Cervicothoracic Spine Flashcards
t/f
stiff areas may not be painful, and if not addressed, will cause painful hypermobile compensations elsewhere in the body
true
why are hypermobile areas usually painful
the axis of motion is less controlled
where is hypermobility most likely in the cervical spine
C5-C7
what determines direction and amount of motion in the spine
orientation of facets
where in the cervical spine do facets favor motion rather equally
C2-7
because of 45 degrees angle
the upper thoracic facets favor motion in which plane
frontal plane
favors SB but ribs limit motion
what section of the cervical spine has the most motion
AA joint
what are the 4 variables for stabilization
joint integrity
passive stiffness
neural input
muscle function
describe local muscles
closer to axis of motion
deeper
stabilization > rotary forces
postural
aerobic
describe global muscles
further from the axis of motion
superficial
rotatory >stabilization
spurt muscles
anaerobic
what is an example of cervical local muscles
longus colli, suboccipital, splenius
what is an example of thoracic local muscles
rotators, multifidus, pelvic floor, transverses abdominus
pain, swelling, joint laxity, disuse causes
decreased motor activation and coordination of local muscles, increased activity of global muscles
supply lowered can lead to easily overworked muscles
local muscle atrophy
increase stress on noncontractile structures
fiber transformation - type 1 to type 2
t/f
normal muscle activity returns spontaneously even when pain is gone
false
normal muscle activity does not return spontaneously even when pain is gone
what is nociceptive pain
non-nervous tissue compromise
MSK including spindylogenic
viscerogenic
what is neuropathic pain
nervous tissue compromise
radicular
radiculopathy
periperal
what is nociplastic pain
altered pain perception without complete evidence of actual or threatened tissue compromise
what is spondylogenic pain
pain from the spine
local/referred spinal pain from noxious stimulation of spinal structure
can spondylogenic pain cause visceral dysfunction
no
what are the symptoms of spindylogenic pain
non-segmental pain
rare parthesia’s
vague, deep, achy, boring pain
referred to ill-defined area that settles into consistent location
what does non-segmental pain mean
not spinal nerve
everything else that is innervated by the nerve will also have symptoms
what are the signs of spondylogenic pain
neuro -WNL
symptoms are not reproduced by motion
what is somatic convergence or referred pain
type of spondylogenic pain
sensory afferents converge on and share same innervation
describe somatic convergence or referred pain
greater referral of proximal and deep structure that distal and superficial structures
spinal facets joint refer more than elbow joint
where is C2-3 referred pain most likely located
base of skull, headaches
where is C3-4 referred pain most likely located
neck pain
where is C4-5 referred pain most likely located
neck and shoulder pain
where is C5-6 referred pain most likely located
neck and shoulder pain
where is C6-7 referred pain most likely located
shoulder and back pain
what is viscerogenic pain
referred pain from an organ
what is viscerosomatic convergence
viscera and sensory afferents converge and share the same innervation
what are the S&S of viscerogenic pain
pain not mechanically reporiduced
neuro - WNL
what is radicular pain
ectopic or abnormal discharge from highly inflammed spinal nerve
what are radicular pain symptoms
lancing, electrical shock-like pain along an extremity in a narrow 2-3’’ band
what are the signs of radicular pain signs
dermatomes/DTR/myotomes - WNL
+ dural mobility bc of high inflammation
what is radiculopathy pain
more persistent blocked conduction of spinal nerve d/t compression or inflammation
what are radiculopathy pain symptoms
segmental paresthesias
constant and long duration
slow progression to ill defined area
possible weakness
__% conduction loss needed before perceivable fatiguing weakness
80%
what are the signs of radiculopathy pain
+ neuro scan for segmental hypoactivity
what is peripheral nerve pain
decreased condition of nerve branch
what are the symptoms of peripheral nerve pain
non-segmental paresthesias
intermittent and short duration
fast progression to well-defined area of numbness
