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Musculoskeletal II > Common Cervical Spine Conditions > Flashcards

Common Cervical Spine Conditions Flashcards

1
Q

Neurogenic Dx with possible overlying Mechanical

A 
Disc pathology	
Annular tears
Bulges, herniation's, prolapses
Radiculitis/Neuritis/Cervicobrachial
ESOA with stenosis, myelopathy, or possible central cord findings
Cervical Spondylolisthesis
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2
Q

Strictly Mechanical

A 
Facet Syndromes
Myofascitis, fibromyalgia, and other myofascial conditions
Osteoarthritis
Whiplash (hyperflexion/extension)
Pseudotortocolis
Cervicogenic Headaches
HA’s
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3
Q

Features of Cervical Radiculopathy

A

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

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4
Q

Clinical Prediction Rule for Cervical Radiculopathy

A

+ Spurlings
+ ULTT Median nerve
+Cervical Distraction Test
+Less than 60 degrees of cervical spine rotation toward the involved side

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5
Q

Clinical Prediction Rule for Neck pain and Cervical Traction

A
  1. Patient reported peripheralization with lower cervical spine (C4-C7) mobility testing
  2. Positive Shoulder abduction test
  3. Age >54
  4. Positive ULTT A
  5. Positive Cervical Distraction Test
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6
Q

Cervical Facet Joint Syndrome

A

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

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7
Q

Clinical Prediction Rule (CPR) for Cervical Spine Manipulation

A
  1. Initial scores on NDI less than 11.50
  2. Presence of bilateral pattern of involvement
  3. Not performing sedentary work for more than 5 hours each day
  4. Report of feeling better while moving the neck
  5. No report of feeling worse while extending the neck
  6. The diagnosis of spondylosis without radiculopathy
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8
Q

Alternative CPR for Cervical Manipulation

A
  1. Symptoms less than 38 days
  2. Positive expectation that manipulation will help
  3. Side to side difference in cervical rotation ROM of 10 degrees or greater
  4. Pain with posterior anterior spring testing (PAIVM) of the mid cervical spine
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9
Q

Clincal features of Cervical Myelopathy, Cervical Stenosis, Severe cervical Arthritis

A

muscle weakness, possible wasting a the end stages, worse with extension possibly better with flexion
Difficulty walking
Sensation maybe impaired

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10
Q

What is decreased with Cervical Myelopathy, Cervical Stenosis, Severe cervical Arthritis?

A

reflexes or possible hypertonic reflexes

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11
Q

Whiplash (WAD)

A

History of hyperflexion/hyperextension injury. Has symptoms of broad based pain due to widespread muscular and ligamentous damage.

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12
Q

Symptoms of WAD:

A

Stiffness/Loss of ROM in all pains.
Increased muscular hypertonicity for guarding
May have co-occurring radiculitis

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13
Q

WAD 1

A

mild strain

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14
Q

WAD 2

A

neck pain and decreased ROM

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15
Q

WAD 3

A

neurological +msk

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16
Q

WAD 4

A

Fracture/dislocation

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17
Q

Who is at a greater risk for WAD?

A

women

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18
Q

What is also seen with WAD?

A

Hypermobility and weakness in deep neck stabilizers seen

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19
Q

What is seen with cervical facet joint syndrome?

A

postural and weakness of deep neck flexors

Hypomobility noted with capsular pattern (side bending and rotation limited to the same side)

20
Q

Congential Torticollis/Pseudotorticollis

A

fixed asymmetry

21
Q

Adult Torticollis

A

Painful SCM spasm with movement restricted in one plane worse than others

22
Q

Pseudotorticollis

A

limited in all planes of motion. Typically seen upon waking i.e. no trauma. Head is often held in neutral. No known cause

23
Q

What do MyoFascial Disorders/Fibromyositis patient not present with?

A

Lack of neurological symptoms

24
Q

What is common with MyoFascial Disorders/Fibromyositis patients?

A

Hypermobility is common but not always present. Rarely hypomobile
Repetitive trauma or postural challenges common

25
Q

What is often noted with trigger point patients?

A

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

26
Q

Annular Tears, Internal Disc Derangement onset?

A

acute

More likely to have an acute onset after accident, trauma, or excessive work load

27
Q

Presentation of Annular Tears, Internal Disc Derangement:

A

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.

28
Q

Presentation of pain with Annular Tears, Internal Disc Derangement:

A

Discogenic or sclerodermal presentation of pain

Point tenderness and tenderness with vibration of the spinous process are indicators of internal disc derangement

29
Q

Treatment of cervical radiculopathy”

A 
tractions
segmental mobs
manipulation once tolerance determined
ULTT
thoracic spine mobs
postural reeducation
core
30
Q

Treatment for cervical facet syndrome

A

joint mobs
traction
core & balance
thoracic mobility

31
Q

Treatment for cervical myelopathy, cernival stenosis, severe cervical arthritis

A 
segmental mobs
ULTT
thoracic spine mobility
postural reeducation
soft tissue mobs
core
32
Q

Treatment for Whiplash

A

Neuro based exercises
soft tissue mobs
coach in fear avoidance
core strengthening & balance

33
Q

Treatment for myofasical disorders/fibromyositis

A

trigger point treatment: dry needling, ART, ischemic pressure with thumbs
joint mobs
postural reeducation
thoracic spinal exercises

34
Q

Treatment for torticollis

A 
strain-counter strain
trigger point treatment
distraction
modalities
joint mobilization
HVLA
35
Q

Treatment for Annular Tears, Internal Disc Derangement

A

Joint mobs
postural reeducation
thoracic spine exercises
traction

36
Q

Migranes

A

visual aura & sensory symptoms first then HA. Vomiting/nausea common. Debated if manual therapy will help

37
Q

Cervicogenic HA’s

A

worse with movement, cervical flexion/rotation test positive C1-C2 segment

38
Q

Cluster Headaches

A

Headache in the eye

39
Q

Tension Type Headaches

A

very common “featureless” headache, tightness/pressing not a pulsatile HA

40
Q

Rebound Headaches

A

Caffeine or medications used frequently. Patient has HA when not on meds or several hours after ingesting caffeine

41
Q

Treatment for headaches

A 
soft tissue techniques (sub-occipital release, MFR, SCS)
joint mobs
trigger point therapy
postural reeducation
cervical spine reeducation
42
Q

CPR for Neck pain patients who will respond to thoracic manipulation

A
  1. Duration of symptoms less than 30 days
  2. NO symptom distal to the shoulder
  3. Looking up does not aggravate their symptoms
  4. FABQ assessment score of less than 12
  5. Diminished upper thoracic spine kyphosis at T3-T5
  6. Cervical Extension range of motion less than 30 degrees
    (excluded stenosis patients, red flags, WAD
43
Q

If repeated cervical spine movement elicits pain:

A

If this increase the shoulder pain consider the cervical spine.

44
Q

Red Flags

A

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

45
Q

Yellow flags

A

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

46
Q

Absolute Contraindication for Joint Mobs:

A 
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
47
Q

Relative precaution for jointmobs:

A 
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

Musculoskeletal II (14 decks)

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