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MS II > Exam 5: Cervical Spine (5-8) > Flashcards

Exam 5: Cervical Spine (5-8) Flashcards

1
Q

True or False:

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

A

False, whiplash is a MOI, WAD is the dx

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2
Q

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

A

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

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3
Q

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

A

Whiplash

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4
Q

True or False:

Whiplash can occur during diving

A

true

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5
Q

Are whiplash injuries easy or hard to treat. Why?

A

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

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6
Q

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

A

WAD

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7
Q

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

A

diagnosis of the century

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8
Q

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

A

MVC - motor vehicle collisions

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9
Q

What is the total societal cost of MVC per year

A

Over $200 billion

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10
Q

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

A

1-34 years old

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11
Q

True or False:

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

A

true

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12
Q

True or False:

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

A

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

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13
Q

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

A

1 in 4

1 in 3

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14
Q

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

A

2

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15
Q

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

A

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

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16
Q

True or False:

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

A

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

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

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

A

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

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20
Q

True or False:

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

A

False, there is no direct link

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21
Q

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

A

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

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22
Q

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

A

hyperflexion

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23
Q

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

A

hyperextension

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24
Q

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

A

hyperextension

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25
Q

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

A

hyperextension

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26
Q

True or False:

Originally, whiplash was exclusively related to head on collisions

A

False, rear end MVC’s

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27
Q

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

A

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

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28
Q

True or False:

Extension injuries are worse than flexion injuries following whiplash

A

True

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29
Q

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

A

140 degrees

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30
Q

True or False:

Wearing a seatbelt dramatically decreases the amount of neck injuries in MVC’s

A

False, it saves lives but increases neck injuries

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31
Q

True or False:

There is no correlation between the damage of the vehicle and the physical damage of the occupant

A

True, speeds as low as 8mph can cause whiplash

32
Q

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

A

flexion; extension

33
Q

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

A

C4 and C5

34
Q

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

A

C3-C4

35
Q

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

A

Extension can cause longus coli problems

Lateral impact can cause longus capitus problems

36
Q

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

A

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

37
Q

What are the most affected discs in WAD patients

A

C5/6 and C6/7

38
Q

True or False:

The vertebral artery can be damaged during whiplash

A

true

39
Q

Where do idiopathic neck problems usually show pain at?

A

The left sub-occiput

40
Q

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

A

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

41
Q

True or False:

WAD symptoms are often a result of trigger points.

A

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

42
Q

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

A

kyphosis

43
Q

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

A

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.

44
Q

True or False:

PTSD can occur after a patient experiences whiplash and WAD symptoms

A

True

45
Q

What are the characteristics of PTSD in WAD patients

A

Disturbing flashbacks
Avoidance or numbing of memories
Hyperarousal

46
Q

Explain the neuroendocrinology of PTSD

A

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

47
Q

True or False:

Cortisol levels can be improved in chronic pain patients from aerobic activity

A

True

48
Q

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

A

less; higher

49
Q

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

A

seated slump

50
Q

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

A

Severe

51
Q

Where will facet joints refer pain too in WAD patients

A

upper thoracic and upper trap

52
Q

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

A

Around the eye and behind the ear

53
Q

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

A

through the mouth

54
Q

Explain the science behind headaches being a main symptom of WAD

A

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

55
Q

True or False:

Most whiplash injuries are easy to diagnose and treat

A

False

56
Q

True or False:

Most injuries post whiplash are often missed on imaging tests

A

true

57
Q

What are the primary tissues damaged in MVC’s

A

Discs, facet joints, and neural tissue

58
Q

What are the secondary tissues damaged in MVC’s

A

Muscles and ligaments

59
Q

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

A

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

60
Q

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

A

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

61
Q

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

A

No studies were found

62
Q

What did the Quebec Task Force state about manipulation

A

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

63
Q

True or False:

Long term manipulation is good intervention in reducing symptoms of WAD

A

False, it is not justified

64
Q

What did the Quebec Task Force state about mobilizations

A

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

65
Q

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

A

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

66
Q

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

A

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

67
Q

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

A

No studies

68
Q

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

A

No studies

69
Q

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

A

No studies

70
Q

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

A

No studies

71
Q

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

A

No studies

72
Q

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

A

No studies

73
Q

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

A

NSAIDS are effective with the use of physical modalities

74
Q

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

A

No studies

75
Q

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

A

No studies on epidural/intrathecal

Intra-articular is not justified in WAD

76
Q

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

A

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

77
Q

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

A

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

MS II (14 decks)

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