Neck CPG Flashcards
Neck pain is most common in what gender and what decade of life?
Women, 5th decade of life
What are predisposing factors for chronic neck pain: (7)
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
What are the two strongest and most consistent risk factors for new-onset neck pain?
Female sex - hx of neck pain
What period of time is optimal recovery time from neck pain?
First 6-12 weeks - variable clinical course afterward, not entirely favorable
What three projected pathways can neck pain clinically follow in terms of recovery?
1) rapid recovery (45%)
2) moderate problems, incomplete recovery (40%)
3) severe problems, no recovery (15%)
What are prognostic indicators for persistent problems (esp in WAD)?
High pain intensity, high disability
What peripheral nerve test is useful in ruling in cervical radiculopathy?
Median nerve
What screening tool can be useful to quickly perform to asses for serious intracranial pathology in pts presenting with headache that worsens with exertion?
Valsalva maneuver (+LR 2.3)
What are the 5 factors regarding use of cervical traction? (CPR)
1) ULTT1a positive
2) age >55
3) shoulder abduction sign
4) + response to manual traction
5) peripheralization with lower cervical CPA
What are the Candian Cspine Rules: (3) + ROM factor
1) age >65
2) paresthesias in UE
3) dangerous MOI
ROM = 45 degrees in either direction
Other low risk Canadian Cspine rules: (5) need to meet following
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
Hoffman’s criteria for instability (5): need to meet following to avoid radiography
1) no focal neurological injury
2) alert/ no intoxication
3) ambulate or sit in ER
4) no other distracting injury
5) no midline tenderness
What age is the cut off for application of adult CCR to children?
Plain views those under 14 y.o.
True or false: WAD has more fat infiltration of neck flexors/extensor as compared to insidious onset neck pain
True - both chronic and insidious onset pain had less fat infiltration
What are degenerative changes of the vertebral bone marrow adjacent to the end plates?
Modic sign
What is the MCD - MCID for the NDI?
5 points - 10%
What is considered a valuable tool in screening/diagnostic process of CGH, cervical radiculopathy and cervical spinal injury?
Cervical ROM measured with inclinometer
What test showed the strongest diagnostic utility in differential diagnosis for headache?
Cervical flexion rotation test - cut off 32 deg, normal 40-45 deg - high spec/+LR
What is the most commonly symptomatic segment with cervical PAIVM testing for CGH?
C1-2 Kappa 0.53 to 0.72
Acute neck pain with mobility deficits - greater evidence for tspine manip with exercise or cervical manipulation?
Tspine manipulation with exercise
Subacute neck pain with mobility deficits - manipulate tspine or cspine?
Both - small to moderate evidence but needs exercise as well
Chronic neck pain with mobility deficits - what approach is best?
Multi-modal; manip, exercise, DN, laser, intermittent traction, pt education
Acute WAD - what two aspects of pt education are highly emphasized?
-Reassurance - recovery is expected
-Return to normal, no collar, -exercise
Can incorporate manual therapy
Acute or chronic CGH - which benefits more from manipulation?
Subacute to chronic; both c and Tspine manipulation
Acute or chronic neck pain with radiating pain - intermittent mechanical traction with multimodal approach?
Chronic