Head and Neck Flashcards
What are the four categories of MSK conditions?
- Fractures
- Infection
- Cancer
- Inflammatory arthritis
Rheumatoid arthritis is (asymmetrical/symmetrical)
symmetrical
(true/false) patients can have RA masking their OA
true
(OA or RA?) Which has an ulnar windswept deformity in the DIP joints?
RA
(OA or RA?) Which has heberden’s nodes?
OA
What are Heberden’s nodes?
Bumps at the dorsal surface of the distal DIP joint
What regions does a subarachnoid hemorrhage affect?
head, face, TMJ
What are risk factors for subarachnoid hemorrhages?
HTN
Symptoms:
- Sudden severe HA
- brief LOC
- aphasia
- nuchal rigidity
- fever
- photophobia
- weakness
- neural dysfuntion
- N/V
Subarachnoid hemorrhage
What is indicated for treatment when a subarachnoid hemorrhage is suspected?
ED
What is VBI?
blood supply to the back of the brain is disrupted
Symptoms:
- Dizziness
- HA
- nausea
- LOC
- vertigo lasting for minutes
- visual disturbance
- apprehensive with end range neck movement
- UNILATERAL hearing loss
- vestibular dysfunction
VBI
What is meningitis?
inflammation of the meninges
(true/false) Meningitis is not life-threatening
FALSE (it is)
Symptoms:
- stiff neck
- high fever
- HA
- N/V
Meningitis
What are the types of meningitis? Which one is most common?
- bacterial *
- Fungal
- Viral –> least serious
What type of meningitis affects 10% of those with AIDS?
fungal meningitis
Bacterial meningitis occurs when bacteria crosses where?
blood brain barrier (BBB)
What are clinical signs for meningitis?
Kernig’s sign and brudzinski’s sign
Describe kernig’s sign. What is a (+) test?
Take patient’s hip @ 90 degrees and passively extend the knee
(+): pain
Describe Brudzinski’s sign.
Take the patient’s head and passively flex it
(+): patient flexing their hips and knees (“scooting up”)
What is the common site of metastases from a primary brain tumor?
CNS (bioccipital or bifrontal)
symptoms:
- intermittent nausea with increasing duration
- HA
- sore throat
- neck/facial pain
- neuro deficits
- mentation/vision changes
- vomiting
- Sz
- changes in speech
primary brain tumor
What is the initial symptom of a primary brain tumor?
intermittent nausea with increasing duration
Symptoms:
- personality changes
- calculation difficulties
- word selection difficulties
- decreased VOR
- nystagmus
- photophobia
- HA
post-concussive syndrome, TBI, Subdural hematoma
Symptoms:
- moderate to severe Throbbing or pulsating
- Periorbital/retroorbital (unilateral)
- Nausea, vomiting, & vision disturbances
- Preceded by visual aura, vertigo, paresthesias
- photophobia and phonophobia
- Normal exam
- Childhood to early adulthood
- Can occur after 50 y.o. (peri-menopausal women)
- Family hx present
migraines
symptoms:
- Dull pressure (vise or band around head)
- Mild-moderate bilateral or global pain
- non-pulsating
- Posture related
- frontal head onset
- tight band around the head
- No assoc signs/sxs
- Phonophobia or photophobia
- Current or hx of: anxiety, depression, or panic disorder
tension HA
symptoms:
- Severe/unilateral; temple/periorbital region
- Attacks occurs cyclical patterns or “clusters”
- horner’s syndrome
- ipsilateral lacrimation
- ipsilateral nasal congestion
- ipsilateral miosis
- ptosis
- ipsilateral lid edema
cluster HA
How long can cluster headaches last?
Last weeks to months (usually followed by complete remission periods)…1 to 2 attacks/yr
What is another name for a cluster HA?
histamine HA
What type of headache is a cluster HA?
histamine HA
symptoms:
- Constant pain (usu unilateral; occ bilateral)
- Intensity varies (mild to severe) with activity/postures
- Worse w/ sustained postures and neck movement
Assoc w/:
Chronic tension, acute whiplash, IV disc disease, Facet joint arthritis
cervicogenic HA
What commonly causes AO dislocation? Which population is more common to get this?
High energy trauma
Children
(true/false) AO dislocation is common and not fatal
FALSE (it is fatal and not common)
What causes AA dislocation?
HyperEXT and distraction of the odontoid Fx or transverse ligament
AA dislocation is when the occiput moves (backward/forward) on C1
forward
What measurement of slippage is indicative of a traumatic dislocation with AA dislocations?
> 3 mm
What dislocation is common with down syndrome?
AA dislocation
What causes a Jefferson Fx of C1?
compression
What are other names for a jefferson Fx of C1?
Burst Fx
Neural arch Fx
What is a jefferson Fx of c1?
bilateral breaks in the anterior and posterior arches
(true/false) jefferson fx of C1 are associated with neuro deficits
FALSE
What is the most common Fx of C2?
Hangman’s Fx
What is the most common Cx spine fx?
hangman’s Fx
What causes a hangman’s fx of c2?
hyperEXT/compression
What is a hangman’s fx?
Fractures through the pedicles of C2 with anterior slip of C2 on C3
(true/false) Hangman’s Fx are not associated with neuro deficits
FALSE (it is)
What is a clue to dx of a hangman’s fx?
