Neck CPG

Question 1

Neck pain is most common in what gender and what decade of life?

Answer 1

Women, 5th decade of life

Question 2

What are predisposing factors for chronic neck pain: (7)

Answer 2

1) age >40
2) coexisting LBP
3) long hx of neck pain
4) cycling
5) loss of hand strength
6) worrisome attitude
7) poor quality of life/ less vitality

Question 3

What are the two strongest and most consistent risk factors for new-onset neck pain?

Answer 3

Female sex - hx of neck pain

Question 4

What period of time is optimal recovery time from neck pain?

Answer 4

First 6-12 weeks - variable clinical course afterward, not entirely favorable

Question 5

What three projected pathways can neck pain clinically follow in terms of recovery?

Answer 5

1) rapid recovery (45%)
2) moderate problems, incomplete recovery (40%)
3) severe problems, no recovery (15%)

Question 6

What are prognostic indicators for persistent problems (esp in WAD)?

Answer 6

High pain intensity, high disability

Question 7

What peripheral nerve test is useful in ruling in cervical radiculopathy?

Answer 7

Median nerve

Question 8

What screening tool can be useful to quickly perform to asses for serious intracranial pathology in pts presenting with headache that worsens with exertion?

Answer 8

Valsalva maneuver (+LR 2.3)

Question 9

What are the 5 factors regarding use of cervical traction? (CPR)

Answer 9

1) ULTT1a positive
2) age >55
3) shoulder abduction sign
4) + response to manual traction
5) peripheralization with lower cervical CPA

Question 10

What are the Candian Cspine Rules: (3) + ROM factor

Answer 10

1) age >65
2) paresthesias in UE
3) dangerous MOI
ROM = 45 degrees in either direction

Question 11

Other low risk Canadian Cspine rules: (5) need to meet following

Answer 11

1) sit in ER
2) simple rear-end MVA
3) ambulatory
4) delayed onset of neck pain
5) does not have midline tenderness of cspine

Question 12

Hoffman’s criteria for instability (5): need to meet following to avoid radiography

Answer 12

1) no focal neurological injury
2) alert/ no intoxication
3) ambulate or sit in ER
4) no other distracting injury
5) no midline tenderness

Question 13

What age is the cut off for application of adult CCR to children?

Answer 13

Plain views those under 14 y.o.

Question 14

True or false: WAD has more fat infiltration of neck flexors/extensor as compared to insidious onset neck pain

Answer 14

True - both chronic and insidious onset pain had less fat infiltration

Question 15

What are degenerative changes of the vertebral bone marrow adjacent to the end plates?

Answer 15

Modic sign

Question 16

What is the MCD - MCID for the NDI?

Answer 16

5 points - 10%

Question 17

What is considered a valuable tool in screening/diagnostic process of CGH, cervical radiculopathy and cervical spinal injury?

Answer 17

Cervical ROM measured with inclinometer

Question 18

What test showed the strongest diagnostic utility in differential diagnosis for headache?

Answer 18

Cervical flexion rotation test - cut off 32 deg, normal 40-45 deg - high spec/+LR

Question 19

What is the most commonly symptomatic segment with cervical PAIVM testing for CGH?

Answer 19

C1-2 Kappa 0.53 to 0.72

Question 20

Acute neck pain with mobility deficits - greater evidence for tspine manip with exercise or cervical manipulation?

Answer 20

Tspine manipulation with exercise

Question 21

Subacute neck pain with mobility deficits - manipulate tspine or cspine?

Answer 21

Both - small to moderate evidence but needs exercise as well

Question 22

Chronic neck pain with mobility deficits - what approach is best?

Answer 22

Multi-modal; manip, exercise, DN, laser, intermittent traction, pt education

Question 23

Acute WAD - what two aspects of pt education are highly emphasized?

Answer 23

-Reassurance - recovery is expected
-Return to normal, no collar, -exercise
Can incorporate manual therapy

Question 24

Acute or chronic CGH - which benefits more from manipulation?

Answer 24

Subacute to chronic; both c and Tspine manipulation

Question 25

Acute or chronic neck pain with radiating pain - intermittent mechanical traction with multimodal approach?

Answer 25

Chronic