Classification of Cervical Disorders Flashcards by Tahlia Wasserman

what % of the population suffers from neck pain?

10-15% of the population

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are more males or females affected by neck pain?

more females

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what age group has a higher incidence of neck pain?

those over 50 yo

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what % of individuals have experienced neck pain in the last 6 months?

54%

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neck pain is second only to what in workers’ comp costs?

LBP

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what makes up 25% of all outpatient PT?

neck pain

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do LBP or neck pain pts experience smaller fxnal improvements?

neck pain pts

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do we need to know the pathologic fxn to treat pts?

nope

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is it better to use impairment-based dx or anatomic-based dx?

impairment-based dx

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classification based on _____ _____ was a more reliable method of classifying LBP pts

sx behavior

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t/f: expert opinion supports the notion that classification schemes avoid the use of pathoanatomic labels

true

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what is more important than performance of the intervention itself?

selecting the pt that’s most likely to benefit from your chosen intervention

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according to the Piva clinical decision making algorithm, if traction produces limited flexion, what intervention should we use?

cervical traction

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how can we determine irritability level?

with palpation and repeated motion

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what is low irritability in the McClure classification?

pain at end range or with overpressure

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what is high irritability in the McClure classification?

pain that blocks motion earlier in the range

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the tension stress profile in the McClure classification causes sx reproduction with what?

pain with opening activities (flexion, SB/ROT away)

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the compression stress profile in the McClure classification causes sx reproduction with what?

pain with closing activities (extension, SB/ROT toward)

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what are the opening cervical motions?

flexion
SB/ROT away

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what are the closing cervical motions?

extension
SB/ROT towards

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symptoms of McClure compression profile are reduced with what?

flexion, SB/ROT away

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symptoms of McClure tension profile are reduced with what?

extension, SB/ROT toward

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if someone has low reactivity compression profile in the McClure classification, what do we want to do for interventions?

restore motion through stretching INTO pain

mobilization/ROM to improve restricted motion

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if someone has high reactivity compression profile in the McClure classification, what do we want to do for interventions?

relieve compression through rest, modalities, meds, pain-free ROM AWAY from compression, avoid end range, traction

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if someone has low reactivity tension profile in the McClure classification, what do we want to do for interventions?

restore motion through stretching INTO pain mobilization/ROM to improve restricted motion, neural tension

if someone has high reactivity tension profile in the McClure classification, what do we want to do for interventions?

relieve tension through rest, modalities, meds, pain-free ROM AWAY from tension, avoid end range

if someone is of high reactivity, do we move them towards or away from the painful direction?

away

if someone is of low reactivity, do we move them towards or away from the painful direction?

towards

if someone has high reactivity tension profile in the McClure classification, is traction indicated?

nope

if sx produced by tension are high, what general intervention should we use?

relieve tension

if sx produced by tension are low, what general intervention should we use?

apply tension (restore mobility)

if sx produced by compression are high, what general intervention should we use?

relive compression

if sx produced by compression are low, what general intervention should we use?

move toward compression (restore motion)

according to the Childs classification, if there was no onset of WAD (or WAD >30 days/NPRS<7/NDI<52), but there are s/s of nerve compression, what syndrome would this be?

centralization syndrome

according to the Childs classification, if there was no onset of WAD (or WAD >30 days/NPRS<7/NDI<52), no s/s of neural compression, but there are s/s distal to the elbow, what syndrome would this be?

centralization syndrome

according to the Childs classification, if there was no onset of WAD (or WAD >30 days/NPRS<7/NDI<52), no s/s of neural compression, no s/s distal to the elbow, but there is a CC of HA with neck pain and with neck movt, what syndrome would this be?

HA syndrome

non-cervicogenic HA

according to the Childs classification, if there was no onset of WAD (or WAD >30 days/NPRS<7/NDI<52), no s/s of neural compression, no s/s distal to the elbow, no CC of HA with neck pain and with neck movt, with duration of symptoms <30 days and the pt is younger than 60 yo, what syndrome would this be?

mobility syndrome

exercise and conditioning syndrome

according to the Childs classification, if there was onset of a WAD with duration <30 days, and NPRS>7, NDI>52, what syndrome would this be?

pain control syndrome

what does WAD stand for?

whiplash associated disorder

what are s/s of nerve compression?

numbness/tingling in the extremities or sx that refer down the arm, pec area, c spine

what are the criteria for a pain control syndrome?

