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
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
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)
4
Q
medical and surgical intervention
A
mostly just PT
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
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
7
Q
order of soft tissue disruption with forward flexion injuries
A
- SS lig
- IS lig
- Disk
- bone insult possible
8
Q
spams
A
-high state of contractility
9
Q
guarding
A
-increased tone to hold person still, neural response/protective phenomenon
10
Q
tissues insulted due to the trauma
A
- ligament
- musculotendonous units
- bone
- disk
- articular cartilage
- nerves/spinal cord
11
Q
acute injuries: diagnostics
A
- x ray
- CT
- MRI
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
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
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
15
Q
derrangement
A
-constant pain for prolonged periods, at rest
16
Q
dysfunction
A
-no pain at rest
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
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
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
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
central stenosis
- ligamentum flavum stenosis
- UMN issues
- spinal canal
26
1deg central stenosis
-congenital
27
2deg central stenosis
- degenerative condition
| - wear and tear
28
lateral stenosis symptomology
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
central stenosis symptomology
myelopathy
- more subtle, particularly in early stages
- neck pain
- unsteadiness in gait or clumsiness
- extrasegmental distribution of paresthesia
30
cervical stenosis: diagnostics
-CT scan, MRI
31
medical and surgical management of cervical stenosis: cervical radiculopathy
cervical radiculopathy
- conservative care primarily-PT, epidural injections
- few RCTs of effectiveness of care
- >3months of relief may result in surgical candidacy
- traction
32
cervical myelopathy: medical and surgical management
- 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
Dejenerative joint disease: characteristics in older pop
- 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
degenerative disc disease: characteristics in older pop
- 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
diagnostics and medical surgical intervention: DJD
- xray: ap, lateral, open mouth
- bone scan-diff. dx
- tx: Pt, NSAIDS, sx (laminectomy)
36
diagnostics and medical surgical intervention: DDD
- xray
- MRI CT
- TX-PT, NSAIDS, sx (decompresison)
- find position/posture that makes it better
37
rheumatoid arthritis
-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
RA
- 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
down syndrome
- 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
torticollis/wry neck
-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
torticollis/wry neck
- 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
cervical headaches
- headaches which change as a result of movement and posture (mechanical)
- dysfunction
- derrangement=constant, but has direction of preference
43
-mechanical diagnosis and therapy (MDT)
- 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
MDT classifications
- 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
cervical spine derangement
- 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
OD: centralization
-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
OD direction of preference
-an immediate, lasting improvement in pain from performing either repeated flexion, extension, or sideglide/rotation tests
48
see end of packet for derangement chart
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