L3 Flashcards
What are three Outcome Assessments Tools
- Neck Disability Index
- VAS
- Numeric Pain Scale
Cervical Disc Derangement
- Disruption in Disc Integrity
- Due to traumatic or gradual microtrauma
- MC in 18-50 yo
MC location of Cervical Disc Derangement
- C5/6
- C6/7
Steps in Cervical Disc Derangement
- Annular (radial) fissure damage
- Nucleus herniates OUT DISC = Disc herniation
IVD Dz breakdown
- MC in Lumbar
- 2nd MC in Cervical
- Least Common in Thoracic
What is the description of a Disc Protrusion
- Base WIDER THAN Herniation
- Confined to disc lvl
- Outer annual fibers intact
What is the description of a Disc Extrusion?
- Base NARROWER THAN Herniation
- Extends above or below endplate
- Complete annular tear
*** uncontained **
What is the definition of a Disc Sequestration?
- Disc herniation breaks off -> Spinal Canal
- Symp. span across many N. Roots
- Requires surgery
What is the definition of the Cervical Disc Derangement symptoms [4]
- Neck pain / Arm pain
- Worse w. cough/sneeze/bearing [Triad of Dejerine]
- Worse w. Ext/Rot/LF
- Pain referred to Occiput
What are some palliative factors to cervical disc?
derangement
chin retraction
good posture
cervical traction
You want to order an MRI in Cervical Disc Derangement if the following occur:
- PT fails to improve w. conservative care
- Worsens / Neuro Deficit
- Red flags present
What are the 4 Medical Management of Cervical Disc Derangement [4]?
- NSAIDS
- Corticosteroids
- N. Block
- Surgery
What are the 5 Chiro Management of Cervical Disc Derangement [5]
- Stim
- Soft tissue / Traction
- Mckenzie
- F &D / Adjust
- Taping / Rehab (Chin tucks, Wall angels)
What are three Causes of Cervical Radiculopathy?
- Disc herniation
- IVF encroachment
- Chemical irritation
What are three Symptoms of Cervical Radiculopathy?
- Pain / Numb / Tingling
- Weakness in UE
- Stiff neck -> Decreased ROM
What are three Imaging for Cervical Radiculopathies?
- Radiograph
- MRI
- EMG (Studies N. Root)
What are 6 Chiro Management of Cervical Radiculopathy [6]?
- Stim
- Soft tissue / Traction
- Mckenzie
- F &D / Adjust
- Tape / Rehab (Chin tucks, Wall angels)
- N. Flossing
What is Cervical Myelopathy?
- Compression of Cervical Spinal Cord
What are some Causes of Cervical Myelopathy [4]?
- Post. Protruding Disc
- OPLL
- Degen change
- Spinal stenosis
What are some Symptoms of Cervical Myelopathy?
- Weak muscle (SPASTIC)
- Gait Disturbance
- Bowel/bladder Disturbance
- Neck pain/stiffness
Hyperreflexia in LE
What are some Signs of Cervical Myelopathy [5]?
- Hand muscle Atrophy
- HYPERreflexia below compression lvl
- Neck flexion causes shock pain down back [L’Hermitte’s]
- Finger escape sign
- Inverted Radial Reflex
What is the Finger escape sign?
- PT hold hand with extends fingers
- Medial (4th/5th) will deviate with flexion
What is the Inverted radial reflex?
- C6 root compression with cord compression
- Weak brachioradialis reflex w. SPASTIC finger flexors
they have C6 reflex diminished with spasticity at C8
What is the Best IMAGING for assessing changes to Spinal Cord?
- MRI
What are some Chiro management of Cervical Myelopathy?
- Contraindication to HVLA (DON’T ADJUST)
- Managed by MD
- Mobilize
- Extension exercises
- Rehab for limbs
What are 4 mechanisms that cause Facet Syndrome?
- Degeneration
- Trauma
- Inflammation
- Cartilage erosion
What are some Symptoms of Facet syndrome in C-Spine?
- Axial neck pain [Unilat]
- Pain w EXT. + ROT.
