Evaluation (Cervicothoracic Spine) Flashcards
What is Internal Disc Disruption?
Tearing of the inner annulus of the disc, possibly causing pain.
What is the primary innervation of the disc?
The Sinuvertebral Nerve.
What are common mechanisms of injury for Internal Disc Disruption?
- Loaded flexion or extension (especially flexion + rotation)
- repetitive poorly-controlled movements
- Proximal 1/3 = No Symptoms
- Middle 1/3 = Small Regional Pain
- Outer 1/3 = Band-form or Broad Regional Pain
What is the typical presentation of a patient with Internal Disc Disruption?
- Small focal pain lateral to the spine, worse in the morning and evening.
What are risk factors for Internal Disc Disruption?
- Age < 50
- sedentary lifestyle
- women > men
- awkward/repetitive work
- prior neck pain.
What is Disc Herniation?
Disruption of the outer annulus with nuclear migration.
What are the three stages of disc herniation?
- Protrusion
- Prolapse
- Extrusion
What are common mechanisms of injury for Disc Herniation?
- Loaded flexion or extension (especially flexion + rotation)
- Repetitive poorly-controlled movements.
What are the typical characteristics of Disc Herniation?
- dynatomal (diffuse) pain
- discogenic pain
- pain worse in AM/Nights
- possible radicular symptoms.
- (+) Chin-tuck with Extension
- (+) Wainner’s CPR
- Weak
- ↓ Sensation
- ↓ DTR
What are risk factors for Disc Herniation?
- Age < 50
- activity outside of norm
- poor sleep position
- prior history of neck pain
What is…
- Facet Chondropathy = ?
- Facet Synovitis = ?
Facet Chondropathy: Irritation of the facet joint surface.
Facet Synovitis: Irritation of the facet joint capsule.
What are common mechanisms of injury for Facet Chondropathy/Synovitis?
Excessive loading, traumatic, repetitive, secondary to disc degeneration.
What are the typical characteristics of Facet Chondropathy/Synovitis?
- Lateral pain, non-midline,
- Worse in PM
- Forward head posture
What are risk factors for Facet Chondropathy/Synovitis?
Age > 50, history of DDD.
What is Foraminal Stenosis?
Compression of the spinal nerve at the foramen.
What are common mechanisms of injury for Foraminal Stenosis?
Disc degeneration, persistent disc bulge, facet arthrosis, ligamentum flavum hypertrophy.
What are the typical characteristics of Foraminal Stenosis?
- Dynatomal pain pattern
- Pain worse in PM
- Forward head posture
What are risk factors for Foraminal Stenosis?
Age > 50, activity outside of norm.
What is Cervicogenic Headache?
Headache originating from the neck.
What are common mechanisms of injury for Cervicogenic Headache?
Greater occipital nerve irritation, C1-3 arthritis.
What are the typical characteristics of Cervicogenic Headache?
Unilateral headache, worse with neck motions, no aura or throbbing.
What are risk factors for Cervicogenic Headache?
History of neck pain, repetitive posturing, female > male.
What is Whiplash Associated Disorder?
Injury due to excessive retraction and global extension of the neck.
What are common mechanisms of injury for Whiplash Associated Disorder?
Rear impact MVA, fall.
What are the typical characteristics of Whiplash Associated Disorder?
Cervical pain, cervicocranial pain, catastrophizing, fear-avoidance.
What are risk factors for Whiplash Associated Disorder?
Trauma, women > men, anxiety or depression, older age.
What is Cervical Artery Dysfunction?
Disruption of blood flow to the brain from the carotid or vertebral arteries.
What are the two types of Cervical Artery Dysfunction?
- Vertebrobasilar Insufficiency (VBI)
- Cervical Arterial Dissection (CAD).
What are common risk factors for Cervical Artery Dysfunction?
(CAD) Younger than 55, (VBI) Older than 55, trauma or infection.
What are the typical symptoms of Cervical Artery Dysfunction?
Unilateral head and neck pain, dizziness, diplopia, dysarthria, dysphagia, drop attacks, nausea, nystagmus, numbness (facial), ataxia.
What is Upper Cervical Spine Instability?
Laxity or tearing of the alar or transverse ligament.
What are common mechanisms of injury for Upper Cervical Spine Instability?
Trauma, genetic predisposition to laxity.
What are the typical characteristics of Upper Cervical Spine Instability?
Varied pain pattern, head feels heavy, dizziness, diplopia, dysarthria, dysphagia, drop attacks, nausea, nystagmus, numbness (facial), ataxia.
What are the key examination tests for Upper Cervical Spine Instability?
Alar Ligament Test, Modified Sharp-Purser Test.
What is Myelopathy?
Compression of the spinal cord causing neurological symptoms.
What are common mechanisms of injury for Myelopathy?
Central canal stenosis, degenerative exostotic entrapment, anterior/retrolisthesis, large disc bulge.
What are the typical characteristics of Myelopathy?
Lhermitte’s Sign, bilateral upper and lower extremity complaints, unfamiliar LE functional deficit, bowel or bladder changes.
What are risk factors for Myelopathy?
- Age > 45
- gait abnormality
- positive Hoffmann Reflex
- positive Inverted Supinator Reflex
- positive Babinski Reflex
What is Thoracic Outlet Syndrome?
Compression of the brachial plexus or subclavian vessels.
What are the three types of Thoracic Outlet Syndrome?
- Neurogenic TOS
- Venous TOS
- Arterial TOS
What are common mechanisms of injury for Thoracic Outlet Syndrome?
Genetic predisposition, heavy or repetitive overhead activity, whiplash.
What are the typical characteristics of Thoracic Outlet Syndrome?
Non-dynatomal arm pain, worse at night, weakness or decreased sensation.
What is Costochondritis?
Irritation of the costosternal or costal attachment.
What is Slipping Rib Syndrome?
Hypermobile and painful interchondral joint between ribs 8-10.