what are the signs of peripheral nerve pain
dermatomes, myotomes, DTRs - WNL
nonsegmental hypoactivity
decreased sensation along peripheral nerve distribution
+ dural mobility tests
what type of pain is defined as altered pain perception without complete evidence of actual or threatened tissue compromise
nociplastic pain
t/f
patients with sensitization are labeled as having nociplasitc pain
true
what is the pathogenesis of nociplastic pain
thinning of myelin sheath in spots
increased sensitivity and misinterpretation by peripheral nociceptors
hard to override pain with motion d/t fiber malfunctions
loss of descending anti-nociceptive mechanisms - less pain control with typical endogenous opiate release in the body
somatic convergence
in regard to nociplastic pain, (increased/decreased) excitability of segmental dorsal horn neurons
increase
what is the pathogenesis of nociplastic pain in regard to somatic convergence
shared areas of innervation share symptoms
C fibers split and travel at least 2 spinal segments superiorly and inferiorly
what is the pathogenesis of nociplastic pain in regard to somatic convergence
shared areas of innervation share symptoms
C fibers split and travel at least 2 spinal segments superiorly and inferiorly
brain perceives the pain as coming from even more areas with persistent symptoms
what are the S&S of nociplastic pain
> /= 3 months of pain
regional or spreading symptoms
pain that cannot be explained by nociceptive/neuropathic pathways
pain hypersensitivity/allodynia
what are autonomic nervous system S&S of nociplastic pain
pitting edema with lymph compromise
decreased sebaceous gland and hair follicle activity
sweaty hands/feet
loss of laterality
decreased peripheral arterial shunting - coldness/clamminess
increase erector pili muscles
+ grapesthesia
what is the PT rx of nociplastic pain
JM and manipulation
patient education
what is the MET for nociplastic pain
low-moderate intensity global aerobic and resistance activities
2-3x/wk
30-90 minute sessions
minimum 7 week duration
how does MET benefit nociplastic pain
helps pt interpret pain and motion as non-threating
reorganizes homunculus
what is the prognosis of nociplastic pain
varying degrees of improvement
long recovery
likely not full resolution of symptoms
what is the functional ROM for full cervical extension
40-50 degrees to look up
what is the functional ROM for cervical rotation for driving
60-70 degrees
t/f
with neck pain, few and specific tissues are involved in the cause of the pain
false
variety and often unknown tissues are involved with neck pain
t/f
MET is only effective with persistent neck pain
false
MET is effective with acute and persistent neck pain
what MET is effective for neck pain with nociplastic pain
motor control and strengthening exercises for stabilization
30-60 minute session s
2-3x/wk
7-12 weeks
what is the focus of MET for neck pain
local and global muscle training
low load endurance for 6 wks
isometrics/isotonics
what is an example of local muscle training for neck pain
forward nod
progress to more advanced exercises while maintaining forward nod
what are examples of proprioceptive training
eye fixation with/without head movement
seated wobble board training
head relocation with eyes open and focused light, eyes closed
what is the effect of modalities for neck pain
current evidence is lacking
not recomended
other than MET, what is another PT intervention that is beneficial to improve neck pain
pt education
when does most recovery happen with neck pain
1st 12 weeks with little recovery after 12 months
what are the variables for worse prognosis of neck pain
pain > 6/10
neck diability index > 30%
pain catastrophizing > 20
post traumatic stress > 33
cold hypersensitivity
what is the etilogy of WAD
acceleration-deceleration event
strains and sprains
includes concussions
what scan is necessary for all neck trauma patients
craniovertebral scan
eventually cervicothoracic scan and BE
what are the sructures most often involved in WAD
z jnt sprains
muscle strains
what is the most common section of the cervical spine that is affected by WAD, why
C2-3
vertebra move from horizontal to 45 degrees
what should be scan findings for left sided z jnt sprain
limited flx, ext, right SB
