Lecture 5: Cervical Spine Whiplash Flashcards
What happens to neck in rear end collision?
hyperextension followed by hyperextension
What happens to neck in frontal impact?
hyper flexion followed by hyperextension
What happens to the muscles involved during a whiplash injury?
fatty infiltrates will develop in neck muscles in pts with chronic whiplash
between 4 weeks and 3 months with severe pain levels
What is the timeline for whiplash classification?
acute- up to 2 weeks after injury
subacute- 2-12 weeks
chronic- more than 12
What is updated clinical classification of whiplash associated disorders?
0- neck neck complaint
1- neck complaint of stiffness, pain and merely tenderness
What is updated clinical classification of whiplash associated disorders level 2A?
neck pain, motor impairment, decreased ROM, altered muscle recruiting patterns, sensory impairment,
What is updated clinical classification of whiplash associated disorders level 2B?
same as 2 A plus psychological impairments, elevated psychological distress on GHQ 28, TAMPA
What is updated clinical classification of whiplash associated disorders level 2C?
same as A and B, plus generalized hypersensitivity, ULTT may show signs of SNS disturbances
What is updated clinical classification of whiplash associated disorders level 3?
neuro signs of conduction loss, decreased or absent DTR, muscle weakness, sensory deficits
What is updated clinical classification of whiplash associated disorders level 4?
neck complaint with fx or dislocation
What are some poor predictors of outcome after whiplash?
high baseline pain (over 5), HA, no seatbelt use, LBP, high NDI, female, WAD grade 2-3, cold sensitivity
What is important to ask during the evaluation?
speed of travel, seatbelt use, airbag, direction hit from, position of victim
What are components of cervical kinesthesia assessment?
used for sensorimotor impairment
joint position sense, balance assessment, oculomotor assessment
What will patients have in they have central sensitization after whiplash injury?
combination of cold hyperalgesia, reduced pain threshold
What are acute interventions for whiplash?
pt education, decrease pain, minimize ms spasm, posture re ed, body mechanics for ADL’s
ICE, estim, TENS, AROM exercises
What are subacute interventions for whiplash?
more emphasis on active exercises and ROM, strengthening, continued postural re-ed
STM, T spine mobs, AC, cervical kinesthetic training
What are chronic interventions for whiplash?
segmental stabilization, joint mobs, scap stab, PNF, AC
What are sign of sx of fibromyalgia syndrome?
widespread pain, tenderness to palpation of multiple joints, morning stiffness, fatigue, sleep disturbances, female, depression, STM loss
What is American college of Rheumatology classification for FMS?
widespread ms pain, pain induced by palpation of tender points, which include occiput at subocciptal muscles, trap- midpoint of upper muscle border
What is updated classification for FMS?
same as before plus 0-19 on widespread pain index, 0-3 on symptom severity score (sleep, fatigue, cog sx, somatic sx)
What are exams findings for fibromyalgia?
allodynia- pain in response to non nociceptive stimulus like brushing of skin, may have trigger points, decreased ROM< decreased strength and endurance
What is CMT?
congenital muscle torticollis
characterized by- head tilt to one side or lateral flexion due to shortening or fibrosis of SCM
What else could accompany CMT?
cranial deformation, hip dysplasia, brachial plexus injury, distal extremity formation
What are 3 types of CMT?
- postural- mildest, postural preference but but without muscle or passive ROM restrictions
- muscular- SCM tightness and passive ROM limitations
- SCM mass- most severe form presents with fibrotic thickening of SCM and passive ROM limitations
What is key for CMT intervention?
early intervention
What is plagiocephaly?
cranial asymmetry with flattening of 1 side of the head
What are interventions for CMT?
passive stretching, use of prone position for 1 hour a day active movement away from the tightness, parent education, AROM to limited side asymmetrical handling
When will a referal be need for PCP after PT for CMT?
4-6 week of intense tx not working, 6 months of tx with moderate resolution, side of CMT changes, mass develops if over 7 months
When should a patient with CMT be discharged?
infant has full PROM with 5 degrees of non affected side, symmetrical active movement patterns throughout passive range, age appropriate motor development, no visible head tilt
