L9 CT Conditions Flashcards
Cervical Spine Motions
- Flexion causes spinal canal widening
- Extension causes narrowing of spinal canal
- Ipsilateral rotation causes larger narrowing of the lateral foramen then contralateral rotation
Systemic S/S
- disturbs sleep
- deep aching or throbbing
- reduced by pressure
- constant or waves of pain/spasm
- not aggravated by mechanical stress
- associated with fatigue, weight loss, rash, fever, etc
Mechanical S/S
- generally lessens at night
- sharp or superficial ache
- usually decreases with cessation of activity
- aggravated by mechanical stress
Cervicothoracic Spine Cancer RF
- age >50 years
- hx of cancer
- unexplained weight loss
- failure of conservative therapy
Cervical Primary tumors
lumbar and thoracic are more common than cervical
Cervical Metastatic Tumors
only 8-20% will appear within cervical tumors
Pancoast Tumors
- most common s/s is sharp posterior shoulder pain as tumor invades brachial plexus and upper ribs
- usually men in 6th decade
Peptic Ulcer
- boring pain from epigastric area to middle thoracic spine
- history of NSAID use
- perforated ulcer can refer pain to shoulder with irritation of diaphragm
Cholecystitis
- right upper quadrant and scapular pain
- fever, nausea, vomiting 1-2 hours after fatty meal
Renal Infection
- renal colic/flank pain
- fever, nausea, vomiting
- increased risk for kidney infection with ongoing UTI
Systemic/Infection S/S
- temperature >100°
- BP >160/95
- resting pulse > 100 bpm
- resting respiration > 25 bpm
- fatigue
Imaging for Cervical Fracture
- High risk = age >65, dangerous MOI, UE paresthesia
- low risk = simple rear end, ambulatory at any time, delayed onset of neck pain, absence of midline tenderness
- able to rotate neck 45°
Cervical Myelopathy
- s/s = imbalanced altered gait, progressive stiffening of spine, clumsiness with hands
- altered sensations, impaired reflexes, B/B changes
- refer for consult and imaging, surgery is often indicated
Cook’s myelopathy cluster
- gait deviation
- positive hoffman’s
- inverted supinator sign
- positive babinski
- age > 45 yo
more than 3 have a high likelihood of having myelopahty
Inverted Supinator Sign
- pt is seated, therapist supports pronated forearm
- PT applies a series quick strikes near styloid process
normal response: slight elbow flexion
positive: finger flexion, elbow extension
indicates UMN lesion and myelopathy
Cervical Myelopathy Grading
- four different categories include upper limb motor, lower limb motor, upper limb sensory, and sphincter (B/B)
- a lower score indicates higher levels of disability
Conservative management for cervical myelopathy
- neck bracing
- bed rest
- PT
- pharmacology
- traction
no RCTs that show effects of specific conservative treatment
Surgical mgmt for Cervical Myelopathy
- anterior decompression and fusion
- posterior laminectomy with or without fusion
- improvements in disability and function seen in majority of pts after surgery
Factors associated with poor surgical mgmt outcomes
age >50
s/s longer than 12 mo
multi-level involvement
hx of smoking
Cervical Arterial Dysfunction
- umbrella term for vascular pathologies in neck
- including carotid artery and vertebro-basilar
- can be atherosclerotic, ischemic, hemorrhagic
- dissection vs no dissection events
CAD Screening (5 Ds and Ns)
Diplopia
Dizziness
Drop Attack
Dysarthria
Dysphagia
Ataxia
Nystagmus
Nausea
Numbness
Physical Exam for CAD
- history/subjective exam will help PT to decide if they should continue with physical exam. HISTORY not exam will increase suspicion of vascular issues in neck
- neuro exam of cranial and pn
- sustained end range rotation for >10 s
- BP
- auscultation
VBI and SMT
- rotation, specifically EOR, has been connected with vertebra-basilar artery dissection
- most common direction of thrust in manipulative therapy
- adverse vascular events usually follow chiropractors and other HCPs, PTs have the least amount of adverse events
Refer when…
- suspicious of fx
- suspicious of infection
- appearance of stenosis–UMN signs, gait, balance, LE s/s
Cervical Manual Treatment recommendations
- avoid cervical manipulation during first week, with recent onset of head and neck pain
- treat with thoracic manip and cervical ROM during first week
- manip of upper cervical spine should be rarely used, if at all
- only low force traction for cervical
- pre-manip hold has to be performed prior to thrust
Regional Interdependence
- primary thoracic mechanical dysfunction and pain
- neck pain due to thoracic impairments
- shoulder pain due to thoracic impairments
- neck pain due to shoulder impairments
- shoulder pain due to cervical impairments
–> limited thoracic or cervical can cause pain in the other. Improving one can improve the other