Teardrop fracture of inferior aspect of C2 or C3
What causes Dens Fx?
hyperextension
What fx is most associated with forward subluxation of C1 on C2?
Dens Fx
What type of dens fx is most common?
base of dens
What is the cause of a simple compression fx?
compression and flexion
Anterior wedging of a vertebrae of ____ mm or more suggests a simple compression fx
> 3 mm
Simple compression fx usually involve what in the spine?
Superior end-plate of the vertebral body
What is a clay-shoveler’s fx?
Avulsion fx of c6 or c7 spinous processes that occurs as a result of ROT of the trunk relative to the neck
(true/false) clay shoveler’s fx are associated with neuro deficits.
FALSE
What causes a FLX teardrop fx?
combination of FLX and compression
Where does a teardrop fragment come from?
Anteroinferior aspect of the vertebral body
–> rest of the body is posteriorly displaced into the spinal canal
–> interspinous spaces and facet joints are usually widened
–> disc space may be narrowed
(true/false) FLX teardrop fx do not have neuro deficits
FALSE (they do)
What are red flags for Cx fx or ligamenous instability?
- major trauma
- RA
- down syndrome
- positive ligament test
- midline cx spine tenderness
- apprehension/unable to actively ROT the head > 45 degrees
What are red flags for Cx central cord lesions?
- > 45 y/o
- major trauma
- incontinence
- gait dysfunction due to LE hyperreflexia
- UE sensory and motor deficits
symptoms:
- Non-segmental Cspine movement
- Vertigo, vision changes, nystagmus w/ combined movements
Vertebral artery syndrome
What can thyroid cancer cause?
torticollis
Symptoms:
- ant neck pain that is worse with swallowing
thyroid cancer
What is a red flag with thyroid cancer?
firm, immovable mass
How many headaches/month leads to a primary PT referral for headache Dx?
15+ days/month
(true/false) 20% of HA cases seen in outpatient pain management clinics are cervicogenic HA
True
0.4-4% of the general population experiences CG HA
What type of HA has the highest annual prevalence?
tension
Cluster is the least prevalent
What are the categories of HA?
Non-mechanical and mechanical
What are causes of non-mechanical HA?
- stroke
- infections
- MS
- vasculitis
- meningitis
- emotional/psychological
- visual disturbance
- drug rebound
- tumors
What are causes of mechanical HAs?
- trauma
- degenerative changes in Cx spine
- posture
- TMJ related
Whiplash headaches commonly originate from what joints of the neck?
C2 and C3
When are cluster headache bouts?
spring or fall
How long are bouts of cluster headaches?
15 minutes - 3 hours
How long do migraines with aura occur?
- visual phenomenon
- ensory disturbance
- speech disturbance
- odd smell
- cravings
- euphoria
- fatigue
- neck stiffness
5-60 minutes
What are the phases of a migraine with an aura attack?
- premonitory phase
- aura
- HA
- resolution phase
Phase of migraine with aura attack:
- irritable
- depressed
- tired
- food cravings
- s/s can occur hours or days before the onset of HA
premonitory phase
Phase of migraines with aura:
- HA gradually fades
- patient may feel tired, irritable, depressed
- difficulty concentrating
resolution phase
What is the duration of migraines without aura?
< 72 hours
What structures do cervicogenic HAs involve?
- trigeminal nerve
- structures Innv. by C1-C3
presentation:
- constant pain
- unilateral burning, aching, throbing pain
- TTP over C2 and C3
- radiating pain to the posterior and lateral head
- pain over the neck, temple, frontal, and TMJ regions
occipital neuralgia
Where does pain from occipital neuralgia originate?
suboccipitals
What movements are normally worse when occipital neuralgia is present?
EXT and ROT
What types of medications are commonly used for HAs?
- antidepressants
- antiepileptics
- muscle relaxants
- NSAIDS
- narcotic analgesics
- beta blockers
- calcium channel blockers
What are red flags for HA?
- progressive worsening
- sudden, severe onset
- HA after exertion
- > 50 y/o
- Hx of major trauma and/or cancer
- N/V
- visual disturbance
- sore throat/resp. infection
- speech/swallowing problems
**- HA with the following: Weakness, convulsions, blackouts, mental changes, fever, rash, systemically unwell **
What types of HAs have mild to moderate pain intensity?
tension
What types of HA have moderate to severe HA?
migraines, cervicogenic
What types of HA has excruitiating pain?
cluster
What type of HA has shooting pain?
Occipital neuralgia
What types of HAs last minutes to hours?
cluster
occipital neuralgia
15 minutes- 3 hours
What types of HAs last hours to days?
migraines and cervicogenic
4 hours to 3 days
What type of HA lasts minutes to days?
tension
30 minutes to 7 days
What is the pain quality of tension HA?
squeezing
dull
pressing
band-like
non-pulsating
What is the pain quality of migraines?
throbbing and pulsating
What is the pain quality of cervicogenic HAs?
dull, deep, boring, non-throbbing
What is the pain quality of cluster HAs?
drilling and boring
What coefficient determines consistency b/n evaluators?
kappa coefficient
Manual therapy is a good (short/long) term treatment for HAs
short term
Combination of manual therapy to cervical spine and exercises is effective: short and long-term.
