Cervical Spine Pathophysiology Flashcards
What is the incidence and prevalence of cervical spine issues?
Affects 90% of individuals within their lifetime
Prevalence of neck pain increases w/age (common in your 50’s)
25% pts in PT for neck pain
Actual origin is often undefinable
~80% of cases involving back & neck pain have an underlying path that can’t be determined
What does it mean if someone has impaired posture?
Center of gravity anterior to OA joint
What can lead to a impaired posture?
Excessive & prolonged forward head pathology
What is postural syndrome?
Symptoms that are developed from sustained loading, relieved by change in position
What is the clinical examination for impaired posture?
Postural Exam
A/PROM→ Flexibility
Strength & Endurance
Accessory Motion Testing/ Joint Play
Ergonomics
What is the intervention for impaired posture?
PT primarily
What is the MOI for acute traumatic injuries?
Violent flexion (C4/5, C5/6)
Impaction
Lateral stretch injuries (brachial plexus)
Extension
Extension followed by flexion (whiplash)
What tissues are hurt due to trauma?
Ligament
Musculotendinous units
Bone
Disk
Articular cartilage
Nerves/Spinal Cord
Acute injuries diagnostics?
X-ray, CT, MRI
What are some interventions for acute injuries?
Short term immobilization
Soft collar or shell based collar
NSAIDs
PT
May need surgery to correct fracture
When should a clinician be suspicious of serious injury in presence of vague clinical signs?
Following a MVA (40MPH) or fall from a height (5 ft) or down 5 stairs
What indications are there to a negative Canadian Cervical Spine Rule?
No high risk factors
Safe Assessment of ROM
Patient is able to actively rotate 45° both
Spondolosis
degeneration
What is the prevalence of disc herniation?
Male or female
25-55 yrs old
What is the area of complaint for disc herniation?
Neck or scapular pain
May complain of vague whole upper extremity or hand aching
Pain at medial border of scapula
What is stenosis?
narrowing of spaces within spine
What can cause cervical stenosis?
disc herniation
What is lateral stenosis?
Narrowing of intervertebral foramen
What is central stenosis?
Narrowing of spinal canal
What are symptoms of lateral stenosis radiculopathy?
Male or female
Pt will most likely report neck & arm symptoms
Pain referred (Scapula & UE)
Paresthesia follows dermatome
Neuro screen will reveal weakness in particular myotome & abnormal MSR/DTR
What are symptoms of central stenosis myelopathy?
Male or female
22-55 yrs old
More subtle particularly in early stage
Neck pain
Unsteadiness in gait or clumsiness
Multidermatomal distribution of paresthesia
Hoffman and Babinski signs are significant
Childs table 1 for more risk factors/key findings
What will Hoffman & Babinski indicate clinically?
Generally indicate cord involvement in cervical spine or intracranial pathology
What diagnostic modalities are needed for cervical stenosis?
EMG/NCS, MRI
What are the 4 criteria for Wainner’s CPR for cervical radiculopathy?
Cervical spine rotation <60°
+ spurlings test
+ distraction test
+ upper limb nerve tension test (Elvy’s test)
What is the management approach for cervical radiculopathy?
Radiculopathy
Consertive care primarily PT (centralization category → cervical traction, RMT etc), epidural injections
What is the management approach for cervical myelopathy?
Surgical, especially if progressive & disabling in nature
What are the characteristics of degenerative joint disease?
Male>Female
45+ years old
Symptoms usually Bilat & often do not cross midline
When bad is can radiate to SSF +/- mid-scapula #ouch
Deep ache
Rarely functionally limiting, but wears patient down
What are the characteristics of DJD in older adults?
Proliferation of calcific deposits in & around the periphery of the joint (Osteophytes)
Wearing away of hyaline cartilage
Thickening of synovial lining & joint capsule
Thickening of subchondral bone
AKA spondylosis
