Cervical Spine TBC 2 Flashcards
Cervical radiculopathy: DDx
- RTC
- peripheral n. entrapment
- TOS
- brachial plexus
- herpes zoster
- CRPS
- tumor/abscess
- cardiac dysfunction
Cervical radiculopathy: typically presumed to involve narrowing of (structure) due to inflammation and/or degenerative changes
intervertebral foramen
Cervical radiculpathy: Common diagnosis based clinically on presence of
- neck pain extending into the arm
- s/s of nerve root compression during PE
Cervical radiculopathy: dysfunction of the nerve root in the cervical spine via
- compression
- traction
- irritation
- lesion
Cervical radiculopathy: causes for nerve root dysfunction in younger patients
herniated disc
Cervical radiculopathy: Causes for dysfunction of nerve root in cervical spine in older patients
- foramina narrowing
- osteophytes
Cervical radiculopathy: People of any age affected, but most frequently seen in this age range
40-50
Cervical radiculopathy: prevalence
83 in 100,000
Cervical radiculopathy: typically (bilateral/unilateral) symptoms
unilateral
Cervical radiculopathy: associated s/s
- radiating arm pain in a dermatomal pattern
- neck pain
- myotomal weakness
- paresthesia/numbness
- HA
- scapular pain
- reflexes
Cervical radiculopathy: symptoms increased with these motions
- rotation
- extension
Cervical radiculopathy: This is the single best neuro screening test for cervical radiculopathy
biceps reflex
Cervical radiculopathy: If the biceps reflex is diminished or absent, the chance of having a cervical radiculopathy increases from 23% to (%)
59%
Cervical radiculopathy: Of the cervical radiculopathy cluster, this test has the highest sensitivity
ULTT
Cervical radiculopathy: cluster
- ULTT median
- (+) Spurling
- (+) distraction
- Ipsilateral rotation < 60˚
Disc lesions: these types of disc prolapses are relatively rare in the cervical spine
posterolateral
Disc lesions: posterolateral disc prolapse relatively rare in cx spine. Why?
Nucleus take up only 15% of disc
Disc lesions: prolapses causing neuro signs are more common in the (upper/lower) cervical spine
lower
Disc lesions: prolapses causing neuro signs more common in the lower cervical spine due to
larger uncinate processes in upper cervical spine
Disc lesions: pain is intense and may be (location)
- scapular
- radiating into arm
Disc lesions: disc prolapses in lower cervical spine
This movement is usually limited and the pt may also present with what (positioning)?
flexion
torticollis
Disc lesions: This treatment modality relieves symptoms
traction
Disc lesions: XR findings?
negative
Disc lesions: Central herniation is most common in this age group
< 45 yo
Disc lesions: central herniation causes these symptoms
- BUE pain
- multisegmental paresthesias, especially in the hands and later in the feet
Disc lesions: central herniation
This movement reproduces symptoms and may also cause these signs
neck flexion
UMN signs
Disc lesions: central herniation
(%) of pts after MVA who have central posterior prolapse
25-40%
Disc lesions: Shoulder abduction test
Decrease in symptoms is indicative of
C5-6 nerve root compression
Radiculopathy treatment cluster: age
< 54
Radiculopathy treatment cluster: dominant arm (is/is not) affected
is not
Radiculopathy treatment cluster: looking down (does/does not) worsen symptoms
does not
Radiculopathy treatment cluster: treatment involves
- manual therapy
- cervical traction
- DNF strengthening
at least 50% of visits
Level of evidence:
Clinicians should consider the use of mechanical intermittent cervical traction, combined with other interventions such as manual therapy and strengthening exercises, for reducing pain and disability in patients with neck and neck-related arm pain
B: moderate evidence
Cervical radiculopathy treatment: these are useful for increasing function, AROM, and decreasing pain and disability
manual therapy + therapeutic exercise
Cervical radiculopathy treatment: manual therapy techniques found to be successful in systematic review
- thrust mobs to cervical and thoracic spine
- cervical mobs
- METs
- neurodynamics
Cervical radiculopathy treatment: PT is (more/less/at least as) effective as surgery for treatment
at least as effective
