Cervical Spine Neck Pain/Whiplash/Torticolis Flashcards
Which cervical spine articulations are considered typical?
C2-C7
In what directions do the upper facets of the cervical spine face?
Points to the eye
In what directions do the lower facets of the cervical spine face?
opposite ASIS
What is the major motion of the OA joint?
Flexion and extension. Minor motions are SB and rotation
The occiput rotates and SB to what direction?
opposite sides
What is the primary motion of the AA joint?
Rotation. Almost no SB or flexion/extension
Are typical cervical segments (C2-C7) type I or II or modified?
Typical cervical segments (C2-C7) are modified Type II mechanics. Rotation and SB to the same side. In clinical cases may encounter SB and rotation to opposite sides
When performing HVLA on the OA in what direction should should your thrust be?
Towards the eyes.
To treat side bending component of typical C spine using HVLA in what direction should the thrust be? Rotation?
SB = Towards T1 spinous process Rotation = use Rays of sun method
Why is HVLA contraindicated for pts on anticoagulants?
Shear stress can lead to intracranial bleed
What are some most frequent complications result of HVLA to C-spine as seen int he 1981 Swiss study?
- occipitobasilar strokes (Wallenburg syndrome)
-vertebral artery compression with thrombosis
arterial dissections
cerebellar infarctions
HVLA complication is primarily occur because of C-spine when _
c-spine is already extended
As seen in HVLA complications, right rotation could occlude which vertebral artery (right or left?)
Right rotation occludes left vertebral a.
What is whiplash?
generic term for acute hyperflexion/hyperextension injuries in the cervical spine
In a whiplash injury, describe the mechanism of injury?
Impact propels body in a linear horizontal direction. Head momentarily remains stationary, then abruptly moves in opposite direction of impact force vector. cessation of impact, combined wth an acute stretch reflex, causes recoil int he same direction as the initial force vector.
In whiplash injury, which casues greater injuries, hyperflexion or hyperextension?
hyperextension
In whiplash injury, which tissues are susceptible to injury?
Superfical soft tissues
- vertebral complexes (vertebrae, ligaments, and tendons)
- peripheral and sympathetic nervous systems
- vascular system
- cerebrum
Explain the pathophysiology of superficial soft tissues damage during whiplash injury.
Abrupt elongation initiates acute stretch reflex, mostly in the intrafusal muscle fibers in the muscle spindles, which normally monitor muscle length. This initiates reflex contraction. if stretch is severe enough, tearing can occur in extrafusal fibers.
In whiplash injury, which anterior superficial soft tissue is the first to become injured?
SCM, can develop head tilt and painful torticollis
What are some possible injuries seen in vertebral complex?
Hyperextension: strain/tearing of anterior longitudinal ligament; vertebral body or spinous process fracture; facet encroachment due to posterior glide.
Hyperflexion: sprain/tearing of supraspinal, intraspinal, or posterior longitudinal ligaments; capsular tear +/- facet subluxation or dislocation; rarely, posterior disc herniation
Cervical nerves connect to sympathetic system via preganglionic fibers in the lateral horns cell from _.
T1-T6
What are some factors affecting whiplash injuries?
- Force of impact
- Position of head (often somewhat turned to one side)
- position of hands
- awareness of impact
- headrest position
- preexisting conditions
In whiplash injury due to MVA what pelvic injuries are often seen?
ilial rotation and pubic shears due to the fact that usually only one foot is planted (usually on brake while stopped)
What are some common upper extremity injury you’re likely to see with whiplash?
Soft tissues of the shoulder like GH capsule, AC, CC, and rotator cuff muscles and traps.