what are the less involved structures of WAD
dens fracture
what are the S&S of dens fracture
splinted, especially with SB
what structures are injured during a dens fracture
alar ligament
what is the function of the alar ligament
attaches from the dens to the base of the skull
limited dens motion
what is the function of the alar ligament
attaches from the dens up and lateral to the foramen magnum
resists transverse stress
keeps dens from hitting spinal cord
what are the common S&S for fractures throughout he body
trauma hx
splinting
Pain with palpation, compresssion, vibration
limited ROM with empty and painful end feels in most/all directions
weak and painful in most/all directions of resisted testing
+ percussion with stethoscope
what part of the bone is most stress fractures located
periosteum
what is the function of type 1 collagen
resists tension
what is the repair phase for bone
1-3 wks
soft callous/fibrous cartilage patch forms from fibro- and chondroblasts
what is the modeling phase for bone
4-8 wks, can be up to 12 wks
osteoclastic activity replaces cartilage and osteoblastic bony/hard callus forms
clinical union
what is the remodeling phase for bone
months to years
cancellous none transitions to cortical bone
what are variables that could complicate bone healing
deficient bone health and hormone levels
not meeting energy expidenture
impaired circulation
infection
poor load management
complicating factors of bone healing can lead to __
delayed union, non-union, or malunion
what is the focus of PT for fracture
consequences of prolonged immobilization where every tissue is negatively influenced
what are the unique S&S of alar ligament tear
splinting, particularly with SB d/t immediate tension on ligament
possible S&S
what are the S&S of transverse ligament tears
likely cord S&S with forward nodding
splinting
what is the function of the transverse ligament
keeps dens from moving p\osterior and contacting cord
what is a rim lesion
horizontal tear of anterior annulus close to end plate
caused by excessive hyperextension
what are the S&S of rim lesion
splinting, with extension d/t tension on torn anterior annulus
pain with compression and distraction
what are the symptoms of WAD
trauma with acute neck and intracapsular referred pain
potential trigeminocervical nucleus (TCN) symptoms
what are the scan signs of WAD
observation: splinting
ROM: limited and empty, painful end feels
RST: weak and painful
neuro: + including cord or cranial
stress: + for involved tissue
what are the biomechanical exam S&S for fx
joint hypomobility d/t immobilizaiton
joint hypermobility d/t laxity if not immobilized
what are trigeminocervical nucleus symptoms
inflammation/sensitization produces head, face, and neck symptoms
may develop nociplastic pain
eight areas of symptoms
what is trigeminocervical nucleus
located at C2, 3 segment
interaction of sensory nerve fibers of trigeminal nerve and upper cervical spinal nerves
what is the PT rx for WAD
POLICED
improve joint mechanics and stabilization
what is the PT rx for WAD with nociplastic pain
body awareness and stabilization exercises
90 minute sessions
2x/week
10-16 weeks
what patients have the best prognosis with WAD
< 35 years of age
low level of disability
what is the prognosis of WAD after MVA
50% report symptoms up to 2 years following MVA
what is a primary headache
due to headache condition itself
tension, migraine, cluster
what is a secondary headache
due to another source
cervicogenic
describe a tension headache
Bilateral band-like tightness
Anxiety/stress etiology
No migraine S&S
Dull pressure
what is the PT Rx for tension headache
address stress/anxiety
describe migraine headaches
Pulsatign
Out of commission
Unilateral
N&V
Dromes
Sensational auras with visual/auditory sensitivity
what is the PT rx for migraines
address CV dysfunction
vasoconstriction of temporal arteries
increase water intake
melatonin nociplastic pain MET
describe cluster headache
Comes and goes
Retro-orbital and temproal regions
Unilateral
Sudden and severe pain
Horner’s syndrome
INtense
Grumpy
what are the symptoms of cervicogenic headache
unilateral
starts at neck/occipital region
provoked by neck motion
mild-moderate pain
non-throbbing/pulsatign
what are the signs of cerviogenic headache
ROM: limited, painful
CM: +
Neuro: +
