Cervicothoracic Spine III Flashcards
What is the etiology of whiplash associated disorder?
Counter Coo Mechanism
What kind of injury can lead to whiplash associated disorder?
Head injuries including concussions
What should we do with ALL neck trauma?
Craniovertebral scan initially
What are common symptoms of whiplash associated disorder?
Trauma
acute neck pain
referred over radiculating pain
Concussion or trigeminocervical nucleus symptoms
What are some common scan signs for whiplash associated disorder?
Concussion or TCN signs
likely splinting
ROM is limited with empty and painful end feels in most if not all directions
Resisted/MMT weak and painful in most if not all directions
Neuro- possible positive UMN or LMN findings
Stress tests positive for involved tissues
What are some common biomechanical exam signs of whiplash associated disorder?
Joint dysfunction
- accessory motion testing = joint hypo-mobility due to scar tissue/fibrosis esp with prolonged immobilization
- Stability testing = joint hypermobility/instability will likey be present more commonly due to laxity from sprains
Muscle inhibition
TTP
What are some concussion or TCN signs or symptoms?
Cervicothoracic MSK impairments
Vestibulo-oculormotor impairments
Autonomic dysfunction/exertion tolerance impairments
motor function impairments
Where is TCN usually located?
C2,3 segment that is often involved
Why can concussion/TCN cause head, face, and neck symptoms?
Inflammation and/or sensitization
What does the mandibular nerve produce with concussion?
ear - pain/tinnitus/hypersensitivity to sound
tongue - altered/hypersensitive taste
What symptoms can the opthalmic nerve produce with concussion /TCN?
Eye pain/hypersensitivity
dry eye
hypersensitive upper face and scalp sensation
What symptoms can the maxillary nerve produce with concussion/TCN?
Tooth pain
hypersensitive peri-oral, cheek, nostril, and lower eye lid sensation
What are Concussion or TCN signs and symptoms?
C1-3 spinal nerve involved
- CV region = upper cervical pain
- Headache
- dizziness
- paresthesias
-Face -> Pain/paresthesias
- Jaw -> TMJ pain
Why can the vagus nerve play a role in concussion / TCN symptoms?
C3,4 roots and can become hypersensitive
What can happen with a hypersensitive vagus nerve?
Irregular HR, lack of sweating, dyspnea, nausea, indigestion, and other GI s&s
Why can coordination be influenced with concussion / TCN?
Retrograde branch of trigeminal nerve goes to cerebellum
What are the MOST OFTEN involved structures in whiplash associated disorder?
Z jt sprains
- C1-3 due to transitional joint surface anatomy
muscle strain
What are the less often involved structures for whiplash associated disorder?
Dens fx
- splinted with SB due to alar ligament pulling on dens
- possible cord S&S if dens displaced
What are signs and symptoms for fractures?
*Trauma HX
*Splinting
*Pain with palpation, compression, and possible distraction
*Limited ROM with empty and painful end feels in most directions
*weak and painful in most if not all directions of resisted testing
*crepitus
*possible positive neuro tests in spine
*positive special tests= percussion with stethoscope, CDR and CPRs for FXs
What is the role of bone?
Support, protection, and attachment
Produces blood cells
houses minerals and fat
Bone is highly ______ & highly __________
Vascular and neural (particularly in peristeum)
What are the elements of bone?
Osteocytes
crystalline calcium phosphate hydroxyapatite
What does type I collagen do?
Resist tension
What are the two types of bone?
Cortical - outer layer, 80% of skeletal tissue
Cancellous (trabecular) - 20% of skeletal tissue, inner layer
What is an avulsion?
Injury to bone where a tendon or ligament pulls off a piece of the bone
What is a complex fx?
Damages soft tissue surrounding
What is an epiphyseal fracture?
Growth plate fx
What is a hairline fracture?
Minimal trauma to bone; incomplete rx with no displacement
ONLY in outer layer of bone
What is an oblique fracture?
A fx that goes at an angle to the axis of the bone
What is a spiral fracture?
Bone broken due to twisting motion
highly unstable
What is a stress fracture?
Extend through all or only part of bone
What is an impaction fracture?
When one fragment is driven into another
What is a comminuted fracture?
A fx with more than two fragments of bone which have broken off
What are some phases that impact bone healing?
Inflammatory phase
Repair phase
modeling phase
remodeling phase
What is the repair phase of bone healing?
1-3 weeks
a soft callous or fibrous cartilage patch forms from fibro- and chondroblasts
What is the modeling phase of bone healing?
between 4-8 weeks but up to 12
Osteoclastic activity replaces cartilage and osteoblastic bony or hard callus formed
What is it called when fracture line is no longer visible on x-ray?
Clinical union
What is the remodeling phase of bone healing?
Can take months to years
Cancellous bone transitions to more abundant compact or cortical bone (more porous to less porous bone)
What are complicating factors for bone healing?
Deficient bone health and hormone levels
not meeting energy expenditure
- inadequate diet
-limited sleep
- high stress
impaired circulation
infection
poor load management
What can complicating factors of bone healing lead to?
Delayed union
non union
malunion (misalignment)
What is PT for bone focused on?
Consequences of prolonged immobilization where every tissue is negatively influenced
When do we start PT for fractures?
when clinical union occurs between 4-8 weeks
Is pain from fractures from the bone?
not typically
What happens when muscle is immobilized?
Atrophy, decreased strength, contracture, etc.
What happens when bone is immobilized?
Generalized osteopenia of cancellous and cortical bone
What are the signs and symptoms of alar ligamentous tears?
Splinting, particularly with side bending due to immediate tension on ligament
Possible cord signs and symptoms due to loss of dens stability
What are signs and symptoms of transverse ligament tears?
splinting
likely cord signs and symptoms with forward nodding
Where is the dens more likely to move with a transverse ligament tear?
relatively posteriorly into cord under atlas gliding excessively anteriorly
What tests can decrease transverse ligament tear symptoms?
Sharp-Pursor test
- manual retraction while stabilizing axis SP
- glides atlas posteriorly and cord away from dens
What are some less involved structures with whiplash associated disorder?
Rim lesions - horizontal tear of anterior annulus close to end plate
How do rim lesions occur?
Excessive hyperextension
What are some unique signs and symptoms of rim lesions?
Splinting with extension due to tension on torn anterior annulus
Pain with compression AND distraction
What are MTs and MET for with whiplash associated disorder?
ROM and stabilization
What do we do for nociplastic pain with WAD?
90 minute submaximal sessions
2x a week
10-16 weeks
WAD is ~50% pain free at 6 months and 8/10 fully recovered if…
less than 35 years of age
low level of disability on NDI
What causes persistent and residual pain / disability with WAD?
More than 35 years of age
high level of disability on NDI
irritable
easily startled
What is the prognosis of WAD at 6 months?
NDI less than 10% fully recovered
NDI 11-29% mild to moderate ongoing symptoms
NDI more than 30% moderate to severe ongoing symptoms
What percentage report symptoms up to 2 years following MVA?
50%
