Cspine Flashcards
Cervical strain definition
whiplash, causes Muscular + ligamentous structures of the cervical spine to be stretched beyond physiologic capacity
Causes
sudden hyperextension followed by hyper-flexion of the neck.
Commonly from Rear end automobile collisions or Sports trauma
Clinical presentation
Neck pain
Persistent stiffness
Trapezial/upper back pain
Muscle spasm
Headaches
Limited ROM
Must be aware to the discomfort it causes patients, however it usually has a benign course + minimal long term sequelae (an aftereffect of an injury)
Our job to rule out morbid conditions, e.g. bony fracture from the large majority of cervical strains. Must be able to identify Ps with bone and neurologic pathology such as fractures, dislocations and spinal cord injuries that mimic the condition of a cervical strain
Prognosis
In at least 40% of people, there should be some resolution of symptoms by 6 weeks, and by 12 weeks, there should be complete resolution in at least 40% of people.
Approximately 50% of people fully recover within 1 year of WAD.
Degeneration definition
Spontaneous degeneration of either disc or facet joints
Causes
Accumulated wear and tear that occurs over a long period of time
Age groups affected
Elderly
By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels.
By the age of 60, more than 90% of people will show evidence of some disc degeneration
Risk factors
- Ageing
- Tough manual labour jobs
- Vigorous sports e.g. rugby
Clinical presentation
Neck pain
Stiffness
Decreased ROM
Numbness, tingling, or even weakness in the neck, arms and shoulders are additional symptoms due to nerves in the cervical area becoming irritated or pinched
Ps should be asked to perform flexion, extension and rotational movements and report whether neck pain increases or decreases.
Prognosis
Symptoms worsen if left untreated
Treatment centred around reliving pain, wont fully treat/relive symptoms
Herniation definition
When the outer part (annulus fibrosus) gets tears or splits, the gel (nucleus pulposus) can poke out. This is what it means for a disk to become herniated. (think jam donut)
Causes
Traumatic events, some spontaneous cases
Most occur between C5 and T1
Age groups
More common in elderly due to wear and tear & less water in discs
Risk factors
Age
Lack of regular exercise
Tobacco use
Poor posture (i.e., incorrect lifting or twisting causing additional stress on the cervical spine)
Injury.
Clinical presentation
Frequent headaches
Limited ROM
Pain that originates around the paraspinal muscles radiates down one of the upper extremities
Paraspinal muscles may go into spasm, causing discomfort on palpation
Finger numbness and tingling
Can cause spinal cord compression, where disc material pushes directly on spinal cord
Prognosis
Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don’t respond to conservative treatment or your symptoms get worse, surgery may be recommended.
Stenosis definiton
A condition in which the spinal canal is too small for the spinal cord and nerve roots. This can cause damage to the spinal cord.
Causes
Bone spurs.
Herniated disks.
Thick ligaments - can become stiff and thick over time. Thick ligaments can push into the spinal canal.
Tumors - Rarely, tumors can form inside the spinal canal.
Spinal injuries.
Age groups
Most people with spinal stenosis are over age 50
Risk factors
Scoliosis or other spinal problems.
Clinical presentation
Numbness
Tingling or weakness in a hand, leg, foot or arm
Neck pain
Common to present vague neurological symptoms -
Problems with walking and balance
Bowl and bladder inconsistence
Ps expected to have hyperreflexia in the in their upper and lower extremities
Prognosis
Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery.
Cervical facet syndrome
A type of osteoarthritis that occurs when the structure of one or more of the vertebral facet joints begins to deteriorate
Causes
Disk degeneration and disk narrowing increase facet joint loading and consequently facet osteoarthritis
Age groups
50 and above
risk factors
- Genetic disposition
- Smoking
- Either sedentary jobs at a computer or high levels of repeated muscle tension
Clinical presentation
- Unilateral pain without radiation to the arm
- Rotation and retroflexion are frequently painful or limited
- Pain with pressure on the dorsal side of the spinal column at the level of the facet joints
- Pain and limitation of extension
- Absence of neurological symptoms
Prognosis
Can get better through manipulation and mobilisation
Cervical Artery Dysfunction
Umbrella term for rare vascular problems of the neck, can involve the internal carotid and/or vertebral arteries.
Age group
Internal most common 35-55
External 55 and above
Causes
Acute injury or linked to other conditions.
Hyoid bone has also been described as a potential mechanical compressor of the internal carotid artery
Risk factors
Whiplash in case history
Smoking habits, poor lifestyle such as diet/nutrition, overweight, previous stroke and vascular presentations like hypertension
Clinical presentation
Neck and head pain.
Headaches.
Dizziness.
Blurred vision.
