Common Cervical Spine Conditions

Question 1

Neurogenic Dx with possible overlying Mechanical

Answer 1

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

Question 2

Strictly Mechanical

Answer 2

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

Question 3

Features of Cervical Radiculopathy

Answer 3

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

Question 4

Clinical Prediction Rule for Cervical Radiculopathy

Answer 4

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

Question 5

Clinical Prediction Rule for Neck pain and Cervical Traction

Answer 5

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

Question 6

Cervical Facet Joint Syndrome

Answer 6

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

Question 7

Clinical Prediction Rule (CPR) for Cervical Spine Manipulation

Answer 7

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

Question 8

Alternative CPR for Cervical Manipulation

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

reflexes or possible hypertonic reflexes

Question 11

Whiplash (WAD)

Answer 11

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

Question 12

Symptoms of WAD:

Answer 12

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

Question 13

WAD 1

Answer 13

mild strain

Question 14

WAD 2

Answer 14

neck pain and decreased ROM

Question 15

WAD 3

Answer 15

neurological +msk

Question 16

WAD 4

Answer 16

Fracture/dislocation

Question 17

Who is at a greater risk for WAD?

Answer 17

women

Question 18

What is also seen with WAD?

Answer 18

Hypermobility and weakness in deep neck stabilizers seen

Question 19

What is seen with cervical facet joint syndrome?

Answer 19

postural and weakness of deep neck flexors

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

Question 20

Congential Torticollis/Pseudotorticollis

Answer 20

fixed asymmetry

Question 21

Adult Torticollis

Answer 21

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

Question 22

Pseudotorticollis

Answer 22

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

Question 23

What do MyoFascial Disorders/Fibromyositis patient not present with?

Answer 23

Lack of neurological symptoms

Question 24

What is common with MyoFascial Disorders/Fibromyositis patients?

Answer 24

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

Question 25

What is often noted with trigger point patients?

Answer 25

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

Question 26

Annular Tears, Internal Disc Derangement onset?

Answer 26

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

Question 27

Presentation of Annular Tears, Internal Disc Derangement:

Answer 27

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.

Question 28

Presentation of pain with Annular Tears, Internal Disc Derangement:

Answer 28

Discogenic or sclerodermal presentation of pain | Point tenderness and tenderness with vibration of the spinous process are indicators of internal disc derangement

Question 29

Treatment of cervical radiculopathy"

Answer 29

``` tractions segmental mobs manipulation once tolerance determined ULTT thoracic spine mobs postural reeducation core ```

Question 30

Treatment for cervical facet syndrome

Answer 30

joint mobs traction core & balance thoracic mobility

Question 31

Treatment for cervical myelopathy, cernival stenosis, severe cervical arthritis

Answer 31

``` segmental mobs ULTT thoracic spine mobility postural reeducation soft tissue mobs core ```

Question 32

Treatment for Whiplash

Answer 32

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

Question 33

Treatment for myofasical disorders/fibromyositis

Answer 33

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

Question 34

Treatment for torticollis

Answer 34

``` strain-counter strain trigger point treatment distraction modalities joint mobilization HVLA ```

Question 35

Treatment for Annular Tears, Internal Disc Derangement

Answer 35

Joint mobs postural reeducation thoracic spine exercises traction

Question 36

Migranes

Answer 36

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

Question 37

Cervicogenic HA’s

Answer 37

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

Question 38

Cluster Headaches

Answer 38

Headache in the eye

Question 39

Tension Type Headaches

Answer 39

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

Question 40

Rebound Headaches

Answer 40

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

Question 41

Treatment for headaches

Answer 41

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

Question 42

CPR for Neck pain patients who will respond to thoracic manipulation

Answer 42

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

Question 43

If repeated cervical spine movement elicits pain:

Answer 43

If this increase the shoulder pain consider the cervical spine.

Question 44

Red Flags

Answer 44

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

Question 45

Yellow flags

Answer 45

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

Question 46

Absolute Contraindication for Joint Mobs:

Answer 46

``` 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 ```

Question 47

Relative precaution for jointmobs:

Answer 47

``` 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 ```