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
Cervical Spine
Key examination techniques for neck pain with mobility deficits:
- Cervical AROM measurements
- Cervical and thoracic segmental examination
Key examination techniques for Neck pain with radiating symptoms:
- Upper limb tension test A (median nerve)
- Spurling’s test
- Distraction test
Cervical Spine
PAIVM (passive accessory intervertebral motion) consists in two parts:
- motion
- pain (high reliability)
what is the difference between PAIVM (Passive accessory intervertebral motion) and PIVM (Passive intervertebral motion)
- PAIVM (Passive accessory intervertebral motion): You directly impart forces to a single segment creating joint glides and determine the end-feel and amount of motion of a single segment
- PIVM (Passive intervertebral motion) In this examination, you move the spine osteokinematically and palpate motion of a single segment (hypo, hyper, normal). That is, as you move the spine with one hand, you are feeling the joint motion with the other. WE will NOT do this in class.
Name of test
VERTEBRAL BASILAR INSUFFICIENCY (VBI) TEST
What makes the vertebral basilar insufficiency test positive?
A positive test is any of the following diplopia, dizziness, drop attacks, dysarthria, and dysphagia, AS WELL AS numbness, nausea, and nystagmus
The patient is placed supine in end-range cervical rotation and extension and held there for 10 seconds. What is the name of this test?
Vertebro Basilar Insufficiency test
A positive test is any of the following
diplopia, dizziness, drop attacks,
dysarthria, and dysphagia, AS WELL AS
numbness, nausea, and nystagmus
Cervical Spine
Associated with whiplash or longer symptom duration
Neck pain +/- UE symptoms
Diagnosis and Treatment:
NECK PAIN WITH MOVEMENT COORDINATION IMPAIRMENTS
- Patient counseling (A)
- Coordination, strengthening, stretching, and endurance exercises (A)
Tests for cervical instability:
- Sharp Purser Test: In sitting, stabilize C2 spinous process; apply a posterior translation using the palm of the hand. A positive test is a reproduction of myelopathic symptoms during neck flexion or a decrease in symptoms with the posterior translation.
- Alar Ligament Test: stabilizes C2 spinous process; passive side bending to the right and assess for movement of C2. A positive test is a failure to feel a movement of C2.
- Transverse Ligament test: in supine, shears the occiput and head anteriorly; A positive test is an excessive movement, no end-feel, lump in the throat or any increase in myelopathic
Migraines duration
4 - 72 hours
migraines intensity
moderate to severe
migraines characteristics
- Unilateral, nausea, vomiting, photo/phonophobia
- Brought on by normal daily activities
- Related to blood flow disturbances in the CNS
Tension type HA duration
30 min to 7 days
tension type HA intensity
mild to moderate
tension type HA characteristics
- Bilateral, pressing tightening (no pulsations), no nausea or vomiting, no photo/phonophobia, or one but not the other
- Not aggravated by routine activity
- Occur within CNS, hereditary in nature, associated with triggered points
cervicogenic headaches duration
episodes of varying duration
cervicogenic headaches intensity
moderate to severe
cervicogenic headaches characteristics
- Unilateral, not throbbing, starts in the neck from sustained or awkward positions
- Aggravated by neck movements
- Etiology trigeminocervical nucleus
HEADACHES – RED FLAGS
-
Severe headache with sudden onset
- Acute subarachnoid hemorrhage (aneurysm): vomiting, seizures, “worse headache ever”
- Carotid or vertebral artery dissection: onset from headache to symptoms: vertebral artery (14.5 hrs), internal carotid (4 days)
-
Sub-acute and worsening headache
- Intra-cranial tumor
- Change in headache , new symptoms
- Progression of the headache and neurological symptoms
- Intra-cranial tumor
