Cervical Spine Pathology- Lecture Flashcards
1
Q
Posture syndrome:
A
- Most common: Forward Head Posture (FHP), protracted shoulder girdle
- Lateral shifts secondary to: pain, scoliosis, discal dysfunction, muscle imbalance
- Upper cervical compensations to posture
- Extension posture with FHP
- Lateral bending/rotation with lateral shift/scoliosis
2
Q
Posture:
A
- Can have underlying deformity
- Need to determine need for imaging (e.g., Klippel Feil)
- Habitual poor posture is felt to lead to early degenerative changes
- Poor posture creates muscle imbalance
- Shortened or overactive upper trap, levator scapula, SCM, Scalenes, suboccipital muscles, pectoralis minor
- Weak middle and lower trap, deep cervical muscles (longus colli)
- Weak deep cervical flexors is a consistent finding across many cervical pain syndromes and dysfunction
- Tested with cranio-cervical flexion test (avoid substitution with SCM)
- When using SCM for resisted neck flexion, head protrudes rather than flexes
- Mouth breathing
- Tongue position
- Elevated first rib
- Tight levator scapulae, pectoralis minor
- Weak lower and middle trap
- Scapular diskinesia leads to impingement at the GHJ with rotator cuff dysfunction
- Initially: pain (maybe HA) with poor posture, relieved with postural correction
- Chronic postural faults: Myofascial pain syndrome, ligamentous changes, discal pathology, thoracic outlet syndrome, thoracic dysfunction
- Upper cervical dysfunction
3
Q
Spondylosis / Spondylolysis:
A
- Condition of (losis) / degeneration of (lysis)
- Degenerative osseous and soft tissue of the vertebral column (spondy = spine)
- Affects the discs, joint, vertebral bodies, and ligaments when advanced
- In advanced stages can lead to stenosis and cervical myelopathy (myelo = spinal cord, pathy = pathology)
- Arthrotic change with disc degeneration
- Typically will see loss of cervical lordosis on x-ray
- Degenerative changes develop over time
- Leads to osteophyte production and secondary syndromes
- Spinal stenosis – myelopathy
- Discal disease
- Capsular pattern
- Rotation (equally and bilaterally) and extension (equally and bilaterally) will be limited to varying degrees
- Full flexion Lateral Bending and Rotation equally limited bilaterally
- Extension limited
- Flexion will be full
4
Q
Discogenic / Facet Torticollis (Acute Torticollis or “Wry Neck”)
A
- Acute onset
- Usually a previous history of neck pain
- Prefers a slight flexed posture, holds head looking to contralateral side
- Limited rotation, lateral bending to ipsilateral side > contralateral side. Extension limited > flexion
- Not a true“torticollis”(torticollis = lateral bending and rotation to opposite sides)
- Typically rotation limited and painful to the side of symptoms > side away from symptoms
- Postures away from symptoms: flexed, rotated away slightly
- Determining actual structures involved is difficult with clinical exam
- May palpate a kyphotic kink, or may be demonstrated with radiograph
5
Q
Nerve Root/spinal nerve Involvement
A
- Muscle weakness of a myotomal distribution
- Loss of sensation in a dermatomal distribution
- Diminished or a loss of deep tendon reflexes associated with that particular nerve root
6
Q
Neural Involvement
A
- Parasthesia
- Pain
- Response of the nerve to chronic compression or chronic stretch
7
Q
Tests for Neural Involvement
A
- Sensation testing (hot / cold discrimination lost first)
- Muscle testing
- Deep tendon reflex testing
- ULNTT
- Assess for autonomic nervous system involvement
8
Q
Acute Nerve Root Pain
A
- Lancinating / Shooting Pain
- Sharp / Burning Quality
- Well defined narrow borders
- Worse distally than proximally
- Spontaneous surges of pain
9
Q
Nerve Root Sleeve or Dural Involvement
A
- Can refer pain to the head
- Extrasegment referral of pain
- Pain is worse proximal but can be referred distal
- Vague distribution of pain
10
Q
Clinical Exam Radiculopathy
Test Item Cluster
A
- Ipsilateral rotation (<60 degrees) [closing motion]
- Spurlings A
- Distraction
- ULNTT A
- Secondary findings:
- Predominant scapular pain
- Arm pain with neck movement
11
Q
Differential: Pain Referral from Deep Somatic Structures
A
- Vague, deep pain
- Pain worse proximally, but spreads distally
- Hard to localize, can be nauseating
- In the limb rather than on the skin
- As the condition worsens the pain spreads distally
12
Q
Cervicomedullary Syndrome
Cervical Myelopathy
A
- Impingement on the spinal cord by bone, disc, tumor, etc.
- Leads to both lower and upper motoneuron signs
- Can be due to injury (trauma), displaced vertebra (listhesis), disc bulge/herniation, osteophyte, tumor, or stenosis
13
Q
Cervical “Instability”
A
- Craniocervical flexion test
- Feeling “head will fall off” with extension
- Headache is common report
- Difficult with returning to neutral from extension
- Manual support relieves symptoms with movement
14
Q
Examination for Upper Cervical Instabilities
A
- Sharps Purser
- Alar ligament test
- ADI on lateral radiograph
- flexion ADI should be less than 3 mm
- Open mouth view radiograph (dens fracture, lateral displacement due to alar ligament failure)
- Life threating situation
- Management is surgical
15
Q
Vertebrobasilar Insufficiency
A
- No clear distinguishing symptoms
- Examining for features to fit
- Symptoms to head and face
- Headaches
- Dizziness
- Visual and / or hearing disturbance
- Drop attacks, syncope
- Paresthesia
- Autonomic disturbance
- Most common symptoms from the vertebral artery are: Neck pain and Headache
