Cx/Cx-Vr Flashcards
whats C3-C7:
CP
CPP
RP
CP: SF/rot > ext > flex
CPP: full ext
RP: slight ext
whats the 2 Combined mvt? How to OP?
Flex+SF+rot
Ext+SF+rot
OP: stab c7 + OP
Indication for ULTN2m?
Scap depression
S/S to median n.
If shld prb and want to avoid shld abd
Indications for ULNT2r
Radial n. distrib
- post shld pain
- lat elbow pain
- dorsal FA pain (radial tunnel syndrom, de Quervain)
Indications for ULNT3
Ulnar nerve distrib
ant shld, axilla, medial arm/elbow, hypothenar eminence, 4-5th finger
C8 radiculo
TOS
CuTS
Guyons canal synd
Clinical present WAD
Pain cx verry irritbale
P with shearing, compress/tract
No changes on RX (after 1y yes)
WAD tx?
Rest, brace Posture Breathing pattern Stab Mobs below injury
Describe WAD grade 0
No neck complaint
No phys sign
WAD grade 1
Neck: pain, stiffness or tenderness
No phys signs
WAD grade 2
neck complaint + MSK sign (ROM, point tenderness)
WAD grade 3
neck complaint + neuro sign (dec/abs td reflexes, weakness, sensory deficits)
WAD grade 4
Neck complaint + fx/disloc (RX +ve)
WAD grade 2A
neck pain motor impairment (ROM and altered recruitement pattern) Sensory impair (local cx mechanical hyperalgesia)
WAD 2B
WAD 2A + Psycho impairment (PTSD)
WAD 2C
WAD 2B +
Motor impairm (jt position errors, gen sensory hypersensitivity, sympathetic NS disturb)
Psy ( acute PTSD)
Whats the 2 different ax WAD pathway?
Acute (0-12w)
Chronic (post 12w, either popping out 12w later or 12+ weeks of tx)
WAD yellow flags
attitude, beliefs about pain emotional response behavior family & work compensation issues dx & tx issues
C spine rule
- 65+ yo
Dangerous MOI (fall 3ft/5stairs, axial load, MVA 100km/h;rolls, collision motorized recr, bicycle collision)
Paresthesia extrem
2. Simple reared MVA Sitting/ambulatory at ER Delayed onset of neck pain Abs of midline c-spine TOP
3.
Cx rotation 45° L/R
Poor prognosis factors of WAD
Factors associated with ongoing pain &/or ongoing disability after whiplash High initial self reported pain intensity (VAS:7/10) & disability (NDI 40/100) Low self efficacy = Pt’s low confidence in their ability to perform some ADL Catastrophizing = negative thoughts Increased sensitivity to cold Anxiety = related to fear of pain (fear avoidance) A large number of initial symptoms & self rated injury severity Reduced Cx ROM Symptoms of post traumatic stress Negative expectation of recovery Headache, Back pain, Dizziness
Factors NOT associated with poor prognosis for WAD?
Factors NOT associated with ongoing pain &/or disability after whiplash Radiological findings OA/flattened Cx lordosis) Kinesiophobia Anxiety Shoulder pain Poor physical health Previous Hx of neck pain Crash related factors Compensatory related factors (need more studies) Age, living situation, work status
Factors with inconsistent evidence for WAD
gender
educational evidence
self-perceived gen health
compensation related factors
Concussion s/s (WAD)
HA
N/V
Dizziness/vertigo, balance
tinnitus
Memory impairment/reduced attn span depression fatiguability insomnia mood swings
Observations (WAD)?
