Cervical & Thoracic Spine

Question 1

Cervical Disc Pathology is also called

Answer 1

Cervical degenerative disc disease (DDD)
Herniated nucleus pulposus (HNP)

Question 2

primary cause of cervical disc pathology

Answer 2

degenerative processes and
space-occupying lesions involving the annulus fibrosis
or the nucleus pulposus

Question 3

cervical DDD can include what 3 things

Answer 3

annular tears
nuclear disc material degradation
loss of disc height

Question 4

cervical HNP occurs when the _______ extends beyond the (superior/posterior) margin of the vertebral body

Answer 4

disc; posterior

Question 5

what are the 4 common classes of cervical spine HNP

Answer 5

disc bulge
disc protrusion
disc extrusion
disc sequestration

Question 6

disc bulge definition

Answer 6

occurs when the nucleus pulposus bulges into the annulus fibrosis;

and the disc margin extends beyond the endplates of adjacent vertebral levels

Question 7

disc protrusion defintion

Answer 7

occurs when the nuclear pulposus from the disc tears through a small portion of the annulus fibrosis

Question 8

disc extrusion definition

Answer 8

occurs when the nucleus pulposus breaks past the outer lamina of the annulus fibrosis and into the space beyond

Question 9

disc sequestration definition

Answer 9

occurs when the nucleus pulposus becomes detached from the annulus and then usually resides within the spinal cord canal

Question 10

cervical disc pathology is often attributed to (caused by) …….

Answer 10

a slow, progressive degenerative process
rarely occurs because of a direct trauma

Question 11

Patients with cervical disc pathology will usually have a history of …….

Answer 11

neck pain episodes that eventually resolved on their own over the past few years.

Usually, each bout of neck pain tends to be worse than the previous bout.

Question 12

common signs and symptoms of cervical disc pathology

Answer 12

pain
limited cervical spine ROM
limited joint mobility
decreased motor control and deep neck flexor recruitment with increased superficial muscle activity
muscular imbalances found int he cervical and scapulothoracic regions

*****The somatic referral pattern for cervical spine disc commonly refers pain into the neck and intrascapular area, but symptoms may also extend down the arm past AC joint.

Question 13

Aggravating activities of cervical disc pathology

Answer 13

sitting for prolonged periods of time
specific neck motions
driving
sleeping prone or sidelying
coughing/sneezing

Question 14

easing activities of cervical disc pathology

Answer 14

lying down
pain medications
cervical spine support
sleeping with the head supported either sidelying or supine
walking
modalities such as moist heat/ice

Question 15

PT treatment of cervical disc pathology

Answer 15

cervical mobes/manip
strengthening exercises (cervical spine & scapulohumeral area)
thoracic spine manipulation
exercises based on stretching and flexibility
neurodynamic mobilization

Question 16

Thoracic disc pathology is also called ……

Answer 16

➢ Herniated thoracic disc
➢ Thoracic bulging disc
➢ Thoracic degenerative disc disease

Question 17

thoracic disc pathology defintion

Answer 17

The failure of either the nucleus pulposus or the annulus fibrosis of any of the discs in the thoracic region.

Question 18

thoracic disc pathology is primarily ___________

Answer 18

degenerative; it rarely occurs because of acute trauma alone

Question 19

Mechanism of injury for thoracic disc pathology

Answer 19

▪ Degenerative changes resulting from repetitive flexion-based activities coupled with compressive loading such as bending and lifting objects.
▪ Increased thoracic kyphosis.
▪ Traumatic incident such as fall onto the buttock.
▪ History of sudden strain such as coughing or sneezing.

Question 20

thoracic disc pathology common signs and symptoms

Answer 20

may be asymptomatic
pain
stiffness and pain in the morning lasting longer than 20 min
intermittent backache
acute thoracic lumbago
restricted neck and back ROM
positive neural tension tests
neurological signs
thoracic root pain & paresthesia
spinal cored compression symptoms

Question 21

aggravating activities of thoracic disc pathology

Answer 21

sitting
coughing
bearing down

Question 22

easing activities

Answer 22

standing & lying supine

Question 23

PT treatment of thoracic disc pathology

Answer 23

▪ Decreasing symptoms and promoting healing
▪ avoid lifting and carrying
▪ Prone thoracic extension and thoracic stabilization exercises
▪ when motion is pain-free, begin loading the spine with functional activities
▪ maintain core stability
▪ proper breathing

Question 24

cervical facet dysfunction is also called

Answer 24

➢ Cervical facet arthropathy
➢ Cervical spine spondylolysis
➢ Cervical spine facet joint syndrome

Question 25

cervical facet dysfunction definition

Answer 25

most commonly involves a pain-generating source located toward posterior spine, behind the intervertebral foramen and associated nerve roots

Question 26

is cervical facet dysfunction a primary issue/source of pain or a secondary issue/source of pain?

Answer 26

BOTH

Question 27

contributing factors of cervical facet dysfunction

Answer 27

degeneration (from aging or a traumatic event) history of MVA or trauma poor posture occupations that require repetitive activities of the neck (house painter, violinist)

Question 28

Primary facet pathology key characteristics

Answer 28

- common in older adults - MOI: degeneration or change in the joint itself - osteophytes/bone spurs common (along with pain they cause) - history of trauma to the neck possible

Question 29

secondary facet pathology key characteristics

Answer 29

- common in younger adult (<40 y/o) - result of other factors (like trauma) - common MOI: a variety of acute injuries (think whiplash, blows to head, falls, acceleration/deceleration injuries)

Question 30

aggravating factors of cervical facet dysfunction (4)

Answer 30

- looking in a specific direction involving a "closing" pattern - repetitive motions - sustained or prolonged positions w/o movement - different sleeping positions (prone or side-lying)

Question 31

easing factors of cervical facet dysfunction (3)

Answer 31

- lying down or gravity eliminated positions - positions that involve an "opening" pattern of the cervical spine - modalities such as moist heat and/or ice

Question 32

cervical muscle strain is also called.... (3)

Answer 32

➢ Cervical strain ➢ Cervical sprain (ligamentous) ➢ Mechanical neck pain

Question 33

cervical muscle strain definition

Answer 33

soft tissue injury to musculature of cervical spine that can be caused by a variety of incidents: fall, MVA, blow to the head of any type (think TRAUMA)

Question 34

is poor posture a contributing factor to cervical muscle strain

Answer 34

it can be

Question 35

signs and symptoms of cervical muscle strain (4)

Answer 35

- neck pain (posterior upper spine, as well as lower spine or shoulder area) - limited cervical spine ROM - tenderness on palpation - muscle spasms

Question 36

cervical muscle strain aggravating factors

Answer 36

▪ Cervical spine ROM that stretches or elongates the tissue in question (e.g., while driving, turn to look behind you) ▪ Prolonged periods of sitting or driving (axial compression) ▪ sleeping positions that aggravate the neck

Question 37

cervical muscle strain easing activities

Answer 37

▪ Supine or lying down, depending on the stage of tissue injury ▪ Avoid activities that excessive stretch or compress cervical spine ▪ Modalities (ice and/or heat) depending on the stage of tissue healing

Question 38

cervical radiculopathy is also called

Answer 38

cervical radiculitis

Question 39

Cervical radiculopathy is characterized by ...?

Answer 39

spinal nerve root dysfunction