Exam 5: Cervical Spine (5-8)

Question 1

True or False:

Whiplash is a diagnosis given to people after sudden hyperextension followed by hyperflexion of the neck

Answer 1

False, whiplash is a MOI, WAD is the dx

Question 2

What is the biggest criticism associated with the labeling of “whiplash” as a diagnosis

Answer 2

The lack of information regarding diagnosis, injury, prognosis, and treatment

Question 3

(WAD/Whiplash) is an acceleration-deceleration mechanism of energy transfer to the neck

Answer 3

Whiplash

Question 4

True or False:

Whiplash can occur during diving

Answer 4

true

Question 5

Are whiplash injuries easy or hard to treat. Why?

Answer 5

They are hard to treat because no two injuries are the same. It is hard to find a treatment protocol

Question 6

(WAD/Whiplash) is referred to as the “disease of the century”

Answer 6

WAD

Question 7

WAD is referred to as “_________” because of the increasing numbers of people diagnosed with WAD and seeking treatment

Answer 7

diagnosis of the century

Question 8

What is the leading cause of death among Americans 1-34 years old

Answer 8

MVC - motor vehicle collisions

Question 9

What is the total societal cost of MVC per year

Answer 9

Over $200 billion

Question 10

What age group is MVC the leading cause of death in Americans

Answer 10

1-34 years old

Question 11

True or False:

WAD can include damage to either nerves, bones, tissues, or ligaments

Answer 11

true

Question 12

True or False:

Although WAD is increasing in number, it typically does not lead to chronic pain or disability

Answer 12

False, it leads to very high rates of chronic pain and disability

Question 13

Approximately __ in __ or as high as __ in __ patients following MVC may develop pain lasting more than 2 years

Answer 13

1 in 4

1 in 3

Question 14

As high as 1 in 3 patients following MCV may develop pain lasting more than __ years

Answer 14

2

Question 15

Explain the stigma surrounding WAD patients “faking” their injury.

Answer 15

Symptoms of WAD can be latent. Patients often don’t need a cervical collar until two weeks after the injury so people think they are faking it

Question 16

True or False:

There are often missed injuries including fx’s on patients with a WAD diagnosis

Answer 16

True, they are missed on x-rays, MRI’s, and CT scans

Question 17

Sometimes believing a patient’s symptoms are true can be hard. How do we treat difficult patients like this

Answer 17

We treat based on what the patient tells us. The false sx fall back on the patient

Question 18

What is a valid way to determine a patient’s disability post whiplash

Answer 18

Take a thorough history and evaluation of the patient’s current disability. Use the NDI or Neck Disability Index

Question 19

The age group that WAD effects the most is: _____
The gender that is affected most: _____
The gender that recovers slower: ____

Answer 19

Middle age 35-55
Women the most due to increased head and neck mass
Women recover slower

Question 20

True or False:

There is a high linkage between chronicity and litigation/compensation claims of WAD patients

Answer 20

False, there is no direct link

Question 21

Although there is no link between chronicity and litigation, how come patients involved in the legal process report more pain

Answer 21

They may have increased pain due to the increased stress of the legal process or they are seeking legal process because they have severe pain

Question 22

During (hyperflexion/hyperextension) of whiplash, the interspinous ligament can be torn

Answer 22

hyperflexion

Question 23

During (hyperflexion/hyperextension) of whiplash, the anterior longitudinal ligament can be torn

Answer 23

hyperextension

Question 24

During (hyperflexion/hyperextension) of whiplash, the spinous processes can be fractured

Answer 24

hyperextension

Question 25

During (hyperflexion/hyperextension) of whiplash, a disc herniation can occur

Answer 25

hyperextension

Question 26

True or False: Originally, whiplash was exclusively related to head on collisions

Answer 26

False, rear end MVC's

Question 27

Originally, whiplash was exclusively related to rear end MVC's. Does the research back this up or not?

Answer 27

No because less than half of patients with whiplash were involved in rear end MVC's

Question 28

True or False: Extension injuries are worse than flexion injuries following whiplash

Answer 28

True

Question 29

How far back can the neck hyperextend to compared to the norm of 85 degrees of extension

Answer 29

140 degrees

Question 30

True or False: Wearing a seatbelt dramatically decreases the amount of neck injuries in MVC's

Answer 30

False, it saves lives but increases neck injuries

Question 31

True or False: There is no correlation between the damage of the vehicle and the physical damage of the occupant

Answer 31

True, speeds as low as 8mph can cause whiplash

Question 32

In the anthropometric studies, it was found that intradiscal pressure increases with (flexion/extension) and decreases with (flexion/extension)

Answer 32

flexion; extension

Question 33

In the anthropometric studies, it was found that the highest disc pressure in flexion and extension is at ____.

Answer 33

C4 and C5

Question 34

In the anthropometric studies, it was found that the highest disc pressure with lateral impact is at ____

Answer 34

C3-C4

Question 35

Which muscle is at most risk in extension and which muscle is at most risk in lateral impacts

Answer 35

Extension can cause longus coli problems | Lateral impact can cause longus capitus problems

Question 36

Explain why whiplash occurs, or in other words, explain why we can't simply brace the neck during impact

Answer 36

The time it takes for muscles to contract as a reflex, is slower than the time it takes for the head to reach peak excursion

Question 37

What are the most affected discs in WAD patients

Answer 37

C5/6 and C6/7

Question 38

True or False: The vertebral artery can be damaged during whiplash

Answer 38

true

Question 39

Where do idiopathic neck problems usually show pain at?

