Lecture 10: The Neck and Head Flashcards
What are the typical signs of a cervical fracture?
- Severe, acute, localized pain
- Guarding behaviour
- Worse with compression on the fracture
What is the purpose of the Alar ligament?
Resists side-bending movements of the head
What is the purpose of the Transverse ligament of the atlas?
Prevents the dens from slipping backwards (anterior-posterior shear)
A construction worker has pain in his neck when he bends his neck and notices some loss of sensation in his right arm. What condition might he have?
Cervical disc herniation
List and describe the 4 grades of whiplash associated disorder.
Grade I: Subjective neck complaints of pain, stiffness, and tenderness, but without objective physical signs
Grade II: Musculoskeletal signs such as decreased ROM and point tenderness
Grade III: Neurologic symptoms, such as muscle weakness or sensory deficits
Grade IV: Fracture or dislocation
List the 4 signs of cervical fracture (serious condition, could be life-threatening).
- Does not move the neck, even slightly (fractured dens)
- Painful weakness of the neck muscles (fracture)
- Gentle traction and compression of the neck that are painful (fracture)
- Severe muscle spasm (fracture)
What is the usual course of rehab (for any injury)?
- PRICE (managing the pain) + NSAIDs
- Mobility
- Strengthening
A patient goes to their doctor with neck pain that they woke up with that morning. They have limited ROM. What do they likely have, and how should it be treated?
- Acute torticollis
- Nothing… should go away on its own
Is the alar ligament stress test a good special test to use? Why or why not?
It has pretty good specificity and sensitivity, but only if you set it up correctly, which can be difficult to do.
Why does the transverse ligament stress test have such poor sensitivity?
You can’t rule out very well because a lot of people with a transverse ligament tear will be guarding the injury which will result in a false negative.
What causes Barre-Lieou syndrome?
Irritation or compression of nerves in the neck (due to cervical spine issues or mechanical restrictions)
Results in vertigo symptoms: Headaches, neck pain, dizziness, visual disturbances, tinnitus, and sometimes nausea
“not really vertigo”
What is Cervical Proprioceptive Vertigo?
Vertigo induced by proprioceptive issues (disfunction in the cervical spine ⇒ impairs the proprioceptive nerves that contribute to balance and coordination)
What is Rotational Vertebral Artery Vertigo?
Reduced blood flow through vertebral arteries due to positional changes (usually neck rotation) which results in dizziness, nausea, visual disturbances.
What is Migraine-Associated Cervicogenic Vertigo?
Migraine and vertigo symptoms due to the interaction between migraines and cervical spine dysfunction.
Symptoms: Vertigo, neck pain, migraines and associated symptoms like light sensitivity, nausea
What can you do to relieve cervicogenic headaches?
Massage the temporalis
What are two common causes for cervicogenic headache?
- WAD
- Postural dysfunction
A woman comes into the clinic with chronic pain in her neck and the back of her head, and notes that the pain sometimes extends into the forehead, orbital region, and temples. She explains that it hurts more after a day at the office and when she bends it. What does she likely have?
Cervicogenic headache
What is the main mechanism of injury for concussion (traumatic brain injury)?
Impact (MVA, falls, contact sports, etc.)
Explain what is meant by Benign Paroxysmal Positional Vertigo (BPPV).
Benign – it is not life-threatening
Paroxysmal – it comes in sudden, brief spells
Positional – it gets triggered by certain head positions or movements
Vertigo – a false sense of movement, often rotational but can be any perceived movement not occurring such as falling, swaying or rocking
In terms of Benign Paroxysmal Positional Vertigo, what is Cupulolithiasis?
Pieces of the otoconia break off and stick to the cupula, thus causing depolarization even when your head isn’t moving.
What is the main risk factor for vertigo (particularly BPPV)?
Increased age
What are the signs and symptoms of vertebrobasilar artery insufficiency? (5 Ds and 3 Ns)
- Drop attacks (walk, turn, collapse)
- Dizziness
- Dysphagia: difficulty swallowing
- Dysarthria: impaired speech (slurred speech, hoarseness)
- Diplopia: double vision
- Nystagmus: involuntary eye movement
- Nausea
- Numbness
What are the indications for CT scan?
- Head trauma
- Stroke.
- Headaches
- Initial evaluation for space- occupying lesions.
- Unexplained change in mental status
- Seizures
- Suspected hydrocephalus
- Suspected intracranial hematoma
What is the Dix-Hallpike test used for?
Identify benign paroxysmal positional vertigo (BPPV)
