Cervical Spine Pathology Flashcards
What are the two general categories of Cervicogenic Dysfunction?
- Hypomobility of cervical spine
- Hypermobility of cervical spine
What types of problems are related to hypomobility of the cervical spine? (Give general categories and examples)
- Postural syndromes (eg. chin poker or upper cross)
- Trauma induced (eg. whiplash, blunt-force)
- Genetic (Ankylosing Spondylitis)
- Age related (OA, spondylosis, stenosis)
What are the possible complications with hypermobility of the cervical spine? (General categories and examples)
- Trauma induced ligamentous injury or bony fractures (eg. transverse and alar ligaments, dens fracture, capsular or ligamentous laxity)
- Genetic (Down’s syndrome, RA)
What are the alar ligaments?
The alar ligaments connect the sides of the dens (on the axis, the second cervical vertebra) to tubercles on the medial side of the occipital condyle.
Two little ligaments that go upwards 45 degrees, help to check rotation. Excessive rotation at the occiput you will put vertebral arteries at risk.
What is the dens? What is the transverse ligament? What might happen if the transverse ligament is damaged?
Dens is part of C2, projects superiorly and atlas rotates around it. Dens kept in place by transverse ligament. Just behind that is spinal cord. If dens was allowed to move freely back in space toward posterior arch of atlas as it would do in flexion if transverse ligament was not holding it in place it would migrate backwards into the spinal cord? Atlas anterior which would bring dens posterior and that would impinge your spinal cord.
What is the etiology and cause of whiplash?
Etiology: Sprain/strain of cervical spine (only refers to cervical spine)
Cause: High velocity forward flexion and/or extension of the cervical spine often from sports or MVA.
What are the symptoms of whiplash?
- Concussion symptoms
- Decreased cervical ROM
- Headaches
- Muscle spasm
- Neck and shoulder pain
- Radiating symptoms down arm (radiculopathy)
What specific part of the cervical spine is usually affected in whiplash?
What if you are hit from behind vs the one running into something?
Compression of facet joints. Not necessarily capsular laxity or ligamentous laxity, more of a compressive force so you get facet joint irritation or potentially fracture depending on head rest and how fast they were going. If you are the one behind who hits the person then you will have hyperflexion (will see transverse and alar ligaments affected) first and then possibly hyperextension.
What ligaments and muscles are more affected if head is turned when the impact happens?
What will happen if you “see the accident coming” vs are “hit out of the blue”?
Alar ligament more on stress if head is turned when the impact happens. Suboccipital muscles on one side will be more stressed.
If you see the accident coming you tense up more which protects your spine but you will have more soft tissue injuries. If you do not see it coming you have a more chance of injuring bones and ligaments.
What are some questions to ask after an MVA?
- Speed of collision
- Position of head
- Hit from behind or T-boned
If the person’s muscles spasm and everything tightens up when you are doing ligament testing what should you do?
Send them back to doctor for imaging. Headaches could be from muscle, vertebral artery, ligaments.
What is the cause and pathophysiology of a concussion?
Cause: Linear and/or rotational forces transmitted to the brain
Pathophysiology: “The Neurometabolic Cascade”: a complex cascade of ionic, metabolic and pathophysiological events that accompany microscopic axonal injury. The energy needed to re-establish homeostasis (disrupted ionic and metabolic balances) occurs in the presence of decreased cerebral blood flow and ongoing mitochondrial dysfunction, resulting in an imbalance of energy supply and demand.
Majority of concussion symptoms resolve within _____ in severe cases they may persists for _____, _____, ______. The definition between concussion and post-concussion syndrome is therefore one defined by time: the presence of concussion symptoms lasting for _____ to ____ is post concussion syndrome.
7-10 days
weeks, months, years
weeks to months (basically if symptoms are lasting longer than a week you have post concussion syndrome)
The concussed brain is ____ responsive to _______ __________. Therefore when ______ cognitive or physical activity occurs before complete recovery, the brain may be vulnerable to prolonged ________.
less; neural activation
premature
dysfunction
What are some physical sn/sx of a concussion?
- Balance problems
- Dazed/stunned/fogginess
- Dizziness
- Fatigue
- Headache
- Nausea, vomiting
- Numbness, tingling
- Visual problems
- Sensitivity to light, noise
What are the cognitive sn/sx of a concussion?
- Confusion
- Difficulty concentrating
- Feeling slowed down
- Forgetfulness
- Mental fog
- Repeated questions
- Slow verbal responses
What are the emotional and the sleep sn/sx of a concussion?
Emotional:
- Irritability
- More emotional than usual
- Nervousness
- Sadness
Sleep:
- Drowsiness
- Difficulty falling asleep
- Sleep more or less than normal
What is second impact syndrome and what is the pathophysiology of it?
SIS: A second concussion is sustained before the effects of the first concussion have dissipated.
Pathophysiology: The exact cause is unconfirmed but it is thought to be a loss of autoregulation of the brains blood supply resulting in vascular engorgement and marked increase in intracranial pressure, brain herniation and ultimately coma or death may occur.
What is the progression of activities before return to sports after a concussion?
- A progression in physical demands, sports specific activities and risk of contact.
- Patient must be symptom free at rest as well as during and after exertion before progressing to next step
- If patient experiences symptoms with a certain level of exertion, they are to be brought back to the previous level.
Are helmets and/or mouthguards useful in preventing concussions? What is the primary form of prevention for concussion?
- Helmets (soft and hard) are best suited to prevent impact injuries but have not been shown to reduce the severity of concussions.
- There is no current evidence that mouth guards can reduce the severity or prevent concussions.
- Primary prevention comes in the form of modification and enforcement of rules of fair play as well as education regarding concussions and post concussion syndrome.
Transverse Ligament Injuries Classification, Causes, Result?
Type I: Intersubstance tear
Type II: Bony avulsion
Causes: Trauma, Down’s syndrome, Rheumatoid Arthritis
Result: Dens (Odontoid) travels posteriorly into the spinal canal.
What is happening when there is clicking or locking of the jaw?
In a normal TM joint the condyle should rest against a disc when the jaw is closed. The disc should also move with the condyle to cushion it when the mouth opens.
If there is clicking it is usually because there is an anteriorly displaced disc such that the condyle does not sit in cartilage when the jaw is closed and has to click over it during opening.
With a locked jaw the condyle is squishing into the disc and the disc is folding to an extent that it blocks the condyle from moving further.
