Common MSK Conditions of the Cervical and Thoracic Spine

Question 1

Neck Pain Risk Factors (7)

Answer 1

Female
Prior history of neck pain
Older age
High job demand
Smoking
Low social/work support
Prior history of MSK condition (spine)

Question 2

Negative Prognostic Factors (9)

Answer 2

Symptoms for more than 3 months.
High pain intensity
High self reported disability
High pain catastrophizing
High acute post traumatic stress symptoms
Cold hyperalgesia
Older age >60 years old and prior history of MSK problems
Yellow flags
Stage (delayed recovery)

Question 3

Neck Pain Grade 1

Answer 3

1. No signs of major structural pathology and no/minor interference with ADLs (positive prognosis).

Question 4

Neck Pain Grade 2

Answer 4

No signs of major structural pathology, but major interference with ADLs (negative prognosis).

Question 5

Neck Pain Grade 3

Answer 5

No signs of major structural pathology, but presence of neurological signs (specific disorders).

Question 6

Neck Pain Grade 4

Answer 6

Signs of major structural pathology (serious pathology).

Question 7

Proper Clinical Evaluation

Answer 7

Triage serious neck pain
Screen specific neck pain
Non-specific neck pain -> check prognostic factors -> related impairments (ICF) ->Recommended treatments.

Question 8

Non-Specific MSK Condition - Definition

Answer 8

MSK condition not attributed to a recognizable, known specific pathology.

Question 9

Specific Disorders (2)

Answer 9

Myelopathy
Cervical Radiculopathy

Question 10

Specific Disorder - Myelopathy

Answer 10

Alteration/degeneration of spinal cord tissue (CNS involved).
Gait related changes (wide gait). Upper limb loss of strength, atrophy.
Bilateral symptoms.

Question 11

Specific Disorder - Cervical Radiculopathy

Answer 11

Neck pain with radiating pain. Affects PNS, unilateral symptoms.
Signs of nerve root involvement, peripheralized symptoms.

Question 12

Cervical Radiculopathy - Special Tests (5)

Answer 12

Wainner’s Cluster:
- ULNT1
- Painful ipsilateral cervical rotation <60°
- Distraction
- Spurling test
Neurological examination

Question 13

Serious Pathologies (4)

Answer 13

Cervical Spine Anatomical Instability
Spinal Fracture
Cervical Spine Instability
Cervical Arterial Pathology

Question 14

Serious Pathology - Cervical Spine Anatomical Instability : Risk Factors (4)

Answer 14

History of trauma, vascular damage
Rheumatoid arthritis
Downs syndrome
Ankylosing Spondylitis

Question 15

Serious Pathology - Spinal Fracture : Risk Factors

Answer 15

Usually trauma or injury (compressive or axial force, fall >3m, MVC >100km/h)
Osteoporosis

Question 16

Canadian Cervical Spine Rules (fracture) - Short Description

Answer 16

High sensitivity, after neck trauma, to rule out fracture, 3 stage process to see if an MRI is needed.

Question 17

Serious Pathology - Cervical Spine Instability (4)

Answer 17

Fracture, ligament damage.
Recent onset headache.
Impaired ROM, sharp pain at end range.
Transient neurological symptoms.

Question 18

Serious Pathology - Cervical Arterial Pathology : Risk Factors, Symptoms (preischemic, ischemic)

Answer 18

Rare.
Recent trauma, vascular anomaly, current or past smoker.
Preischemic symptoms: ipsilateral posterior neck pain, occipital headache.
Ischemic symptoms: ataxia/imbalance, weakness U.L. & L.L., dysphasia, dysarthria, aphasia.

Question 19

Neck Pain Impairment - Classifications (4)

Answer 19

Impairments
NP with mobility deficit
NP with movement coordination impairment
NP with cervicogenic headache
NP with radiating pain (radiculopathy)

Question 20

Non-Specific - Neck Pain with Mobility Deficit : Symptoms (3)

Answer 20

Central and/or unilateral neck pain.
Limited ROM (reproduction of symptoms at end of range).
Referred shoulder girdle pain.

Question 21

Non-Specific - Neck Pain with Mobility Deficit : Special Tests (3) and Management

Answer 21

Limited and painful at end range active/passive ROM.
Spring test
Trigger points
Education, manual therapy, exercises.

Question 22

Non-Specific - Neck Pain with Movement Coordination Impairment : Symptoms (6)

Answer 22

Whiplash. Poor recovery.
May have referred upper limb pain.
Dizziness/nausea
Headache
Hypersensitivity to thermal
Central sensitization

Question 23

Non-Specific - Neck Pain with Movement Coordination Impairment : Special Tests (4) and Management

Answer 23

Craniocervical flexion test
Neck flexor endurance test
Neck extensor endurance test
Sensorimotor impairment
Education, manual therapy, exercise depending on the state.

Question 24

Non-Specific - Neck Pain with Cervicogenic Headache : Symptoms and Aggravates

Answer 24

Red Flag: check for cervical artery dissection and upper cervical anatomical instability.
Non continuous, non-pulsatile mild to intense pain. Starts at neck, then headache, ipsilateral.
Limited ipsilateral rotation.
Aggravates: Provocative movements, sustained position.

Question 25

Non-Specific - Neck Pain with Cervicogenic Headache : Special Tests (3) and Management

Answer 25

Limited ROM (rotation)
Cervical flexion-rotation test
Upper cervical spring test
Manual therapy with movement.