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Clinical Medicine 1 > Cervical Spine Pathophysiology > Flashcards

Cervical Spine Pathophysiology Flashcards

1
Q

incidence/prevalence of neck pain

A
  • increasing, 10-20% of pop reports neck problems, 54% exerienced in last 6 months
  • pain and impairment is common. 22-70% of pop will experience in life
  • prevalence increases with age, most common in women 5th decade of life
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2
Q

impaired posture

A
  • COG ant. to OA joint
  • excessive and prolonged forward head can lead to pathology
  • postural syndrome vs impaired posture
  • impaired posture: sends pain when moving
  • changes w/movement? musculoskeletal
  • no direction of preference? MRI
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3
Q

impaired posture diagnostics

A

clinical examination

  • A/PROM-flexibility
  • strength and endurance
  • accessory motion testing/joint play
  • postural exam
  • ergonomics (work station, etc)
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4
Q

medical and surgical intervention

A

mostly just PT

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5
Q

whiplash injuries (MVA)

A
  • extension: ALL, deep spinal and extrinsic anteriorly sublux, anterior disk protrusion
  • flexion=PLL, interspinous, erector, flavum, etc
  • facet joint/capsule open up when flexed
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6
Q

whiplash: risks for ongoing pain and disability

A
  • poorer chance of recovery among those:
  • older than 35
  • higher level of disability
  • trouble sleeping
  • irritable: over alert, easily startled
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7
Q

order of soft tissue disruption with forward flexion injuries

A
  1. SS lig
  2. IS lig
  3. Disk
  4. bone insult possible
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8
Q

spams

A

-high state of contractility

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9
Q

guarding

A

-increased tone to hold person still, neural response/protective phenomenon

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10
Q

tissues insulted due to the trauma

A
  • ligament
  • musculotendonous units
  • bone
  • disk
  • articular cartilage
  • nerves/spinal cord
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11
Q

acute injuries: diagnostics

A
  • x ray
  • CT
  • MRI
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12
Q

acute injuries: medical and surgical interventions

A

-short term-immobilization/NSAIDS
-soft collar or shell based collar
-ibuprofen-acetaminophen
PT: may need surgery to correct dislocation

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13
Q

connective tissue dysfunction

A
  • joint subluxation/dislocatoin
  • ligamentous sprain
  • musculotendinous strain
  • true cervical joint subluxation=medical emergency
  • unstable=cant move neck (guarding)
  • strained=resisted isometrics
  • active movement rules out instability
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14
Q

acute injuries: MOI

A
  • MVA
  • violent flexion: C4/C5, C5/C6
  • impaction (of head against car)
  • lateral stretch injuries: brachial plexus
  • -result in nerve stretch syndrome (within min.)
  • extension
  • extension followed by flexion=whiplash
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15
Q

derrangement

A

-constant pain for prolonged periods, at rest

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16
Q

dysfunction

A

-no pain at rest

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17
Q

impaired joint mobility, motor function, muscle performance, ROM, reflex integrity associated with spinal disorders

A
  • degenerative disk=myotomal impairment
  • neural tension=disc on nerve
  • central canal stenosis: showed by unsteady gait, hyperreflexia
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18
Q

brachial plexus injuries

A
  • anterior primary rami of C5-T1
  • roots-trunks-subdivisions-cord
  • subscapular, suprascapular, radial, etc.
  • affected by trauma, peripheral nerve, nerve root
  • impaired peripheral nerve integrity and muscle performance
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19
Q

classes of brachial plexus injuries: class 1-neuropraxia (pins and needles)

A
  • most common
  • pain resolves in minutes most often
  • pain may last 5 minutes to 25 hours
  • stinger or burner
  • no actual damage to nerve, only compression
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20
Q

class 2: axonotmesis

A
  • some axon and nerve injury
  • crush mechanism
  • wallerian degeneration distal to site with loss of axon, myelin and n. conduction
  • muscle weakness ensues
  • may last 10 days to 2 weeks
  • reversible
21
Q

class 3: neurotmesis

A
  • partial tear or complete severance of all neural and connective tissue elements
  • for partial tear, weakness may last upwards of 1 year
  • little hope of functional recovery without surgery if completely torn
  • may regenerate very slowly
22
Q

peripheral nerve injuries: secondary to trauma

A
  • spinal accessory nerve: trap/SCM. injury near clavicle
  • suprascapular nerve: supra and infraspinatus: blow to the base of the neck
  • axillary nerve: deltoid/teres minor: GH dislocation or GH hyperextension
  • long thoracic nerve: serratus anterior
23
Q

cervical stenosis

A

narrowing

  • cervical spinal canal=17-18mm
  • diameter of cord is 10mm
24
Q

lateral stenosis

A

-intervertebral foramen

25
Q

central stenosis

A
  • ligamentum flavum stenosis
  • UMN issues
  • spinal canal
26
Q

1deg central stenosis

A

-congenital

27
Q

2deg central stenosis

A
  • degenerative condition

- wear and tear

28
Q

lateral stenosis symptomology

A

radiculopathy

  • parathesias (pins)/dysesthesias in a dermatomal pattern
  • myotomal deficit
  • down nerve root
  • affects muscle stretch reflex (hyporeflexia)
  • loss of sensitivity
  • loss of strength
29
Q

