Common Cervical Spine Conditions Flashcards
Neurogenic Dx with possible overlying Mechanical
Disc pathology Annular tears Bulges, herniation's, prolapses Radiculitis/Neuritis/Cervicobrachial ESOA with stenosis, myelopathy, or possible central cord findings Cervical Spondylolisthesis
Strictly Mechanical
Facet Syndromes Myofascitis, fibromyalgia, and other myofascial conditions Osteoarthritis Whiplash (hyperflexion/extension) Pseudotortocolis Cervicogenic Headaches HA’s
Features of Cervical Radiculopathy
Neuro symptoms of bright pain into the UE’s, or myotomal abnormalities, or deratomal abnormalities
Lhermitt’s sign
Neck pain is not always present but neck, shoulder, upper extremity pain and paresthesia into the extremity. Reflexes also impaired in some cases. Some patient’s have mid cervical hypermobility
Clinical Prediction Rule for Cervical Radiculopathy
+ Spurlings
+ ULTT Median nerve
+Cervical Distraction Test
+Less than 60 degrees of cervical spine rotation toward the involved side
Clinical Prediction Rule for Neck pain and Cervical Traction
- Patient reported peripheralization with lower cervical spine (C4-C7) mobility testing
- Positive Shoulder abduction test
- Age >54
- Positive ULTT A
- Positive Cervical Distraction Test
Cervical Facet Joint Syndrome
Mild/moderate Neck pain that is often long standing with no neurological symptoms into the arm but some patients can have shoulder or arm pain that is not deratomal in nature
Clinical Prediction Rule (CPR) for Cervical Spine Manipulation
- Initial scores on NDI less than 11.50
- Presence of bilateral pattern of involvement
- Not performing sedentary work for more than 5 hours each day
- Report of feeling better while moving the neck
- No report of feeling worse while extending the neck
- The diagnosis of spondylosis without radiculopathy
Alternative CPR for Cervical Manipulation
- Symptoms less than 38 days
- Positive expectation that manipulation will help
- Side to side difference in cervical rotation ROM of 10 degrees or greater
- Pain with posterior anterior spring testing (PAIVM) of the mid cervical spine
Clincal features of Cervical Myelopathy, Cervical Stenosis, Severe cervical Arthritis
muscle weakness, possible wasting a the end stages, worse with extension possibly better with flexion
Difficulty walking
Sensation maybe impaired
What is decreased with Cervical Myelopathy, Cervical Stenosis, Severe cervical Arthritis?
reflexes or possible hypertonic reflexes
Whiplash (WAD)
History of hyperflexion/hyperextension injury. Has symptoms of broad based pain due to widespread muscular and ligamentous damage.
Symptoms of WAD:
Stiffness/Loss of ROM in all pains.
Increased muscular hypertonicity for guarding
May have co-occurring radiculitis
WAD 1
mild strain
WAD 2
neck pain and decreased ROM
WAD 3
neurological +msk
WAD 4
Fracture/dislocation
Who is at a greater risk for WAD?
women
What is also seen with WAD?
Hypermobility and weakness in deep neck stabilizers seen
What is seen with cervical facet joint syndrome?
postural and weakness of deep neck flexors
Hypomobility noted with capsular pattern (side bending and rotation limited to the same side)
Congential Torticollis/Pseudotorticollis
fixed asymmetry
Adult Torticollis
Painful SCM spasm with movement restricted in one plane worse than others
Pseudotorticollis
limited in all planes of motion. Typically seen upon waking i.e. no trauma. Head is often held in neutral. No known cause
What do MyoFascial Disorders/Fibromyositis patient not present with?
Lack of neurological symptoms
What is common with MyoFascial Disorders/Fibromyositis patients?
Hypermobility is common but not always present. Rarely hypomobile
Repetitive trauma or postural challenges common
What is often noted with trigger point patients?
Examine the shoulder and upper back musculature to look for trigger points in the soft tissue that can refer symptoms to the arm. Patients will often note distant pain (arm/head) with deep palpation of trigger points
Annular Tears, Internal Disc Derangement onset?
acute
More likely to have an acute onset after accident, trauma, or excessive work load
Presentation of Annular Tears, Internal Disc Derangement:
Commonly don’t have radicular symptoms but the pain intensity is much greater than facet syndromes and they don’t have the range of motion loss seen in torticollis patients.
Presentation of pain with Annular Tears, Internal Disc Derangement:
Discogenic or sclerodermal presentation of pain
Point tenderness and tenderness with vibration of the spinous process are indicators of internal disc derangement
Treatment of cervical radiculopathy”
tractions segmental mobs manipulation once tolerance determined ULTT thoracic spine mobs postural reeducation core
Treatment for cervical facet syndrome
joint mobs
traction
core & balance
thoracic mobility
Treatment for cervical myelopathy, cernival stenosis, severe cervical arthritis
segmental mobs ULTT thoracic spine mobility postural reeducation soft tissue mobs core
Treatment for Whiplash
Neuro based exercises
soft tissue mobs
coach in fear avoidance
core strengthening & balance
Treatment for myofasical disorders/fibromyositis
trigger point treatment: dry needling, ART, ischemic pressure with thumbs
joint mobs
postural reeducation
thoracic spinal exercises
Treatment for torticollis
strain-counter strain trigger point treatment distraction modalities joint mobilization HVLA
Treatment for Annular Tears, Internal Disc Derangement
Joint mobs
postural reeducation
thoracic spine exercises
traction
Migranes
visual aura & sensory symptoms first then HA. Vomiting/nausea common. Debated if manual therapy will help
Cervicogenic HA’s
worse with movement, cervical flexion/rotation test positive C1-C2 segment
Cluster Headaches
Headache in the eye
Tension Type Headaches
very common “featureless” headache, tightness/pressing not a pulsatile HA
Rebound Headaches
Caffeine or medications used frequently. Patient has HA when not on meds or several hours after ingesting caffeine
Treatment for headaches
soft tissue techniques (sub-occipital release, MFR, SCS) joint mobs trigger point therapy postural reeducation cervical spine reeducation
CPR for Neck pain patients who will respond to thoracic manipulation
- Duration of symptoms less than 30 days
- NO symptom distal to the shoulder
- Looking up does not aggravate their symptoms
- FABQ assessment score of less than 12
- Diminished upper thoracic spine kyphosis at T3-T5
- Cervical Extension range of motion less than 30 degrees
(excluded stenosis patients, red flags, WAD
If repeated cervical spine movement elicits pain:
If this increase the shoulder pain consider the cervical spine.
Red Flags
signs and symptoms that would indicate the problem is not musculoskeletal or a more serious problem that should be referred to the appropriate health care professional
Yellow flags
Yellow flag signs and symptoms are also important for the examiner to note as they denote problems that may be more severe or may involve more than one area requiring a more extensive examination, or they may relate to cautions and contraindications to treatment that the examiner might have to consider, or they may indicate overlying psychosocial issues that may affect treatment. Divorce, marital problems, financial problems, or job stress or insecurity can contribute to increasing the pain or symptoms because of psychological stress
Absolute Contraindication for Joint Mobs:
hypermobility/ instability joint inflammation/effusion medically unstable hard end feel acute radiculopathy bone disease/fracture spinal arthropathy deteriorating central nervous system status poist joint effusion blood clotting disorder
Relative precaution for jointmobs:
malignancy total joint replacement pregnancy bone disease connective tissue disorder recent trauma inability to communicate steroid use open wound/rash early healing phase elevated pain levels