- Tender palpation
- Refer to Shoulder / Mid Back
What are some Clinical Evaluation of Facet Syndrome?
- Compression & Distraction tests helps INDICATE
What is the GOLD STANDARD for Facet Syndrome Dx?
- Medial branch block (anesthetic injection)
** (+) = Response to 2 diagnostic blocks @ 2+ lvls **
What are 5 Chiro management of Facet Syndrome [5]?
- TENs
- Shockwave (Performs better than other stim)
- Pulse electromagnetic
therapy - Myofacial soft tissue massage
- Tape / Rehab
*** Manipulation w. exercise encouraged by literature **
What is Whiplash?
- Trauma resulting in Musculolig. sprain/strain
What are some Causes of Whiplash?
- Sudden accel. / decel. of Head relative to Trunk
- In ANY PLANE
Whiplash can even occur at ______ mph
- 5 mph
MVA what can cause Whiplash [4]
- Roller Coaster
- Sports
- Punched
- Shaken baby
Amount of car damage is..
- Inversely proportional to Whiplash incidence
Grades of Whiplash
0: No complaints
1: Neck pain, no physical signs
2: Decrease ROM, point tenderness
3: Neuro signs
4: Neck pain w Fx
Median time to RECOVER from WAD (Whiplash)
~ 101 days
** Still not recovered after 1 yr **
Paresthesias assoc w. WAD can attribute to… [4]
- TOS
- Myofascial injury
- Stretch injury of Brachial Plexus
- Central cord injuries
WAD injuries include these 5 components:
- C-Spine muscle tear
- C-Spine Lig tear
- Disc Herniation
- Instability / Sprain
- Esophageal Hematomas
4 causes of Retropharyngeal Hematoma
- Hyperextension to airbag
- Cough / Sneeze / Vomiting
- WAD
- Trauma
What is Myelomalacia?
- Softening of spinal cord
- Can bring Hemorrhagic Infarction to spinal cord
UNILATERAL facet dislocation causes ________
BILATERAL facet dislocation causes ____
Radiculopathy
Cord injury (compression)
What are 3 Affects of muscle spasm?
- Wide open sensory gate and blocked mechanoreception
- Metabolic waste accumulation
- Prolonged spasm leads to myofascial pain syndrome
Explain the Tonicity scale [1-4]
+1 : Sustained contraction, mild resistance in passive ROM
+2 : Sustained contraction, moderate resistance in passive ROM
3+ : Muscle rigidity, complete resistance to passive ROM
4+ : Spasm, triggered by movement to EX. irritation (poking muscle causes spasm)
What is the WAD PT intake protocol:
- Cervical radiographs w. Flex/Extension
- Normal / Mild loss of lordosis
Traditional management of WAD [4]
- Rest
- Analgesic (Anti-Inflam)
- Oral meds / Injections
- Collar
What are 4 chiro management results of treating WAD?
- Heal soft tissue 1st
- Aim to reduce pain / inflammation
- Expedite healing
- Encourage mobility
When to REFER in WAD Patient?
- Fx
- Instability
- Soft tissue damage
- Neuro deficit
What is the Purpose of C1/C2?
- Support occiput
- Provides greatest ROM in C-Spine while maintaining support
What are two Conditions that lead to Upper cervical instability?
- Down Syndrome (30%)
- RA (25%-80%)
What are the 4 Types of Upper Cervical Instability?
I: simple rotary displacement with intact transverse
2: anterior displacement, 3-5mm, deficiency of transverse
3: anterior displacement beyond 5mm
4: posterior displacement of C1 on C2
Explain Type 3 & 4 Upper Cervical instability:
- Highly unstable and require ER immediately
3 main Radiograph requirements for C-Spine instability:
- 3mm or 25% ANT. body movement
- 25% vertebral body compression
- 11 degree of angular instability
Asymptomatic Cervical unstable patients can be minored with what?
- Be monitored with MRI
** if worsens, neuro consult is required **
Cervical Instability & Chiro management can be used for:
- Type 1 & 2 are co manageable
- Type 3/4 are surgery
** NO HVLA at all ***