Observation Fatigue +++ often secondary to important pain Nausea/vomiting
AROM as you do the subjective Ax Important ↓↓ in ROM may be Fx or subluxation Torticollis may be Fx Ms wasting, especially SCM &/or trap (cranial supply) may be neuro deficit (brainstem lesion) or Fx base of skull
Others ax WAD (after observ & concussions signs)
neuro exam
cx rom
altered ms recruit patterns (CCFT)
WAD tx principles & education
Adopt a supportive, patient centered approach
Provide information & advice during initial visit EDUCATION
Provide a clear explanation EDUCATION
Ensure that a consistent message is conveyed
Develop a management plan
Use a stepped approach to care
Encourage active forms of treatment
Promote independence self management
Review the effectiveness of treatment
Take recommended action(s) where there is a lack of improvement
WAD IIC avoid Rx that are noxious & pain provoking for pts (gentle mobs & AROM exs)
WAD multimodal thx
Modalities Pharmacotherapy Manual therapy Soft tissue techniques (massage, soft tissue stretch) Mobs HEP ROM & stretching exs; strengthening exs (DNF ms; DNE ms) Low load isometric Postural endurance
WAD acute tx
Active exercise (ROM and mobilizing exercises, strengthening of the neck and scapula
muscles)
-
Advice to “act as usual”, reassurances, education
Rxs that may be undertaken provided that there is ongoing evidence of benefit - Passive joint mobs/manipulation - Heat, ice and massage - Electrotherapies - Multimodal therapy
Rxs that should NOT be undertaken - Collar immobilization and/or prescribed rest - Surgery except in WAD IV - Cervical pillows - Intra articular injections
wad chronic tx
Advice to “act as usual”, reassurances, education
-
Active exercise invoving functional exercise, ROM exercises, strengthening of the neck and
scapula muscles, specific strengthening exercises of the deep neck flexor muscles
Rxs that may be undertaken
provided that there is ongoing evidence of benefit
-
A coginitve behavioural approach to treatment
-
Passive joint mobilization/manipulation combined with active therapy
-
Multimodal therapy
-
Vestibular therapy
Rxs that should NOT be undertaken - Collar immobilization - prescribed rest - Surgery - Cervical pillows - Intra articular injections - electrotherapy
larger superficial ms
- name
- movers/stabilizers
splenius capitis, SCM
movers
T/F
deeper ms have a greater capacity to exert torque than the superficial muscles
F
Superf ms have a greater capacity to exert torque than the deeper muscles (multifidus,
longus colli and longus capitis)
T/F
larger superf ms have larger lever arms and cross sectional areas
T
T/F
Superficial ms are segmentally arranged with direct attachments to the cervical vertebrae
F
Deeper ms are segmentally arranged with direct attachments to the cervical vertebrae
T/F
Superfic ms have larger spindle densities
F
Deeper ms are segmentally arranged with direct attachments to the cervical vertebrae
T/F
Deep ms are characterized by a greater proportion of low threshold slow twitch
muscle fibres
T
T/F
splenius capitis, sternocleidomastoid reflects their contribution to postural support
F
Deeper ms reflects their contribution to postural support
????? can be seen when only the large superficial muscles of the neck were
stimulated to produce movement in the absence of deep muscle activation
regions of local segmental instability
Superficial flexor muscles ?
SCM muscle
Anterior scalene muscle
Superficial extensor muscles?
Splenius capitis ms (Cr Vx extensor ms
Levator scapula (when working bilaterally)
Deep flexors ms?
Longus capitis
Longus colli
Deep neck extensors ? What they do?
Multifidus (stability via segmental attach) Semispinalis cervicis (lower DNE, post stability)
T/F
DNE are dynamic stabilizers and they tend to become activated but weak
F
Tend to become weak and inhibited (reduced activity)
T/f
upper trap, levator scap and rhomboids may induce compressive loading on cervical motion segments
during upper limb function because of their attachments
F
IDK but rhomboids was not on the list
people with neck pain will use superficial neck muscles for??
craniovertebral flexion isometric neck contractions repeated upper limb movements
Several biomechanical disturbances are noted in people with
neck pain. What are the motor output?
• reduced ROM • slower speed movements • reduced smoothness of movement • reduced neck muscle strength • Reduced endurance (observed indirectly as a reduced ability to maintain an upright sitting posture) • Decreased force steadines s
several biomechanical disturbances are noted in people with
neck pain. What are the ms behaviors?
increased muscle coactivation Reduced specificity of neck muscle activity Decreased activation of deep muscle activity Delayed muscle responses Reduced muscle relaxation Increased muscle fatiguability
what is the neural subsystem responsible for?
Responsible for: timing of contraction strength of contraction recruitment pattern
Provocative factor: Neck pain when looking down reading or using a device for prolonged periods
Possibilities?
Provocative factor: Neck pain when looking down reading or using a device for prolonged periods
Possibilities?
◦
Adverse strain on posterior elements, compression of anterior elements
◦
Neck extensor endurance inadequate for the task
Provocative factor: Catching pain, suboccipital region on quick turning (driving)
Possibilities?
Provocative factor: Catching pain, suboccipital region on quick turning (driving)
Possibilities? ◦ C1 C2 dysfunction ◦ Poor movement sense
Provocative factor:
Neck pain and later HA develops with prolonged computer use
Possibilities?
Provocative factor: Neck pain and later HA develops with prolonged computer use Possibilities? • Adverse loading and dysfunction upper cervical joints • Poor control of posture • Poor endurance of deep neck flexors • Poor scapular muscle control
Provocative factor:
•
looking up causes neck pain and light headedness, unsteadiness
Possibilities?
Provocative factor:
•
looking up causes neck pain and light headedness, unsteadiness
Possibilities?
•
Upper cervical joint dysfunction
•
Poor control and strength of neck flexors
•
Poor sensorimotor function proprioception, balance
•
Rule out Vertebrobasilar insufficiency (VBI)
Provocative factor:
Carrying bags of groceries increase neck pain
Possibilities?
Provocative factor: Carrying bags of groceries increase neck pain Possibilities? • Excessive compressive loads on cervical joints • Poor scapular muscle control • Poor neck flexor and extensor control • Adverse load on the brachial plexu s
Provocative factor:
•
Neck and arm pain on reaching backwards
Possibilities?
Provocative factor:
•
Neck and arm pain on reaching backwards
Possibilities? • Adverse strain on neural tissues • Adverse loading on cervical joints • Adverse strain on glenohumeral join t