central stenosis symptomology

A

myelopathy

  • more subtle, particularly in early stages
  • neck pain
  • unsteadiness in gait or clumsiness
  • extrasegmental distribution of paresthesia
30
Q

cervical stenosis: diagnostics

A

-CT scan, MRI

31
Q

medical and surgical management of cervical stenosis: cervical radiculopathy

A

cervical radiculopathy

  • conservative care primarily-PT, epidural injections
  • few RCTs of effectiveness of care
  • > 3months of relief may result in surgical candidacy
  • traction
32
Q

cervical myelopathy: medical and surgical management

A
  • surgical mgmt primary due to progressive and disabling nature
  • early sx. vs late=better long-term outcome
  • laminotomy or laminoplasty typical with possible fusion
  • mechanics/neurosigns get better before you feel better
33
Q

Dejenerative joint disease: characteristics in older pop

A
  • DJD
  • proliferation of calcific deposits in and around the periphery of the joint
  • wearing away of hyaline cartilage
  • thickening of the synovial lining and joint capsule
  • thickening of subchondral bone
  • the above are pathophysiologies of DJD
34
Q

degenerative disc disease: characteristics in older pop

A
  • dehydration of nucleus pulposus
  • narrowing of the intervertebral space
  • weakening and degeneration of the annular rings
  • approximation of the facet joints
  • the above are the pathophysiologies of DDD
  • neck retration will localize problems
  • centralizaiton=prediction of favorable outcome
35
Q

diagnostics and medical surgical intervention: DJD

A
  • xray: ap, lateral, open mouth
  • bone scan-diff. dx
  • tx: Pt, NSAIDS, sx (laminectomy)
36
Q

diagnostics and medical surgical intervention: DDD

A
  • xray
  • MRI CT
  • TX-PT, NSAIDS, sx (decompresison)
  • find position/posture that makes it better
37
Q

rheumatoid arthritis

A

-can lead to instability because affected transverse ligament
-manipulation of neck could be life threatening
-instability of neck=complaints of lump in throat
-lump is C2 body
C2 on C1 unstable

38
Q

RA

A
  • systemic Autoimmune inflammatory disease–chronic synovitis
  • predominately young-middle aged female
  • ingrowth of inflammatory tissue destroys AC
  • joint laxity and deformity
  • CARE with PROM
  • NO MANIPULATION
  • cervical rotation could rupture the transverse ligament
39
Q

down syndrome

A
  • congenital hereditary disease
  • 1 in 600 births
  • mental deficiency moderate to severe (MR)
  • trisomy 21
  • present with sloping forehead, small ear canals, absent bridge to nose, low-set ears, dwarfed physique
  • agenesis/hypoplasia of odontoid process
  • -AA instability in 10-20% of pt with down syndrome=transverse ligamentous laxity
40
Q

torticollis/wry neck

A

-congenital muscular abnormality
-etiology unkown, however, 40% had difficult delivery
-noticeable within first few weeks of life
-SCM implicated-1st firm swelling which resolves to a contracture
-head laterally flexed to the ipsilateral side and rotated to the contralateral
in baby=dysfunction
-in adults=derrangement

41
Q

torticollis/wry neck

A
  • differential dx for klippel-feil syndrome via x-ray
  • -congenital fusion
  • -short and stiff neck
  • 20% with wry neck also have dysplasia of 1 or both hips
  • tx-early stretching=within 1st month and for 1 yr=90% permanent recovery
42
Q

cervical headaches

A
  • headaches which change as a result of movement and posture (mechanical)
  • dysfunction
  • derrangement=constant, but has direction of preference
43
Q

-mechanical diagnosis and therapy (MDT)

A
  • subjects classified according to pt response to repeated movements
  • MDT intervention relies heavily on pt generated forces
  • manual therapy is incorporated if pt plateaus with self treatment or incapable of self treatment
44
Q

MDT classifications

A
  • postural syndrome: test movements do not reproduce complaint. symptoms brought on by sustained postures-no pathology
  • dysfunction syndrome: shortened or impaired connective tissue. typically produces end range pain
  • derangement syndrome: symptoms may dramatically change as a result of test movements: centralize, abolish, or worsen
  • -constant pain past acute stage
45
Q

cervical spine derangement

A
  • classification which may be determined by the movement examination and history
  • characterized by pain during movement or end range pain
  • symptoms may centralize, peripheralize, made better, worse, or abolish
46
Q

OD: centralization

A

-the progressive reduction and abolition of distal pain in response to therapeutic loading strategies. it is one of the key symptomatic responses that denotes derangement

47
Q

OD direction of preference

A

-an immediate, lasting improvement in pain from performing either repeated flexion, extension, or sideglide/rotation tests

48
Q

see end of packet for derangement chart

A

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Clinical Medicine 1 (7 decks)

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