Cervical Spine: Neck Pain, Whiplash and Toricollis Flashcards
What are the mechanics for C1 (OA Joint)?
Modified Type 1: Can contain a flexion/extension component
What are the major motions of the OA joint?
Flexion and Extension
What is the primary motion of the Atlantoaxial Joint?
Rotation (Atlas rotates about the dens)
Almost NO SB or flexion/extension
What are the mechanics for the Typical C-Spine segments (C2-C7)?
Type II - Like Mechanics
What are some contraindications to HVLA of the C-Spine?
- Rheumatoid Arthritis
- Down Syndrome (Might not have a full Dens)
- Peripheral Vascular Disease
- Osteoporosis of risks thereof
- Patients on Anticoagulants
Define Whiplash injuries.
Generic term for acute hyperflexion-hyperextension injuries in the c-spine
Which motion within Whiplash injuries is going to cause greater injury?
Hyperextension
Explain the pathophysiology of superficial soft tissue damage in whiplash injuries.
Abrupt elongation initiates acute stretch reflex
If stretch is severe, tearing can occur in EXTRAfusal fibers (contractile elements of muscles)
What is the 1st muscle to get injured on the anterior aspect of the neck?
Sternocleidomastoid M.
What are the muscles that can be injured on the posterior aspect of the neck?
Suboccipital Ms.
Intrinsic Ms. (Multifidus)
Should girdle Ms. (Levator Scapulae, rhomboid, and trapezius)
Which ligaments can be messed up with Hyperextension and Hyperflexion?
Hyperextension: Anterior Longitudinal L.
Hyperflexion: Posterior Longitudinal L. (Rare Disc herniation)
Which nerve is going to be giving you the headaches after a whiplash event? What is a treatment that can relieve that pain?
Greater and Lesser Occipital N. irritation
Suboccipital Release
What should you check for if a patient describes a blinding or exploding sensation in head at the time of Whiplash Injury?
Concussion
How can you prevent a hyperextension injury?
Adjust the head rest to the correct height!
You should immobilize the C-Spine until which event?
Immobilize C-Spine until cleared by X-Ray
What other injuries might occur with Whiplash?
- Pelvic Injury: Ilial Rotations and Pubic Shears
- Thoracic and Lumbar Injuries
- Cranial Injury
- Upper Extremity Injury
Will patients feel better or worse the next day after a whiplash injury? Why?
Worse!
Swelling is going to get worse overnight, tell them to use Ice Packs and Anti-Inflammatories
Describe Treatment during the Acute Stage for Whiplash Injuries.
- Start off with gentle INDIRECT techniques
- Ice Packs and NSAIDs
Describe Treatment during the Early Chronic Stage for Whiplash Injuries.
(1 Week to 1 Month)
- More Aggressive Tx
- ME and HVLA in Thoracic and Lumbar areas
- ME to C-Spine and lymphatic drainage, suboccipital and fascial release, and counterstrain
- Moist heat
- NSAIDs
- Tricyclic antidepressants (TCAs): Low dose at night (sedative)
Describe Treatment during the Late Chronic Stage for Whiplash Injuries.
(1 to 3 Months or Longer)
- More OMT similar to Early Chronic Stage
- Electrical stimulation to avoid atrophy of muscles
- Emotional Support
What are the two important predictors of pain 1 year after an accident (according to UK study)?
- Pain severity at time of rear-end collision
2. Presence of a compensation claim (Sometimes when the money is gone, then the pain goes with it!)
What are the different muscles involved with Torticollis?
Toricollis: SCM spasm (rotation of head)
Laterocollis: Trap spasm (lateral tilt)
Anterocollis: Spasm anterior neck Ms. (flexion)
Retrocollis: Poster neck Ms. spasm (Extension of head)
If you notice Congenital Torticollis, what else should you consider? How might this have been caused? What do you need to do if you suspect congenital Torticollis?
- Clubfeet, Congenital Hip Dysplasia
- Cause: Difficult Delivery, One SCM is shorter than the other
- C-Spine x ray to rule out any other abnormalities
What is the best treatment for a child that is over 1 year of age? What if they are younger than 1 year?
Surgical release of SCM (Send to ortho)
You can try and fix it with OMT!
Describe the Treatment for Torticollis on an Adult.
Indirect Tx and then Progress to M. Energy
At what level of the spinal cord is the vertebral artery likely to become compressed and spasm?
C1-C2
