Common MSK Conditions of the Cervical and Thoracic Spine Flashcards
Neck Pain Risk Factors (7)
Female
Prior history of neck pain
Older age
High job demand
Smoking
Low social/work support
Prior history of MSK condition (spine)
Negative Prognostic Factors (9)
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)
Neck Pain Grade 1
- No signs of major structural pathology and no/minor interference with ADLs (positive prognosis).
Neck Pain Grade 2
No signs of major structural pathology, but major interference with ADLs (negative prognosis).
Neck Pain Grade 3
No signs of major structural pathology, but presence of neurological signs (specific disorders).
Neck Pain Grade 4
Signs of major structural pathology (serious pathology).
Proper Clinical Evaluation
Triage serious neck pain
Screen specific neck pain
Non-specific neck pain -> check prognostic factors -> related impairments (ICF) ->Recommended treatments.
Non-Specific MSK Condition - Definition
MSK condition not attributed to a recognizable, known specific pathology.
Specific Disorders (2)
Myelopathy
Cervical Radiculopathy
Specific Disorder - Myelopathy
Alteration/degeneration of spinal cord tissue (CNS involved).
Gait related changes (wide gait). Upper limb loss of strength, atrophy.
Bilateral symptoms.
Specific Disorder - Cervical Radiculopathy
Neck pain with radiating pain. Affects PNS, unilateral symptoms.
Signs of nerve root involvement, peripheralized symptoms.
Cervical Radiculopathy - Special Tests (5)
Wainner’s Cluster:
- ULNT1
- Painful ipsilateral cervical rotation <60°
- Distraction
- Spurling test
Neurological examination
Serious Pathologies (4)
Cervical Spine Anatomical Instability
Spinal Fracture
Cervical Spine Instability
Cervical Arterial Pathology
Serious Pathology - Cervical Spine Anatomical Instability : Risk Factors (4)
History of trauma, vascular damage
Rheumatoid arthritis
Downs syndrome
Ankylosing Spondylitis
Serious Pathology - Spinal Fracture : Risk Factors
Usually trauma or injury (compressive or axial force, fall >3m, MVC >100km/h)
Osteoporosis
Canadian Cervical Spine Rules (fracture) - Short Description
High sensitivity, after neck trauma, to rule out fracture, 3 stage process to see if an MRI is needed.
Serious Pathology - Cervical Spine Instability (4)
Fracture, ligament damage.
Recent onset headache.
Impaired ROM, sharp pain at end range.
Transient neurological symptoms.
Serious Pathology - Cervical Arterial Pathology : Risk Factors, Symptoms (preischemic, ischemic)
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.
Neck Pain Impairment - Classifications (4)
Impairments
NP with mobility deficit
NP with movement coordination impairment
NP with cervicogenic headache
NP with radiating pain (radiculopathy)
Non-Specific - Neck Pain with Mobility Deficit : Symptoms (3)
Central and/or unilateral neck pain.
Limited ROM (reproduction of symptoms at end of range).
Referred shoulder girdle pain.
Non-Specific - Neck Pain with Mobility Deficit : Special Tests (3) and Management
Limited and painful at end range active/passive ROM.
Spring test
Trigger points
Education, manual therapy, exercises.
Non-Specific - Neck Pain with Movement Coordination Impairment : Symptoms (6)
Whiplash. Poor recovery.
May have referred upper limb pain.
Dizziness/nausea
Headache
Hypersensitivity to thermal
Central sensitization
Non-Specific - Neck Pain with Movement Coordination Impairment : Special Tests (4) and Management
Craniocervical flexion test
Neck flexor endurance test
Neck extensor endurance test
Sensorimotor impairment
Education, manual therapy, exercise depending on the state.
Non-Specific - Neck Pain with Cervicogenic Headache : Symptoms and Aggravates
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.
Non-Specific - Neck Pain with Cervicogenic Headache : Special Tests (3) and Management
Limited ROM (rotation)
Cervical flexion-rotation test
Upper cervical spring test
Manual therapy with movement.