clinical syndromes of the cervical spine Flashcards
describe the epidemiology of neck pain
- most people can expect neck pain at some point in their life
-lifetime prevalence = 70%
-less than 1% chance that neck pain is due to a serious condition
-50-85% neck pain patients will have recurrence within 1-5 years
what are the possible causes for neck pain or dysfunction?
-trauma - whiplash associated disorder (not just RTA, could be sports too)
-degeneration
-inflammatory
-mechanical neck pain (non traumatic)
-cervical artery dysfunction
-torticollis/dystonia (paediatrics)
-infections
-tumour
what are examples of degenerative causes of neck pain?
-spondylosis
-spondyloisthesis
-facet joint arthrosis
-discogenic neck pain
what are examples of non traumatic mechanical neck pain causes?
-postural neck pain
-cervicogenic headache
-acute locked neck / wry neck
-TMJ dysfunction
what are some examples of cervical red flags?
-cord compression symptoms / cervical myelopathy
-RA
-cervical artery dysfunction
what are examples pf symptoms of cervical myelopathy?
-hypereflexia + babinski signs
-numbness in hands/ feet
-ataxic gait
-weakness in legs
describe the whiplash biomechanics
-trunk is well stabilised with seatbelt
-hyperextension + hyperflexion
what is whiplash by definition?
an acceleration-deceleration mechanism of energy transfer to the neck. it may result from motor vehicle collisions
what injuries can be involved with whiplash?
-very wide range!!
-anterior long ligament sprain
-disc pathology - cervical + lumbar
-articular facet capsule sprain
-nerve root traction injury
-muscle strains - SCM, longus, colli, scalenes
-retropharyngeal haematoma (difficulty swallowing)
-cervical sympathetic chain reaction
-fracture
-dislocation
-sternal contusions (eg against steering wheel)
-aortic rupture
what are some symptoms of whip lash?
-most common = neck pain and or stiffness
-headaches
-pain in shoulders + arms
-dizziness
-motor weakness
-altered sensation, numbness or p+ns
-dysphagia
-TMJ pain
-visual and auditory symptoms
-concentration difficulties
describe the classification of whip lash
0= no complaint about the neck + no signs
1= neck complaint of pain, stiffness and tenderness only, no other signs
2= neck complaint and MSK signs eg decreased ROM and point tenderness
3= neck complaint and neuro signs eg decreased or absent reflexes, weakness or sensory deficits
4= neck complaint & fracture or dislocation
what grade are the majority of people classified into whip lash classification?
grade 2
in terms of assessment for acute whiplash injury, what do the Australian guidelines recommend?
-assess symptoms - pain, initial disability (NDI), other symptoms etc
-number of symptoms
-pre crash health
-physical exam: ROM, palpation + neurological assessment to establish diagnosis (WAD grade)
what is the Canadian C spine rule?
a decision rule used to determine whether patients w/ trauma require cervical spine imaging eg xray, CT scan to out rule a cervical spine injury
what does the 3 step process of the Canadian C spine rule involve?
1.assess high risk factors eg age >65, dangerous mechanism of injury eg high speed motor collision, bicycle collision, parenthesias in the extremities
2. assess low risk factors eg simple rear end motor vehicle collision eg not high speed, sitting position in ED, delayed onset of neck pain, no midline cervical spine tenderness
3. assess active neck rotation - if they can rotate 45 degrees to right and left- imaging isn’t needed
how to test pain sensitivity for people with whip lash?
-cold pressor test with ice cubes - sensation of pain in 5seconds and time to pain on application of ice to the skin - clinical test to identify cold hyperalgesia
-cold pressor test with icy water
what symptoms might a patient have if they have postural neck pain?
-mild to moderate pain levels
-subjective exam- am is ok but end of day is worse
-aggravations = sustained load eg computer/desk or repetitive tasks
-stretching, massage and heat helps
what kind of things would you do in the physical exam for postural neck pain?
ROM
PPIVMS
PAIVMS
PNF - passive neck flexion
muscle length tests - will be +
muscle control- will be +
in terms of advice for postural neck pain for office, what would we recommend?
-monitoring the height of the chair and the computer
-desk/chair height
-position in chair - phone, mouse
-lumbar support eg back of chair
-break periods eg pomodoro
what is the clinical pattern of acute locked neck/wry neck?
-sudden onset - sudden movement in the morning that causes instant pain
-patient stuck in side flexion +/ flexion = position of ease
-most common level C2/C3
-facet joint or meniscoid getting stuck
-lots of spasms
-goes away by itself
describe cervical spondylosis
-usually >50 years
-primarily C5-C7
-cause is unknown - trauma in the past, overuse, genetic
-degeneration can be painless
-could show up with cervical radiculopathy is there is lateral canal stenosis
describe the clinical pattern of cervical spondylosis
-central/ unilateral pain +/- arm pain or radiculopathy
-pain is worse at EOD
-stiffness worse in am
-PAIVM
-localised hypomobility
explain what are the 4 main types of headaches?
-migraine (most common) - 4-72 hours
-tension type
-cervicogenic
-cluster episode
describe cervicogenic headaches subjective findings
-unilateral or one side dominant
-side consistency - it will stick to the same side
-neck or suboccipital pain before headache
-most commonly ,moderate
-other symptoms eg nausea, dizziness or visual problems
-history of trauma/ postural strain/degeneration
describe the clinical pattern of discogenic neck pain
-age 30-55 years
-work history -prolonged cervical flexion eg desk job or a single incident eg RTA
-disc herniation usually in degenerating disc
-most common C5/C6, C6/C7 + C4/C5
-often just causes pain with no radiculopathy
what is cervical radiculopathy
pain in a radicular pattern one one of both of the upper extremities related to compression and or irritation of one or more cervical nerve roots
-symptoms include varying degrees of sensory, motor and reflex changes as well as dysesthsias and parasthesias
what can cause cervical radiculopathy?
-soft disc - single level, inflammation, majority spontaneously resolve in weeks - months
-spondylosis
what is the clinical prediction rule for cervical radiculopathy?
-set of tests used to diagnose cervical radiculopathy
-involves different tests including spurlings test, distraction test, upper limb tension test for median nerve & cervical rotation test
