L13 C Spine Pathology Flashcards
acute cervical facet: clinical picture
s/s: local pain in neck and upper back, not down arm
Exam:
AROM: restrictions into closing or downgliding
Eg R facet: extension, R SB, R Rotation
resolves 1-2 weeks, recurrs
acute cervical facet: exam findings
+ painful AROM
+ UL PA on involved side
local mm guarding and spasm
acute cervical facet treatment includes:
joint mobs into impaired directions
traction
strengthening after ROM restored
forward head posture clinical picture
insidious onset of muscle pain related to inefficient posture/muscle use
related to upper crossed
shortened suboccipitals, pec major/minor, subscap, scalenes, SCM
lengthened trap, rhomboids, deep cervical flexors and extensors
treatment of FHP
diminish muscular tension
- ergonomic cuing
- manual - trigger point release
strengthen lengthened muscles and stretch shortened muscles
cervical muscular headache clinical picture
progression of myofascial pain syndrome to include main complaint of headache
cervical muscular headache exam findings
aggravated by posture/FHP
neuro clear
imaging clear
suboccipital muscle tension/tender/tight
OA flexion limitation
cervical muscular headache treatment
STM
joint mobs in upper cervical
postural reeducation/training similar to FHP
HNP protrusion without nerve root involvement exam findings
increased pain with sitting and flexion
lacking extension
extension will centralize pain
forward head posture
high pain
HNP protrusion without nerve root involvement treatment
postural reed - mckenzie - to allow disc healing
neck flexibility and strengthening
HNP protrusion with nerve root involvement clinical picture
most often caused by DDD
positive imaging findings
most common at C5-6
more correlated to imaging findings
HNP protrusion with nerve root involvement exam findings
worsening of symptoms starting at base of neck, spreading to shoulder and arm as condition worsens
referral pain to upper thoracic
interscapular pain
correcting posture increasing peripheral symptoms
HNP protrusion with nerve root involvement treatment
reduce protrusion to restore normal posture
traction with passive extension by changing angle of pull
whiplash - cervical sprain/strain - clinical picture
soft tissue trauma from hyperextnesion of neck including:
longus coli and SCM injured
anterior ligament tears
annular disc tear
SNS plexus damage
nerve root damage
esophageal damage
closed head injury
whiplash exam findings
pain developed 12-24 hours after
no hard neuro signs
negative imaging
WAD quebec task force classification
0: no complaints/s/s
1: neck complaints with no physical s/s - pt has full ROM, no limitations, only local pain
2: neck complaints and MSK s/s - trigger points, TTP, limited ROM, joint play
3: neck complaints and neuro signs.- CN or in UE
4: neck complaints and fracture/dislocation
s/s of WAD
local or referred pain
paresthesias
diffuse muscle tenderness/weakness
movement restrictions
headache
blurred vision
dizziness
dysphagia
treatment of WAD
reduce spasm
start w passive modalities
soft collar
progress to active therapy
pts at poor risk of recovering
NDI >15/50
VAS>5/10
poor expectation of recovery
RA of neck
overactive immune system
pain, swelling, stiffness
can be progression or present at start of disease
worse in the morning and with inactivity
risk of cervical instabilty
treatment of RA
hands off
modalities
STM to proximal shoulder
gentle mid range postural awareness
isometric strengthening
cervical spondylosis
chronic degenerating condition affecting spinal canal/nerve roots, vertebral bodies/facets, and IVD space narrowing
can lead to myelopathy, stenosis
cervical spondylosis clinical presentation
initial hypermobility turning into chronic hypomobility
slow onset
risk of neuro involvement increases with progression
pain and muscle guarding
imaging positive
cervical spondylosis treatment
mechanical traction
electrotherapy
collar if significant irritation
manual therapy for stretching, ROM
isometrics for cervical stabilization
cervical stenosis
narrowing of the spinal canal central or laterally
can be caused by spondylosis
more common in 50+ pts, progressive
causes of cervical stenosis
disc space narrowing
ligament flavum buckling
osteophytes on facets
directional preference of cervical stenosis
flexion
extension narrows spinal canal by 20%
flexion widens canal by 30%
s/s of cervical stenosis
neck pain, may not be severe
pain/weak/numb in shoulders, arms, legs
hand clumsiness
paresthesia in involved extremities
symptoms worse in extension
s/s of cervical myelopathy
neck pain
headache
dizziness
BL LE symptoms
bowel/bladder disturbance
hyperreflexia
multisegmental weakness or sensory changes
wasting in hands
hoffmans/babinski
loss of dexterity
unsteady gait
cervical myelopathy
spinal cord disrupted in cervical region interrupting normal transmission of neural signals
caused by spinal cord compression from bone, ischemia from compromised vascular supply, repeated trauma
risk factors for cervical myelopathy
55-70+
male
asian
worse stage = worse prognosis
stages of myelopathy
mild: hand and arm symptoms, normal ADLs
mod: difficulty using arms and legs affecting ADLs
severe: needing ambulatory aide, confined to bed, chair, or home
Test cluster for cervical myelopathy
gait deviation
+ hoffman’s
inverted supinator sign
+ babinski
age 45+
