Cervicothoracic Spine II Flashcards
What condition creates “muddying of sensation”
Nociplastic pain
What are some neck pain functional questionaires?
General - Neck Disability Index (NDI)
Whiplash Associated Disorder (WAD)
What percentage of people will experience neck pain?
70%
What percentage of people will experience PERSISTENT neck pain?
33-44%
What is the cost of neck pain second to?
Worker’s comp costs
Which population experiences neck pain more?
Women
Is neck pain more common in older or younger people?
Older
What part of the spine has the smallest amount of spine related pathology?
Thoracic
What are the strongest risk factor for Neck pain?
Female
HX of neck pain
What are some other risk factors for neck pain?
Over 40 years of age
Coexisting LBP
Regular cycling
Hand weakness
worrier
poor quality of life
low vitality
high job demands
smoking
low social/work support
What is the etiology of neck pain?
Most often unidentified
- typically Mechanical Neck Disorder
- Nerve root compromise
What is the functional range of motion for extension of the neck?
50-70 degrees to look up
What is the functional range of motion for rotation of the neck?
60-70 degrees for driving
full is 70-90
What are signs and symptoms of neck pain?
Varied
patterned
impaired scapular mechanics
What does imaging fail to do?
identify symptomatic structures
What are MRIs good at finding?
asymptomatic MRI findings in the neck
-50-73% with bulging and herniated discs
-94% annular tears
-13% cord compression
What is not good about tests and measures for neck pain?
Poor screening tools and lack diagnostic accuracy
Why are JMs recommended for neck pain?
JM to modulate neck muscle function, increase deep muscle recruitment, reduce superficial muscle recruitment
What are JMs more effective than?
PCP or non-manual Rxs
Why are Cervical Manipulation CPRs helpful for neck pain?
predict success
Name some CPRs for neck pain?
Bilateral involvement
Sedentary work more than 5 hours a day
feeling better with movement
extension does not increase symptoms
OA without radiculopathy
What are the MOST RECENT CPR for cervical pain?
Symptoms over 38 days
less than 10 degrees difference in rotation
pain with PA springs
What are some Thoracic manipulation CPRs?
Symptoms over 30 days
No symptoms distal to shoulder
Extension does not increase symptoms
Fear avoidance beliefs questionnaire under 12
Diminished T3-5 kyphosis
Cervical extension less than 30 degrees
What kind of neck pain is MET effective on?
Acute and persistent neck pain
What kind of METs should we prescribe for nociplastic pain?
Motor control and strengthening exercises for stabilization
30-60 minute sessions
2-3 x a week
7-12 weeks
What should our METs for cervicothoracic spine focus on?
Local and global muscle training
Is there strong evidence for MET for cervicothoracic spine?
Yes
What are the parameters for METs for cervicothoracic spine?
8-12 visits
2x a week for 6 weeks led to benefits that lessened by 6 months
3x a week over 1 year was till good at 3 years
Is stretching beneficial in isolation?
NO
Needs to be combined with MET
Are modalities recommended for cervicothoracic pain?
Current evidence is lacking, not recommended
Is pt education/counseling effective for cervicothoracic pain?
YES - strong evidence
- early movement without provocation
-reassurance of good prognosis and full recovery
What is the prognosis for ACUTE neck pain?
mild problems with rapid recovery (~45%)
moderate problems with incomplete recovery (~40%)
severe problems and no recovery (~15%)
What are some indications for a worse prognosis of neck pain?
Pain over a 6/10
NDI less than 30%
Pain catastrophizing
Post traumatic stress
cold hypersensitivity
Why are major limitations of pharmaceuticals important?
Lack of replications of findings, creates inconsistent results
Are epidural injections effective?
Limited evidence of effectiveness
Are NSAIDs effective for neck pain?
NO - limited evidence of effectiveness
