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OMM M1T2 test 2 > Cervical Sprain & Strain Injuries > Flashcards

Cervical Sprain & Strain Injuries Flashcards

1
Q

Whiplash

A

Sudden, forceful hyperextension of the neck with flexion recoil
Usually from riding in a wehicle and being struck by another
Acceleration-deceleration injuries

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2
Q

Which groups are likely to obtain a serious injury from whiplash?

A

Women
Elderly
If there is significant underlying degenerative disc disease

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3
Q

What is the highest force the head and neck can experience in a whiplash injury?

A

8 Gs

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4
Q

It is better to brace yourself before an impact or not?

A

Not known, though some evidence says those who were intoxicated (relaxed) seemed to not be injured

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5
Q

The jolt syndrome

A

When the seat back in a car acts like a spring and magnifies the forward injury

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6
Q

What are the non-neck and shoulder whiplash type injuries?

A

Pelvis
Spine
Cranium
All segmentally-related structures

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7
Q

What are the biomechanics of whiplash?

A

Initially, all parts of the body move toward point of impact then recoil away from the point of impact

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8
Q

What are the osteopathic considerations in a whiplash injury?

A 
X-ray and alteration of cervical lordosis
Soft tissue warm and boggy
Sacrum involvement 
Occiput and sacrum restriction
Temporal bones vulnerable due to SCM
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9
Q

What types of areas may be injured in a whiplash causing accident?

A

Longitudinal arch of the foot
Ankle and knee
Posterior hip acetabulum
Anterior rotation of the innominate
Superior shear of a public bone unilaterally
Right lower costal cartilage (driver)
Structural and respiratory dysfunctions of lower right ribs

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10
Q

What could happen in a disc is damaged in a whiplash type injury?

A

Internal derangement of cervical disc architecture leading to late sequel of degenerative disc disease
Potential or disc herniation, most commonly C5-C6 disc

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11
Q

What would be seen in a whiplash injury that involved the brain?

A

Closed head injury:
Cerebral dysfinction
Cranial somatic dysfunction

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12
Q

Macro trauma

A

Initial symptoms are present immediately following injury

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13
Q

When would muscle hypertension develop in a whiplash injury?

A

2 to 3 days

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14
Q

How long might it take for all injuries to fully appear?

A

Up to one month

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15
Q

Where is pain often felt in the whiplash injuries (ligament)?

A

Ligamentum Nuchae
Especially C2 and T1
Partial or total ligament rupture

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16
Q

Where is pain often felt in the whiplash injuries (bone)?

A

Fracture
Avulsion fracture Spinous process of C2
Avulsion fracture Spinous process of T1
Compression fracture most commonly C5

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17
Q

What is posterior neck pain and muscle hypertonicity caused by?

A

Muscle overstretching (strain)
Reflex from injury to the anterior neck musculature, discs and ligaments
Guarding reaction to direct neural trauma

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18
Q

How can you obtain and significant range of motion loss?

A

Fracture
Sprain and strain
Disc herniation
Congenital anomalies (klippel-feil, block vertebrae)

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19
Q

What is the stated range of motion for flexion the neck?

A

60 degrees

45-90?

20
Q

What is the stated range for extension of the neck?

A

75 degrees

45-90?

21
Q

what is the stated range of motion for sidebending of the neck?

A

45 degrees

22
Q

What is the stated range of motion for rotaton of the neck?

A

80 degrees

23
Q

Where does half of the rotation of the neck occur at?

A

Atlanto-axial joint

24
Q

What muscles are active in torticollis and what do they cause?

A

Sternocleidomastoid - head rotates away from side of injury, sidebends to
Scalene muscles - head rotates and sidebends towards side of injury

25
Q

How could a pt obtain an occipital headache?

A

Suboccipital muscle injury

Irritation of greater & lesser occipital nerves

26
Q

How is the somatovisceral reflex mediated?

A

Through the upper thoracic cord segments which provide the sympathetic never supply to the head, neck and upper extremities
Distortion of cranium

27
Q

What is raynaud syndrome?

A

Vasospasm of the distal blood vessel of the upper extremity in response to a hypersympathecotonia, again emanating from the upper thoracic spinal cord segments

28
Q

How could painful or difficulty swallowing be caused?

A

By direct stretching of the esopjagus over the anterior surface of the cervical spine
Potential for formation of retropharyngeal hematoma
(Dysgeusia/Dysphagia)

29
Q

What causes wallenberg’s syndrome?

A

Injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis

30
Q

What are some symptoms of wallenberg syndrome?

A 
Homolateral facial pain or paresthesias
Vertigo
Vomiting
Unilateral paralysis of the palate, pharynx and vocal cords
Nystagmus
intention tremor
Ataxia with a tendency to fall toward the side of lesion
Akinetic Mutism
31
Q

What are some psychiatric repercussion of cervical strain and sprain?

A 
Driving Phobia
Depression
Withdrawal
Panic Attacks
Anxiety
32
Q

What should be measured in vital signs in a neck injury?

A 
Pulse (stretch injury to the vagus n. or cervical sympathetics can alter pulse rate
Blood pressure (stretch injury to carotid sinus and/or carotid body can inc or dec BP
33
Q

What could happen in a cervical injury?

A

Injury to autonomic nerves can trigger dysrhythmias or coronary vasospasm

34
Q

What do all pts need in terms of imaging in a neck injury?

A

X-ray

Cervical AP, lateral, oblique, open mouth views

35
Q

What should be viewed in an imaging CT of a cervical spine?

A

Cervical spine - reserved for those with symptoms of nerve root injury and those with pain persisting without significant recovery beyond six weeks
Brain - reserved for neurologic symptoms not just headache
Special studies - retropharyngeal hematoma

36
Q

When would you use cervical spine x-ray flexion and extension films?

A

6-12 weeks
Used to diagnose segmental instability
Recurrent segmental somatic dysfunction

37
Q

What is the treatment for cervical sprain and strain?

A

Soft/hard collar
OMT adjacent to most severely injured (craium and sacrum)
NSAIDs
After inflam dec treat somatic dysfunction

38
Q

What should you do if a pt has trigger points?

A

Inject botulinum toxin - type A

39
Q

How long do most pts take to recover?

A

4-6 weeks

40
Q

What percent of pts have not recovered at 6 months?

A

12%

41
Q

What are risk factor for poor recovery?

A 
Being hit by a truck
Neck pain on palpation
Pain or numbness radiating from neck to arms
Headache
Significant degenerative disc disease
42
Q

Which heals better, “forward/lateral flexion” or “extension” injuries?

A

Extension

43
Q

Grade 0 whiplash-associated disorder

A

No neck pain, stiffness, tenderness

44
Q

Grade I whiplash-associated disorder

A

Neck pain, stiffness, tenderness (+)

45
Q

Grade II whiplash-associated disorder

A

Neck pain, stiffness, tenderness (+), physical signs (+), musculoskeletal signs (+)

46
Q

Grade III whiplash-associated disorder

A

Neck pain, stiffness, tenderness (+), physical signs (+), Musculoskeletal signs (+/-), neurological signs (+)

47
Q

Grade IV whiplash-associated disorder

A

Neck pain, stiffness, tenderness (+), physical signs (+), neurological signs (+/-), fracture/dislocation (+)

OMM M1T2 test 2 (9 decks)

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