Cervicothoracic Spine IV Flashcards
What is the lifetime prevalence of headaches?
90%
What are the types of headaches?
Tension
migraine
cluster
What is the secondary cause of headaches?
Cervicogenic
What are tension headaches signs and symptoms?
Bilateral band like tightness
anxiety/stress etiology
No migraine S&S - milder
Dull pressure
What percentage of headaches are tension headaches?
~40%
Why are tension headaches commonly confused with cervicogenic headaches?
Associated muscle tension with both
What can we do for tension headaches?
Address stress/anxiety
improve muscle tension
MET plus biofeedback
What are the qualities of a migraine?
Pulsating
out of commission
unilateral
N&V
drome’s
sensational auras
Why do migraines cause nausea and vomiting?
Extremity and gut vasoconstriction thus cold with poor intestinal absorption/diarrhea
How long can moderate to severe pain last with migraines?
up to 3 days
What percentage of headaches are migraines?
~10-15%
What is the pathophysiology of migraines?
Temporal artery vasodilation
TCN hypersensitivity
What can we prescribe for migraines?
Caffeine to help with vasoconstriction
Increase water intake to 1.5 L per day
2-3 mg melatonin prior to bedtime
address possible cervical joint dysfunction
What are characteristics of cluster headaches?
comes and goes
retro-orbital (around eye) and temporal regions
unilateral
sudden and severe pain
Horners syndrome
Intense
grumpy
What percentage of headaches are cluster headaches?
Less than 1%
What is the etiology of cluster headaches?
Abnormal hypothalamus
genetic
sleep dysfunction
med side effects
What is the pathophysiology of cluster headaches?
TCN hypersensitivity
What is the pathophysiology of cervicogenic headaches?
O-C3 particularly C2,C3 joint dysfunction
TCN hypersensitivity
What are symptoms of cervicogenic headaches?
unilateral
starting in neck and occipital region, progresses to fronto-occular region
Provoked by neck motion
mild to moderate pain
non-throbbing pulsating
What percentage of headaches are cervicogenic?
15-20%
What are some scan findings with cervicogenic headaches?
limited and painful a/prom
possible positive combined motion
possible positive PA tests in upper cervical segments
possibly positive hypersensitivity
positive cervical flexion-rotation test
positive TTP in O-C3 region
What can be prescribed for cervicogenic headaches?
Postural ed
address cervical joint dysfunction
neck and shoulder MET
When is dry needling helpful with cervicogenic headaches?
With manual therapy and exercise
What is thoracic outlet syndrome?
Compression of subclavian artery and possibly brachial plexus
What can cause thoracic outlet syndrome?
Repetitive stress/ overuse
FHP
prolonged UE elevation
scalenes shortening and tightness
What is thoracic outlet syndrome also known as?
T4 syndrome
What happens with chest breathing?
excessive use of accessory respiratory muscles
What are differential diagnosis for thoracic outlet syndrome?
Cervical rib
pancoast tumor compression medial cord of brachial plexus
carpal tunnel syndrome
spinal nerve impingement
neurovascular diseases
What are signs and symptoms of a peripheral nerve loss of conduction vs spinal nerve losing conduction
Non segmental
positive dural mobility
not in dermatomal pattern or radiculopathy
muscle weakness in muscles innervated by spinal nerve
reflexes normal bc perepherial cutaneous nerve is not whats tested
CN tests normal
What are symptoms of thoracic outlet syndrome?
UE glove/sleeve like paresthesias
non-segmental paresthesias (short and fast progression)
Possible weakness
Coldness and sweating with vascular compromise
What are thoracic outlet syndrome symptoms increased by?
Raising arms
sleeping
poor sitting posture
What are signs of Thoracic outlet syndrome?
FHP
possible UE discoloration
A/PROM upper thoracic restriction signs
Resisted tests/MMT decreased strength/endurance in posterior shoulder/scapular muscles
dermatome, DTR, myotomes WNL
Non segmental hypoactivity
ULTT Dural mobility tests positive
What are signs and symptoms of a dural tension restriction?
Paresthesias increased from both ends
If not tension restriction or hypersensitivity contributing to paresthesias, then what kind of restriction is likely present?
Gliding
Why would a gliding restriction be present?
Adhesion
What do we do for a gliding restriction?
Neural mobilizations
motion with resistance or symptoms (OK in this situation)
what effect do neural mobilizations have on gliding restrictions?
moderate to large effect on pain, disability, and mechanosensitivity
What are some signs of gliding restriction in accessory motion testing?
Accessory motion testing
- unilateral upper thoracic hypomobility
- limited 1st rib anterior glide
What can FHP cause in terms of circulation?
Reduced circulation
- may cause up to 300 mmHg pressure in the muscle
- a 30% max voluntary contraction of the muscle will produce circulation
- 70% max voluntary contraction will nearly eliminate circulation
What are some FHP issues?
thorax flexed and depressed
-diaphragm compressed
- decreases anti-gravity reflex of muscles
thoracic extensors and accessory respiratory muscles overworked to compensate
Upper thoracic joint dysfunction can develop what?
T1-6 hypomobility
c7-T1 hypermobility due to anterior shearing forces
dowager’s hump
wedging of vertebra
What can we do to help with FHP?
Postural ed
ergonomic modifications
diaphragmatic breathing
neural mobilizations
MT/MET for upper thoracic mobility
MET for stabilization in cervicothoracic and shoulder complex regions
