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PCM II > Cervical Spine Neck Pain/Whiplash/Torticolis > Flashcards

Cervical Spine Neck Pain/Whiplash/Torticolis Flashcards

1
Q

Which cervical spine articulations are considered typical?

A

C2-C7

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2
Q

In what directions do the upper facets of the cervical spine face?

A

Points to the eye

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3
Q

In what directions do the lower facets of the cervical spine face?

A

opposite ASIS

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4
Q

What is the major motion of the OA joint?

A

Flexion and extension. Minor motions are SB and rotation

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5
Q

The occiput rotates and SB to what direction?

A

opposite sides

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6
Q

What is the primary motion of the AA joint?

A

Rotation. Almost no SB or flexion/extension

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7
Q

Are typical cervical segments (C2-C7) type I or II or modified?

A

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

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8
Q

When performing HVLA on the OA in what direction should should your thrust be?

A

Towards the eyes.

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9
Q

To treat side bending component of typical C spine using HVLA in what direction should the thrust be? Rotation?

A 
SB = Towards T1 spinous process 
Rotation = use Rays of sun method
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10
Q

Why is HVLA contraindicated for pts on anticoagulants?

A

Shear stress can lead to intracranial bleed

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11
Q

What are some most frequent complications result of HVLA to C-spine as seen int he 1981 Swiss study?

A
  • occipitobasilar strokes (Wallenburg syndrome)
    -vertebral artery compression with thrombosis
    arterial dissections
    cerebellar infarctions
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12
Q

HVLA complication is primarily occur because of C-spine when _

A

c-spine is already extended

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13
Q

As seen in HVLA complications, right rotation could occlude which vertebral artery (right or left?)

A

Right rotation occludes left vertebral a.

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14
Q

What is whiplash?

A

generic term for acute hyperflexion/hyperextension injuries in the cervical spine

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15
Q

In a whiplash injury, describe the mechanism of injury?

A

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.

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16
Q

In whiplash injury, which casues greater injuries, hyperflexion or hyperextension?

A

hyperextension

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17
Q

In whiplash injury, which tissues are susceptible to injury?

A

Superfical soft tissues

  • vertebral complexes (vertebrae, ligaments, and tendons)
  • peripheral and sympathetic nervous systems
  • vascular system
  • cerebrum
18
Q

Explain the pathophysiology of superficial soft tissues damage during whiplash injury.

A

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.

19
Q

In whiplash injury, which anterior superficial soft tissue is the first to become injured?

A

SCM, can develop head tilt and painful torticollis

20
Q

What are some possible injuries seen in vertebral complex?

A

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

21
Q

Cervical nerves connect to sympathetic system via preganglionic fibers in the lateral horns cell from _.

A

T1-T6

22
Q

What are some factors affecting whiplash injuries?

A
  • Force of impact
  • Position of head (often somewhat turned to one side)
  • position of hands
  • awareness of impact
  • headrest position
  • preexisting conditions
23
Q

In whiplash injury due to MVA what pelvic injuries are often seen?

A

ilial rotation and pubic shears due to the fact that usually only one foot is planted (usually on brake while stopped)

24
Q

What are some common upper extremity injury you’re likely to see with whiplash?

A

Soft tissues of the shoulder like GH capsule, AC, CC, and rotator cuff muscles and traps.

25
Q

What are some common lower extremity injury you’re likely to see during whiplash?

A
  • Pain and decreased ROM due to sacral or iliac dysfunction as well as iliopsoas strains.
  • Injuries to hip, knee, foot and ankle
  • pelvic fracture if the foot was firmed planted impact.
26
Q

often time, juries with whiplash, symptoms due to sympathetic nervous system involvement, vascular and lymphatic impairment, become evident when?

A

May be few days to 2-3 weeks.

27
Q

What are some ways to treat acute stage whiplash injuries?

A
  • OMT as soon as possible after pt stabilizes
  • Minimize edema development and tissue reaction via OMT
  • Adjunct tx: ice packs, ice massage 1st day to two days; NSAIDS with acute inflammation
  • Physical activity with severe injury require 1-3 bed rests and then passive exercises in bed. Moderate to mind injuries need limited activities immediately as tolerated with passive ROM daily and avoid rapid movement of head
28
Q

What are some ways to treat early chronic stage (1 week to 1 month) whiplash injuries?

A

OMT - more aggressive tx: ME and HVLA in thoracic and lumbar areas. ME to cervical spine as well as vigorous lymphatic drainage, suboccipital and fascial release, and counterstrain. ROM techniques for remainder of body

  • moist heat; NSAID therapy; TCA
  • Physical activity
29
Q

What are some ways to treat late chronic stage (1-3 months or longer)

A

OMT to whole body as indicated. HVLA to any area, including the cervicals. begin with soft tissue techniques, vigorous active range of motion treatment
-Adjunct therapy similar to early chronic stage
-electrical stimulation to avoid atrophy
trigger point therapy
-PT
-Physical activity

30
Q

Torticollis is associated with what muscle and what kind of motion?

A

SCM spasm –> rotation

31
Q

Laterocollis is associated with what muscle and what kind of motion?

A

scalene m., lateral tilt

32
Q

Anterocollis is associated with what muscles and what motion?

A

Spasm of anterior neck muscles and flexion

33
Q

Retrocolli is associated with what of muscles and motion?

A

Posterior neck spasm –> extension

34
Q

What muscle is associated with congenital torticollis?

A

injury or malformation of SCM

35
Q

Congenital torticollis is usually seen by what age?

A

Usually by 2 months of age

36
Q

What is klippel-feil syndrome?

A

fusion of 2 or more cervical vertebra.

37
Q

how would you treat congenital torticollis?

A

Stretching of SCM: 1 hand stablizes chest/shoulders, and other tilts head away from contracted ms and rotates chin towards contracted side, holding for 10 sec, with 15 reps.

38
Q

What is the next step if indirect tx for congential torticollis does not work after 1-2 months?

A

Refer to ortho

39
Q

What is the best course of action for torticollis that is diagnosed after 1 year of age?

A

best tx = surgical release of SCM

40
Q

How do you treat adult torticollis?

A

OMT - indirect tx, then progress to ME
- PT
- Botox - if conservative measures don’t help
-Anticholinergics
Benzodiazepines
Muscle relaxants
Surgical tx: muscle resection, nerve ablation

PCM II (11 decks)

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