Cervical Spine Syndromes Flashcards
lifetime prevalence of neck pain
70%
trauma causes of cervical spine pain
Whiplash Associated Disorder (WAD): # VB, ligt sprain, muscular strain
degenerative causes of cervical spine pain
Spondylosis
Spondylolisthesis,
Facet Joint arthrosis
Cervical Myelopathy
Discogenic Neck pain
inflammatory causes of cervical spine pain
Ankylosing Spondylitis
Rheumatoid Arthritis
other causes of cervical spine pain
mechanical - cervicogenic headache, TMJ dysfunction
Cervical artery dysfunction/vertebrobasilar insufficiecny
torticollis/dystonia
infections
tumours
types of red flags in patients presenting with neck pain
vascular compromise
structural integrity
cord compromise
causes of compromise in structural integrity of the cervical spine
Trauma
Cancer
Infection
Congenital anomalies
Inflammatory disorder
Metabolic disease
symptoms of cord compression/cervical myelopathy
Hyperreflexia, (+) Babinski signs
Numbness in hands / feet
Weakness in legs (difficulty walking) & arms (difficulty using hands)
Ataxic gait
Bilateral limb pain
symptoms of rheumatoid arthritis
Occipital numbness/paraesthesia, headaches, vertigo, tinnitus, visual disturbances
biomechanics of whiplash
hyperextension and hyperflexion
sprain or strain of cervical tissue
whiplash associated disorder definition - WAD
Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from motor vehicle collisions. The impact may result in bony or soft tissue injuries, which in turn may lead to a variety of clinical manifestations
possible injuries in whiplash associated disorder - WAD
Ant. Long. ligt sprain
Disc pathology – cervical & lumbar (shear)
Articular facet capsule sprain
Nerve root traction injury (especially side-on impact)
Muscle strains – SCM, longus colli, Scalenes etc.
fracture/dislocation
symptoms of whiplash associated disorder - WAD
Headaches
Pain in the Shoulders and Arms
Dizziness
Altered sensation (P&N) or numbness
Motor weakness
Visual and auditory symptoms
Dysphagia
TMJ pain
Concentration difficulties (cognitive function)
Classification of whiplash associated disorder - WAD
grade 0 = no complaint about neck, no physical signs
grade 1 = neck pain, stiffness or tenderness. no physical signs
grade 2 = neck complain + MSK signs e.g reduced ROM, tenderness
grade 3 = neck plaint + neurological signs e.g. reduced or absent DTR, weakness and sensory deficits
grade 4 = neck complaint + # or dislocation
risk stratification of whiplash associated disorder
age under 36 = low risk, predicted full recovery
of any age with hyperarousal = medium risk
above the age of 35 and no hyperarousal = high risk
clinical pattern in postural neck pain
mild to moderate pain
fine in the a.m worse in the EOD
aggravating factors - sustained load e.g computer/desk or repetitive tasks
stretching massage, heat helps
deep neck flexors weak
trapezius and levator scapula tight
tight pectorals
weak rhomboids and serratus anterior
physical exam for patient with postural neck pain
ROM
PPIVMs
PAIVMs
PNF
Muscle length tests
Muscle control
DNF
clinical pattern for acute locked neck
Sudden onset
sudden movement – instant pain
AM
Pt ‘stuck’ in side flexion +/- flexion = Position of Ease
Most common level C2/3
all movements pain (ext & ipsi LF) + regional spasm ++
Theories
Meniscoid entrapment / extrapment in facet joint
Natural Hx: spontaneous recovery over few days
clinical pattern of cervical spondylosis
Central / unilateral neck pain +/- arm pain +/- radiculopathy
Pain worse EOD
Stiffness worse a.m.
PAIVM – hypo not reactive
headache classification
migraine
tension type
cervicogenic headache
features of migraine
builds to crescendo
headache before neck pain
photophobia
aura may precede
features of tension type
bilateral tightening pain
not aggravated by physical
activity
no associated symptoms
subjective findings of cervicogenic headache
unilateral/dominant side
neck/suboccipital pain
neck pain before headache
commonly moderate
other symptoms e.g. nausea, dizziness, visual disturbance
reduced functional ROM
Painful segmental dysfunction C0-3
reduced AROM flex/ext
muscle tightness
reduced DNF muscle control
clinical pattern discogenic neck pain
wok hx - prolonged cervical flexion, cumulative, traumatic
disc herniation
often causes pain
signs of cervical radiculopathy
varying degrees of sensory,
motor and reflex change
dysesthesias
paresthesias related to nerve root(s) without evidence of spinal cord dysfunction (myelopathy)
radiating pain in arm with motor reflex and/or sensory changes
diagnostic criteria for cervical radiculopathy
Positive ULNT1
Positive Spurling’s A test
Limited cervical rotation to affected side (<60degs)
Positive distraction test
Positive arm squeeze test