Balance disturbance.
Speech or swallowing issues.
Increase in blood pressure.
Facial numbness.
Nystagmus (involuntary eye movements).
Feeling sick or faint.
Loss of taste.
Prognosis
Not fully curable but symptoms can be minimised
Trigger points
Hyperrritable spot, a palpable nodule in the taut bands of the skeletal muscles’ fascia.
Direct compression or muscle contraction can elicit jump sign, local tenderness, local twitch response and referred pain which usually responds with a pain pattern distant from the spot
Causes
- Acute trauma or repetitive micro trauma, leading to developmental stress on muscle fibres
- Lack of exercise
- Acute sports injuries
Age groups
Common in men between 30 and 55 with lack of exercise
Risk factors
Occupational or recreational activities that produce repetitive stress on a specific muscle/group commonly cause chronic pain leading to trigger points
Prolonged poor posture
Joint problems
Clinical presentation
Regional persistent pain, decreased ROM
Muscles used to maintain body posture, neck, shoulders and pelvic floor muscles
Tension headaches, tinnitus
Muscle weakness or imbalance
Painful movement and/or movement that sometimes can exacerbate symptoms.
Postural abnormalities and compensations.
Prognosis
Can loosen through treatment
Acute disc prolapse
Slipped disc pressing on a nerve root
Causes
Sudden unguarded flexion and rotation
Predisposed abnormality of disc with increased nuclear tension
Age groups
30-50
Risk factors
Genetics, smoking, ageing, improper lifting
clinical presentation
- Pain and stiffness in the neck
- Pain radiating to scapular region and occiput
- Pain and paraesthesia in one lower limb, radiating to the outer elbow, back of wrist, index and middle fingers
- Neck may be tilted forwards and sideways
- Muscles tender and movements restricted
- Arm can be examined for signs of nerve root irritation or compression
Prognosis
Can improve through treatment
Pyogenic infection
local inflammation of skin, soft tissue and bodily parts which are mainly caused by invasion and multiplication of pathogenic microorganism
Causes
Pathogen, usually staphylococcus, reaches the spine via the blood stream.
Initially destructive changes are limited to the intervertebral disc space and the adjacent parts of vertebral bodies
Later, abscess formation occurs and pus may extend into spinal canal or soft tissue planes of the neck
Age
Can affect any age
Risk factors
Clinical presentation
- Pain in the neck, often associated with muscles spasm and stiffness
- Severely limited neck ROM
- Blood tests may show a leucocytosis and an elevated erythrocyte sedimentation rate
Prognosis
Antibiotic treatment works best in the early stage
Rest
Tuberculosis
spinal infection caused by tuberculosis
Causes
- Blood borne infection that localises in the intervertebral disc and the anterior parts of the adjacent vertebral bodies
- As bone crumbles the Cspine collapses into kyphosis
- Retropharyngeal abscess forms and points behind sternomastoid muscle at the side of the neck
Age
Usually children
Risk factors
Clinical presentation
- Neck pain and stiffness
- Retropharyngeal abscess (in neglected cases) causes difficulty swallowing. Shows as swelling in posterior triangle of neck
- Neck extremely tender, all movements limited
- In late cases there may be obvious kyphosis
- X-rays show narrowing of disc space and erosion of adjacent vertebral bodies
Prognosis
Immobilisation of the neck in a brace for 6-18 months and antituberculosis drugs
Rheumatoid arthritis
Long-term condition that causes pain, swelling and stiffness in the joints. The condition usually affects the hands, feet and wrists.
Age
Mainly women, elderly
Risk factors
Family history.
Smoking. C
Excess weight.
Clinical presentation
Neck pain and noticeable restriction
Tender, warm, swollen joints
Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and loss of appetite
Lower limb weakness due to cord compression in extreme cases
Prognosis
No cure for rheumatoid arthritis, early treatment and support (including medicine, lifestyle changes, supportive treatments and surgery) can reduce the risk of joint damage and limit the impact of the condition.
Ankylosing Spondylitis
inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse.
Causes
No known specific cause, though genetic factors seem to be involved.
Age
- Teenagers and young adults
- 2x more common in men
Risk factors
Gut inflammation, suggesting a potential origin in the gut. It’s thought disruption to the microbiome in your gut may play a role in its development.
Smoking.
Clinical presentation
Neck pain and stiffness, some years after onset of backache
Neck gradually becomes rigid and kyphotic, some movement preserved at atlantooccipital and atlantoaxial joints
Pain that’s worse in the morning or after sitting for a long time
A rigid spine that curves forward
Tiredness
Swelling in your joints
Trouble taking deep breaths
Prognosis
No treatment can only manage symptoms
