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7 Orthopedics > L16 WAD and Headache > Flashcards

L16 WAD and Headache Flashcards

1
Q

Whiplash

A
  • approximately 3 mil/year in US due to trauma
  • more females are impacted
  • 35-55 yo
  • smaller and shorter necks are more prone to WAD
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2
Q

MVA impacts on WAD

A
  • as low as 10 mph MVA can cause an injury
  • MVA rear impact is most common MOI
  • vehicle creating collision bigger than other vehicle is bad for WAD
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3
Q

____ injuries are by far the worst in terms of tissue damage and prognosis to WAD

A

extension

extension ROM may be far past physiologic range

can be a combo of shear, compression, distraction, adn torsion

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4
Q

S-Shape phase

A
  • Upper cervical spine at risk of flexion injury
  • lower cervical spine at risk of HE injury

followed by cervical extension and then cervical flexion

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5
Q

What can reduce the risk of injury/rear-ended crashes

A
  • airbags
  • front crash detection sensors
  • properly adjusted headrest
  • proper seat back height
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6
Q

Prognostic factors for worse presentation of WAD

A
  1. high pain intensity
  2. High self-reported disability scores
  3. High posttraumatic stress symptoms
  4. strong catastrophic beliefs
  5. cold hyperalgesia

50% will recover in 3 months

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7
Q

For work related WAD

A

older age and prior hx of msk disorders were the prognostic factors for WAD

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8
Q

Quebec Task Force for WAD Scale

A

0 = no complaint, no signs
1 = complaint of neck pain, stiffness, tenderness only, no physical signs
2 = neck complaints and msk signs, dec ROM and tenderness
3 = neck complain AND neuro signs
4 = neck complain AND fracture

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9
Q

Whiplash Management

A
  • CT mob and manip
  • motor control and coordination exercises
  • proprioceptive, kinesthetic and postural control
  • psychological interventions
  • pain control
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10
Q

Manual Therapy for WAD

A
  • start outside the most painful area
  • STM gently at first
  • traction may not be great
  • when irritability and severity reduce, can target jt mobs more locally and aggressively
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11
Q

Exercises for WAD

A
  • cranio-cervical flexion control
  • DNF control and endurance
  • cervical extensors
  • postural stability
  • differentiation exercises (like VOR)
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12
Q

Role of PT in WAD

A
  1. thorough eval
  2. educate pt about pain
  3. give them hope
  4. set goals
  5. develop home program
  6. focus on cardiovascular
  7. focus on healthy habits
  8. decrease fear
  9. calm the nervous system
  10. exercise
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13
Q

Different types of headaches

A
  • 14 types documented by international headache society
  • primary include migraine, tension type, trigeminal autonomic cephalalgias, other
  • Secondary is cervicogenic
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14
Q

Tension Teype Headache

A
  • most common type
  • lack of aura, nausea, photophobia, phonophobia
  • lack of history of trauma
  • lack of upper cervical mobility restrictions
  • often related to stress, poor sleep, anxiety
  • commonly bilateral and described as tight ache
  • common to find trigger points
  • typically responds to pain med, STM, stress/sleep management
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15
Q

Cervicogenic Headache

A
  • unilateral HA associated with neck symptoms aggravated by neck movements or positions
  • HA produced with provocation of isilateral soft tissue or joint segments
  • restricted ROM
    • CRFT
  • weakness in DNF
  • active trigger points
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16
Q

Headache Behavior for Referral

A
  • sudden onset
  • worsening pattern
  • change from previous headaches
  • fixed laterally
  • triggered by cough, exertion, postural change
  • nocturnal onset
  • new onset after 50
  • systemtic s/s
  • seizures
  • focal neurologic symptoms
  • new, worst pain
  • cognitive impairments
  • no response to treatment
17
Q

Evidence for HA management: Tension type or cervicogenic

A
  • expect higher levels of irritability, proceed with caution
  • manual therapy equal to medications for treating both
  • manual therapy is better than GP care in both short and long term
  • TENS
  • specific Exercise
  • Mullgan SNAG
18
Q

Possible Causes for Dizziness

A

cardiovascular
neurological
metabolic
psychiatric
vestibular
cervicogenic

19
Q

Pre-syncope/Orthostatic

A

BP changes with posture changes, systolic drop > 20 mmHg

20
Q

Dysequilibrium

A

unsteadiness/imbalance secondary to visual impairment, peripheral neuropathy, msk disturbances

21
Q

Diagnosing Cervicogenic Dizziness

A

diagnosis of exclusion

rule out
1. cervical fracture
2. central disorders
3. cervical artery disorders
4. cervical myelopathy
5. cervical instability

22
Q

Diagnosing Cervicogenic Dizziness

A
  • intermittent dizziness precipitated by head and neck movement
  • onset of symptoms is immediate with provoking position
  • duration may be brief, but fatiguable
  • associated s/s include neck pain, suboccipital headache, occassional numbness
  • medical history of cerical spine trauma or degeneration
  • upper cervical mobility deficits
    • neck torsion test
    • joint position error test
23
Q

Consequences of impaired cervical afferent input

A
  • sensory mismatch, disturbances in sensorimotor control
  • afferent input can be either increased or decreased with dizziness, head movement control, eye movement control, postural stability
  • can be experimentally changed with injections or vibration

7 Orthopedics (14 decks)

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