Cervical Spine TBC 5 Flashcards
Acute torticollis: What is it?
sustained involuntary contraction of neck muscles
Acute torticollis: Typically unknown pathogenesis but two hypotheses (broad categories)
- Genetics
- Trauma
Acute torticollis: Typically unknown pathogenesis but two hypotheses
Genetics
significant % of first degree relatives of pts with focal dystonia/tremor also have it
Acute torticollis: Typically unknown pathogenesis but two hypotheses
Trauma: Prevalence of patients with cervical dystonia related to trauma is
15-21%
Acute torticollis: AKA
- cervical dystonia
- spasmodic torticollis
Acute torticollis: 75% of the time, pt presents with
- head rotation to one side
- pain
Acute torticollis: types of spasms that may be present
- intermittent
- clonic
- tremulous
Acute torticollis: In addition to pain and head rotation to one side, what may also be seen?
- lack of postural control
- spasms
- alterations in vestibular function and perception of body orientation
Acute torticollis: How direction of torticollis named?
by direction of rotation
Movement coordination impairments: chronicity
> 12 weeks
Movement coordination impairments: management evidence
- coordination, strengthening, endurance exercises
- effective exercise methods: proprioceptive and dynamic resisted exercises
- strengthening of neck and shoulder muscles
- patient education and counseling
- stretching
Pain control: may present with varying degrees of
- motion loss
- HA
- emotional disturbance
- cold hyperalgesia
- high disability score
- post-traumatic stress
WAD: Strain results in
- secondary edema
- hemorrhage
- inflammation
WAD: MOI
- MVA
- sports injury
- child abuse
- blow to head from falling object
- similar acceleration-deceleration injury
WAD: most common symptoms
- sub-occipital HA
- pain that is either constant or motion induced
WAD: May have delay in onset of symptoms up to
48 hrs
WAD: In addition to delayed onset of pain, may also present with these symptoms
- cervical instability
- neuro symptoms
- dizziness
- tinnitus
- visual disturbances
- difficulty sleeping
- TMD
- difficulty with concentrating/memory issues
WAD: acute
symptoms last no longer than
2-3 mos
WAD: chronic symptoms last over
3 mos
WAD: (%) recover within 6 mos
85%
WAD: up to (%) turn into chronic
50%
A level evidence:
To improve recovery in pts with WAD, clinicians should
- educate pt that early return to normal, non-provocative, pre-accident activities is important AND
- provide reassurance that good prognosis and full recovery commonly occurs
WAD: treatment
AROM in this position
anti-gravity
WAD: graded exercise progress to
more direct treatment
WAD: Will require this type of approach overall
Multimodal
PT alone often insufficient
WAD: 9 predictors of chronicity
- no post-secondary education
- female
- hx of neck pain
- baseline neck pain intensity > 55/100
- neck pain at baseline
- HA at baseline
- catastrophizing
- WAD grade 2 or 3
- no seat belt use in collision
A level recommendation
WAD: Clinicians (should/should not) consider using cervical manipulation and mobilization procedures to reduce neck pain and headache.
should
A level recommendation
WAD: Clinicians should consider the use of these types of exercises to reduce neck pain and HA
- coordination
- strengthening
- endurance
Level of evidence:
- should consider use of UQ and nerve mobilization in pts with neck and arm pain
- should consider cervical IMT combined with other interventions in pts with neck and neck-related arm pain
B
Level of evidence:
Centralization procedures (repeated motions) to promote centralization are not more beneficial in reducing disability when compared to other forms of interventions
C
Level of evidence:
Thoracic manipulation can be used for pts with primary complaints of neck pain and neck-related arm pain
C
