsalva * **Cramping and/or aching muscle pain

herniation degeneration trauma

Cervical Disc Herniation x 9 8---Natural Hx – tend to resolve in ___-____ weeks 9---Management * *******Class 3: usually LIMITED success with CMT * *******Class 4: referred for NEURO consult * **CMT – JMPT 1998 – found CMT to upper c/s reduced symptoms in lower c/s herniations * **_________

7-12 Traction

Types of Disc Involvement X 5 ``` 1----________ 2---Herniation 3---Protrusion 4---Extruded 5---_____________ ```

Bulge Sequestered disc

Burner/Stinger X 2 1---Sudden burning pain down _______ arm following a lateral FLEXION injury 2---Traction injury of the nerve root or plexus yielding brief (minutes) AKA ___________

lateral = neuropraxia ****Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery. Neurapraxia is derived from the word apraxia, meaning “loss or impairment of the ability to execute complex coordinated movements without muscular or sensory impairment”.

Burner Exam Findings X 3 1--Painful and decreased __________ flexion 2--Shoulder depression positive on side AWAY from lateral flexion 3--____________ on shoulder abduction, external rotation and flexion

lateral Weakness

Cervical Instability X 4 1---Rust’s Sign 2---Diagnosed primarily through x-ray 3---May be ______ cervical C1-C2 due to RA, AS, Reiter’s, PA, or Down syndrome ***ADI > 5 mm in children and > 3 mm in adults equals pathology (Q: what would be a “normal” ADI?) 4--May be _________ cervical due to degeneration and/or previous trauma > 3mm translation of flexion > 11 degree kyphosis Need to do Davis series

upper lower

Upper Crossed Syndrome X 3 1----___________ head carriage 2----WEAK deep neck _______ and scapular stabilizers 3----Tight __________, upper trapezius/levator scapulae mm (resulting in rounded shoulders)

Anterior flexors pectorals,

Syringomyelia X 3 (Syringomyelia is damage to the spinal cord due to a fluid-filled hole that forms in the cord.) 1---Developmental problem in which the central spinal cord develops a ______ or from a tumor 2---Associated with _____- _____ ___________ ***The cerebellum and brain stem protrude, or herniate, through the foramen magnum and into the spinal cord. 3---Usually found in adolescents/young adults

syrinx ***A syrinx results when a watery, protective substance known as cerebrospinal fluid, that normally flows around the spinal cord and brain, transporting nutrients and waste products, collects in a small area of the spinal cord and forms a pseudocyst. Arnold-Chiari malformation

Syringomyelia Exam Findings X 4 1---Loss of pain/temperature recognition in a “____-___” distribution 2---Atrophy and _________ 3---Scoliosis-LEFT thoracic, RIGHT lumbar curves 4---Treated with decompression surgery, laminectomy, shunt

shawl-like ***a piece of fabric worn by women over the shoulders or head or wrapped around a baby. areflexia = ****areflexia - absence of a reflex; a sign of possible nerve damage.

Management--Mercy Guidelines of Syringomyelia X 2 1---6 weeks of care is usual for “__________ ______” A. 3-5 treatments per week for 1-2 weeks B. Gradually _______ frequency if the patient is responding C. If NOT responding: ____ more weeks of care, but consider a different course of treatment or altered diagnosis 2---Factors that may INCREASE recovery time: A. Prior history of > 4 episodes B. Symptoms lasting > 1 week prior to presenting C. Severe PAIN or ___________ pathology

uncomplicated cases decrease TWO structural

Acute Management of Syringomyelia x 5 ``` 1----Ice 2----E-stim 3----Ultrasound 4----BRACING a----Use of soft collars beyond 72 hrs will probably ____________ disability Rehab? = (“________”) ```

increase No, no, no . . .

Sub-Acute Management of Syringomyelia x 6 ``` 1---Ice 2--E-stim 3---Ultrasound 4---Mobilization, CMT 5---Gentle _________ 6---Rehab (“No, no, no . . .”) ```

stretching

Chronic Management of Syringomyelia x 3 1---Aggressive stretching and rehab??? (“No, no . . . never mind . . .”) 2--CMT 3--____________ focus on passive modalities

Decrease