WAD duration <30 days NPRS>7 NDI>52 both interventions in first 3 sessions

what are the principles of intervention for a pain control syndrome?

cervical spine mobilization cervical ROM (direction preference) modalities

what are the criteria for centralization syndrome?

evidence of neural involvement s/s distal to elbow duration >30 days NPRS<7, NDI<52 (lower disability) either intervention received

what are the principles of intervention for centralization syndrome?

manual/mechanical traction cervical retraction (chin tucks)

what are the criteria for mobility syndrome?

no evidence of neural involvement no c/o HA duration <30 days <60 yo both interventions in first 3 sessions

what are the principles of intervention for mobility syndrome?

cervical, thoracic non-thrust/thrust mobs strengthening for deep neck flexors

what are the criteria for exercise and conditioning syndrome?

no evidence of neural involvement no c/o HA >60 yo both interventions in at least 50% of sessions

what are the principles of interventions for exercise and conditioning syndrome?

strengthening for upper quarter strengthening for deep neck flexors

what are the criteria for HA syndrome?

HA with neck pain HA with neck movts no dx of migraine HA receive all interventions

what are the principles of interventions for HA syndrome?

cervical spine nonthrust/thrust strengthening for deep neck flexors strengthening for upper quarter

irritation of what nucleus can produce sx in various areas of the head and face?

the trigemino-cervical nucleus (TCN)

what is the pattern of referral and centralization of cervicogenic HAs?

mouth nose eye frontal parietal temporal tmj ear occiput SO

do all cervicogenic HAs peripheralize/centralize the same?

nope

what are the dx criteria for cervicogenic HA?

pain in the neck/occiput that spreads into the head pain precipitated by movt or postures motion restrictions, Ms tone changes, OR neck ms tenderness radiology reveals flexion/extension limitations, abnormal posture, pathology (fx, tumor, RA) (+) flexion rotation test

the flexion rotation test isolates what area of the neck?

the suboccipital motion

if cervicogenic HA produces sx in the epicranium, what is the culpable segment? mobilization technique?

culpable segment=OA mob=C1 central anterior

if cervicogenic HA produces sx in the frontal, temporal, peri-orbital area, what is the culpable segment? mobilization technique?

culpable segment=OA mob=C1 unilateral anterior or transverse

if cervicogenic HA produces sx in the occipital, supra, retro-orbital area, what is the culpable segment? mobilization technique?

culpable segment=AA, C2/3 mob=C2 unilateral anterior

if cervicogenic HA produces sx in the parietal area, what is the culpable segment? mobilization technique?

culpable segment=OA, AA mob=C1, C2 unilateral posterior

if cervicogenic HA produces sx in the facial, aural, nasal, gum/teeth area, what is the culpable segment? mobilization technique?

culpable segment=TMJ, OA mob=TMJ, C1 transverse

if cervicogenic HA produces sx in the neck, eye area, what is the culpable segment? mobilization technique?

culpable segment=C3 mob=central or unilateral anterior

what is included in the hx of HA of upper cervical origin?

no lower cervical, thoracic, UE sx SO and upper cervical sx only onset could be anytime

what is included in the hx of HA of lower cervical origin?

lower cervical, thoracic, or UE sx HA sx alternate sides frequently HA onset around the same time as lower cervical sx onset

can pts change categories during the course of PT?

yup

can a pt fit into more than 1 syndrome?

yup

what Quebec task force grade is characterized by no complaint of neck pain and no physical signs?

grade 0

what Quebec task force grade is characterized by neck pain, stiffness, and tenderness with no physical signs?

grade 1

what Quebec task force grade is characterized by neck pain, MSK signs (tenderness to touch and decreased ROM)?

grade 2

what Quebec task force grade is characterized by neck pain, MSK signs (tenderness to touch and decreased ROM), neuromuscular signs (diminished DTRs, ms weakness, sensory loss)?

grade 3

what Quebec task force grade is characterized by failing the upper quarter screen at some level?

grade 3

what Quebec task force grade is characterized by neck pain and fx/dislocation confirmed by imaging?

grade 4

are we likely going to be treating a grade 4 Quebec task force pt?

nope

what are the Canadian cervical spine rules?

>65 yo/hx of trauma or paresthesia no simple MVA/sitting in ER/ambulatory/delayed onset of neck pain/absence of midline tenderness no ability to rotate neck actively 45 deg each direction

if a pt is over 65 yo or has a hx of trauma/paresthesia, do they need a radiograph?

yes

if a pt is younger than 65 yo, has no hx of trauma/paresthesia, has had no simple MVA/sitting in ER/not ambulatory/no delayed onset of neck pain/midline tenderness do they need a radiograph?

yes

if a pt is able to rotate their neck actively 45 deg in each direction, do they need a radiograph?

if a pt is unable to rotate their neck actively 45 deg in each direction, do they need a radiograph?