Answer 39

The left sub-occiput

Question 40

Describe the correlation of anterior or posterior pain and what the literature says

Answer 40

PT's say that 80% of problems are from posterior muscles, but the research is showing that anterior is the most common. This shows the discrepancy between clinical observation and reporting of injuries

Question 41

True or False: WAD symptoms are often a result of trigger points.

Answer 41

False, trigger points are often a result of WAD and the damaged tissue

Question 42

WAD can lead to secondary muscle problems such as increased forward head and increased (lordosis/kyphosis)

Answer 42

kyphosis

Question 43

(sympathetic/parasympathetic) symptoms can occur post whiplash. Explain how this can happen

Answer 43

The sypmathetic chain is anterior to the spinal column in the cspine, so if the longus colli is injured during extension, then the sympathetic chain will be affected.

Question 44

True or False: PTSD can occur after a patient experiences whiplash and WAD symptoms

Answer 44

True

Question 45

What are the characteristics of PTSD in WAD patients

Answer 45

Disturbing flashbacks Avoidance or numbing of memories Hyperarousal

Question 46

Explain the neuroendocrinology of PTSD

Answer 46

PTSD may arise after an over reactive adrenaline response. High levels of stress suppress hypothalamic activity

Question 47

True or False: Cortisol levels can be improved in chronic pain patients from aerobic activity

Answer 47

True

Question 48

Chronic WAD patients have (more/less) ROM and a (higher/lower) VAS score

Answer 48

less; higher

Question 49

What neurodynamic test can be done to test the nerves in WAD patients

Answer 49

seated slump

Question 50

A patient will have (no/severe) pain if a disc lesion leads to proinflammatory chemicals mixing with blood

Answer 50

Severe

Question 51

Where will facet joints refer pain too in WAD patients

Answer 51

upper thoracic and upper trap

Question 52

Where will pain be referred if a trigger point in the scalene muscle is compressed

Answer 52

Around the eye and behind the ear

Question 53

The dens is more likely to fx before a ligament is torn. If the dens is fractured, how should the xray be taken

Answer 53

through the mouth

Question 54

Explain the science behind headaches being a main symptom of WAD

Answer 54

All sensory information from C1, C2, and C3 dumps into the trigeminal nucleus which is located by the temple. Over stimulation or damage to the nerves inputting info to the trigeminal nucleus will cause pain in the head

Question 55

True or False: Most whiplash injuries are easy to diagnose and treat

Answer 55

False

Question 56

True or False: Most injuries post whiplash are often missed on imaging tests

Answer 56

true

Question 57

What are the primary tissues damaged in MVC's

Answer 57

Discs, facet joints, and neural tissue

Question 58

What are the secondary tissues damaged in MVC's

Answer 58

Muscles and ligaments

Question 59

What did the Quebec Task Force state about how collars impact WAD

Answer 59

Although they are commonly prescribed, they may delay recovery by decreasing ROM and increasing pain. They also do not immobilize the spine adequately

Question 60

What did the Quebec Task Force state about rest in WAD patients

Answer 60

It is commonly prescribed but should be limited to less than four days or there will be detrimental effects in recovery

Question 61

What did the Quebec Task Force state about cervical pillows in WAD patients

Answer 61

No studies were found

Question 62

What did the Quebec Task Force state about manipulation

Answer 62

A single manipulation has effects lasting less than 48 hours and has the same effect as mobs

Question 63

True or False: Long term manipulation is good intervention in reducing symptoms of WAD

Answer 63

False, it is not justified

Question 64

What did the Quebec Task Force state about mobilizations

Answer 64

Maitland and McKenzie mobs were significantly greater in improving pain and ROM than other mob techniques. Patients given active exercises and advice healed just as good as a mob group, which indicates that PT should be utilized early on

Question 65

What did the Quebec Task Force state about traction in WAD patients

Answer 65

Not a lot research, but no significant results with traction in the studies that do exist

Question 66

What did the Quebec Task Force state about exercise in WAD patients

Answer 66

Exercise alone has no great effect, but should be utilized in a multi-modal intervention

Question 67

What did the Quebec Task Force state about Diathermy or Ice in WAD patients

Answer 67

No studies

Question 68

What did the Quebec Task Force state about surgery in WAD patients

Answer 68

No studies

Question 69

What did the Quebec Task Force state about posture in WAD patients

Answer 69

No studies

Question 70

What did the Quebec Task Force state about spray and stretch in WAD patients

Answer 70

No studies

Question 71

What did the Quebec Task Force state about TENS and E-stim in WAD patients

Answer 71

No studies

Question 72

What did the Quebec Task Force state about ultrasound in WAD patients

Answer 72

No studies

Question 73

What did the Quebec Task Force state about pharmacology in WAD patients

Answer 73

NSAIDS are effective with the use of physical modalities

Question 74

What did the Quebec Task Force state about muscle relaxants in WAD patients

Answer 74

No studies

Question 75

What did the Quebec Task Force state about injections in WAD patients

Answer 75

No studies on epidural/intrathecal | Intra-articular is not justified in WAD

Question 76

What is the overall conclusion by the Quebec Task Force about WAD patients

Answer 76

NSAID's and short term manip/mobs in grade II and III, in combo with active exercises is good. Without prolonged use of soft collars and rest

Question 77

What were the results of Curtin's study in WAD patients

Answer 77

The immobilized group improved pain, ROM, strength and returned to work faster than the exercise and control group