Cervical spine pathologies Flashcards
what is cervical spondylosis
degenerative disc disorder affecting interbody joint, lower cervical spine most affected (C5-6, C6-7, C4-5), age groups 45+, onset= insidious or traumatic. Disc space narrowing, anterior osteophyte formation, lipping & irregularity of vertebral bodies
cervical spondylosis- patho-anatomical changes
loss of disc height due to disc dehydration and degermation, vertebrae approximate, formation of marginal osteophytes, increased WB on facet joints, possible nerve root entrapment and spinal cord compression due to degenerative changes
cervical spondylosis- symptoms and signs
symptoms- bilateral/unilateral neck pain, referred pain into shoulder/arm/head, this can be somatic referred pain or radicular referred if degenerative irritate a spinal nerve, neck stiffness
signs- decreased cervical ROM (rotation and SF most affected), pain on PAIVM on affected level, altered posture, dermatomal changes if nerve root involved, degenerative changes on X-rays
cervical disc herniation
caused by degenerative weakening of annulus- nucleus propulsus goes through, affects individuals in 30’s, C6-7 and C5-6 most common affected. Uncommon- IVD in Cx supported posteriorly by PLL and laterally by uncovertebral joints, nucleus pulposus is Cx is largely fibrocartilaginous
cervical disc herniation- risk factors
age, smoking, lifting heavy objects, diving
cervical disc herniation- source of pain and disc prolapse
source= tear of outer annulus, inflammatory process, can be bilateral issue with all 4 limb (affect gait)
disc prolapse- centrally, posterolateral, bulge
cervical disc herniation- symptoms
S&S depended on size and location, acute and rapidly worsening neck pain (central or unilateral), referred pain to scapula, pain worse on ext and prolonged flex activities (cough and sneeze), antalgic posture- head held in flex
cervical disc herniation- different positions symptoms
posterolateral and spinal nerve will produce- radicular referred pain into arm and hand (lateral canal stenosis), paraesthesia and or anaesthesia into UL
if prolapse is posterior and central spinal cord may be involved= myelopathy, may get signs of cord compression (central canal stenosis)
Facet OA
degenerative disorder affecting synovial joints, most common in >65 y/o
pathology- synovitis, disintegration of articular cartilage, osteophyte formation, joint space narrowing
Facet OA- symptoms and signs
symptoms- local- often unilateral pain, somatic pain referral into shoulder/scap region depending on levels affected, stiff neck
signs- decreased ROM into facet closed pack position- ext and ipsilateral SF/ rotation
pain reproduced on PAIVM affected levels
Facet OA- position of affected levels
C2-C3= posterior to ear on left side, C3-C4= pain on neck on right side, C4-5= pain on neck lower than C3, C5-C6= pain over right shoulder, C6-7= pain over scapula
Facet OA- X ray changes
cartilage destruction of facet joints, loss of joint space, osteophyte formation around joint margin, IVD and vertebral bodies normal
Cervical radiculopathy
links to disc prolapse= nerve irritated, 9 cervical nerve roots, emerge above corresponding vertebrae but below IVD
Cervical radiculopathy- lateral canal stenosis
narrowing of I-V formation, causes nerve root compression and irritation, neurological changes
Cervical radiculopathy- nerve roots as source of pain
irritation of cervical nerve root in the IV foraminal usually in the medial half by: inflammation, posterolateral disc prolapse, degenerative changes of facet joints, most common affects C5/6/7
Cervical radiculopathy- signs and symptoms
acute severe arm pain in dermatomal distribution, altered sensation in dermatomal distribution, myotomal/reflex change, may have neck pain, arm pain worsened on movements or postures closing down IV foramina (e.g. ipsilateral rotation), significant night pain, antalgic posture, overhead arm positions may relieve
Cervical myelopathy
compression of SC by- severe central degenerative changes (osteophytes) and large central disc prolapse
S and S- chronic neck pain, less severe than lateral canal stenosis, associated symptoms= mild gait disturbances and numb clumsy hand, may have other cord signs= bladder dysfunction/ gait disturbances, LL dysfunction
cervical myelopathy- aggravated by
aggravated with movements or postures that decrease size of spinal canal (e.g. ext), usually medical emergency
what is whiplash
whiplash is an acceleration-deccerlation mechanism- may result from rear end or side impact, may result in bony or soft tissue injuries
rear end collision mechanism: hyperextension (affects anterior cervical structures) occurs first followed by hyperflexion (limited by chin on chest)
possible lesions in whiplash
muscle strain (SCM and scalenes), facet joint (capsule strain), ligament sprains/tears- ALL/PLL/IVL, IVD- prolapse and annular tears, SC and nerve root traction injuries, vertebral artery, concussion, Thoracic outlet syndrome
Whiplash- clinical picture
whiplash is a multi-level/tissue/pathology disorder, be aware of potential for instability and cervical artery trauma, often involves BOS component (PTSD)
Whiplash- duration and biological symptoms
duration= 6 weeks - 1 year biological= pain, stiffness, headaches, nausea, dizziness, referred pain, paraesthesia, blurred vision, difficulties swallowing
Whiplash association disorder (WAD) classification
WAD 1- neck pain only and no physical signs, WAD 2a- neck pain with alterations in movement and muscle recruitment and local mechanical hyperalgesia, WAD 2b- above plus psychological impairment, WAD 2c- above plus generalised hyperalgesia, WAD 3- above plus neuro sign, WAD 4- fracture/dislocation
postural dysfunction
no tissue damage/ pathology, pain is a result of tissue overstress/ strain
postural dysfunction S and S
symptoms= widespread neck pain radiating into shoulders and head, worsened by prolonged postures, often easier in morning and worse at end of day
signs- poor upper quadrant posture= trigger points, may have fall AROM and absence of joint signs, find postures that work better
cervicogenic headache
down to irritation of nucelli in top of cervical spine (trans general nucleus- TGN) or cranial nerves. Onset- often pain related to trauma, postural strain and degenerative disease, precipitating factor- sustained neck postures or movements
cervicogenic headache- S and S
dysfunction in upper Cx can present at- headaches, face/eye/TMJ/ear pain pain in suboccipital region
nausea, dizziness, SQ- headaches (5D’s) and 2 N’s
5 D’s and 2 N’s
dizziness, drop attacks (faiting), dysarthria ( loss of speech), dysphagia (loss of ability to swallow), diplopia (blurred vision)
Nause, numbness and nystagmus
Convergence theory
pathomechanics- referred pain from upper cervical spine structures
somatic referred pain from upper Cx spine
front of head- C0/1= pain above eyebrows, C1/2- pain at eyebrows= C1/2, C2/3= pain at the eyes
back of head- C0/C1= pain is in head, C1/2= pain at occiput and upper neck, C2/3= pain in the head and into neck
cervicogenic headaches- symptoms
classically unilateral, side consistency, associated with suboccipital or neck pain, pain starts in neck and spreads to head, variable severity, rarely has other symptoms, no pattern, aggravated by neck movements or sustained head or neck posture
cervicogenic headaches- signs
forward head posture, positive upper cervical joint findings- decreased upper cervical AROM, decreased upper cervical accessory ROM, weakness in deep neck flexors, trigger points in muscles supplied by C1-C3- nerves
