MSK III: neck pain and headaches Flashcards
risk factors for developing neck pain
greater than 40 years of age, co-existing low back pain, loss of strength in the hands, poor quality of life, worrisome attitude, less vitality
Caused by compression of the spinal cord from osteophytes or disc degeneration: (+) Hoffman, >45 y/o, gait disturbances, (+) Babinski, (+) inverted supinator sign
these are UMN signs and symptoms, therefore Cervical Myelopathy.
“Myelo” = spinal cord
Clinical Prediction Rule (Cook et al 2010)
what is the difference between cervical spondylosis and cervical myelopathy
- cervical myelopathy is a spinal cord injury caused by osteophytes or disc degeneration
- in a cervical spondylosis, disc degeneration, longitudinal ligament degeneration, osteophytes that can press on nerve roots (radiculopathy) or spinal cord (myelopathy), stenosis
Caused by compression of nerve roots from osteophytes, disc or tumor: >50, headache, loss of motion, crepitus, pain
Cervical Radiculopathy
Disc degeneration, longitudinal ligament degeneration, osteophytes that can press on nerve roots (radiculopathy) or spinal cord (myelopathy), stenosis
what is cholecystitis and where can cholecystitis pain be referred to?
- Cholecystitis is inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct by gallstones
- pain referred to right scapula/upper back.
Cervical Spine
Canadian Cervical Spine Rule (100% sensitivity) to determine if the patient needs an X-Ray, includes the following factors:
- for patients with trauma who are alert ONLY:
- Age >65 with paresthesias in extremities
- Unable to rotate the neck 45 deg
- dangerous MOI
Cervical Spine
ICF diagnosis of neck pain with mobility deficits is made with a reasonable level of certainty when the patient presents with the following clinical findings:
- Younger individuals <50
- Acute neck pain (<12 weeks)
- symptoms isolated to the neck
- Restricted cervical ROM
Most often, the term spondylosis is used to describe
osteoarthritis of the spine, but it is also commonly used to describe any manner of spinal degeneration
Cervical Spine
ICF diagnosis of neck pain with headaches is made with a reasonable level of certainty when the patient presents with the following clinical findings:
- Unilateral HA associated with neck/suboccipital area symptoms that are aggravated by neck movements or positions
- HA reproduced with neck movements
- Restricted cervical ROM and segment mobility
Cervical Spine
a spinal disorder in which vertebrae slips forward onto the bone below it
spondylolisthesis
TBC
Neck pain with radiating pain in involved UE
UE numbness, paresthesias, and/or weakness may be present
Diagnosis and Treatment:
NECK PAIN WITH RADIATING PAIN
- Manual/mechanical traction (B)
- Neural mobilization (B)
- Thoracic spine manipulation (C)
- Scapular exercises
TBC (Treatment Based Classification)
Unilateral neck pain
Neck motion limitations
+/- referred arm pain
Diagnosis and treatment
Neck pain with mobility deficits
- Manipulation and/or mobilization cervical (A) and/or thoracic spine (C)
- Coordination, strengthening/endurance (A), stretching exercises (C)
TBC
Non-continuous unilateral neck pain with headache
Headache affected by neck movements
Diagnosis and treatment:
NECK PAIN WITH HEADACHES
- Manipulation and/or mobilization cervical spine (A)
- Coordination, strengthening, stretching, and endurance exercises (A)
Cervical Spine
Key examination techniques for neck pain with movement coordination impairments:
-
Cranio cervical flexion test (CCFT):
- Normal Test: patient able to generate 26-30mmHg pressure for 10 seconds without compensations
-
Deep neck flexor endurance test (DNF):
- Have patient tuck chin, raise head off table 1 inch. Assess for substitution in SCM. Longus colli and capitis. Normal > 38 seconds
Cervical Spine
Key examination techniques for neck pain with headaches:
- Cervical AROM
- Cranio cervical flexion test
- Segmental examination AA/AO