Neck P! with Mobility Deficit Flashcards
What is the proposed underlying cause of this condition? The Pathoanatomy can be categorized into 2 broad conditions, what are these conditions?
Mobility deficits are caused by impairments to the facet joints and periarticular soft tissue
2 Conditions
- Spondylosis
- Sprain/Strain
With the 2 conditions associated with Mobility deficits, what is the difference between Spondylosis and Spain/Strain?
Spondylosis
- Gradual Progression of age-related joint changes
- Adaptive shortening of the joint connective tissue and periarticular soft tissue
Sprain/Strain
- Acute onset sudden awkward movement causing:
–Muscle strain and/or Ligament sprain
–Primary/secondary disk related injury
–Intra-articular meniscus entrapment
Differential diagnosis for Mobility deficit should include other impairment-based diagnoses. What are those different diagnosis?
- Neck Pain with Movement Coordination impairments
- Neck Pain with Radiating Pain
- Rotator Cuff related shoulder Pain
- Thoracic and/or Rib pain with mobility deficit
What system, structure, pain mechanism (phenotype), and phase of healing are unique to Mobility Deficit patients?
System
- Musculoskeletal
Structure
- Zygopophyseal Joint and Periarticular Soft Tissue
Pain Mechanism (Phenotype)
- Nociceptive
Phase of Healing
- Muscle strain 2-4 weeks, ligament sprain and cartilage injuries 10-12 weeks
With Pts. with Neck P! with Mobility Deficit, what are common subjective reports? What are General Symptoms, Spondylosis Symptoms, and Sprain/Strain Symptoms?
General Symptoms
- Central or Unilateral Symptoms
- Possible (Somatic Referred) UE pain
Spondylosis Symptoms
{Degeneration of tissue, more chronic}
- Gradual onset with Progressive loss of motion
Sprain/Strain
{More Acute, Awkward movement caused immediate P!}
- Immediate onset of pain and loss of motion
- Recent unguarded/awkward movement or position
With Pts. with Neck P! with Mobility Deficits what are Aggravating and Easing Factors?
Aggravating
- Dull ache and stiffness with inactivity
- Symptoms reproduced with certain active movements which may be sharp
Ease
- Staying active
- Progressive cervical spine movement
With this condition, what is common is the 24 hour pain behavior?
Morning
- May have pain and stiffness that is worse upon waking that eases with activity and movement
Noon to Evening
- Symptoms may vary throughout the day depending on the patients activities,
Night
- Symptoms may disrupt sleep with changing positions depending on symptom irritability
With the Movement and Provocation Examination, What will you typically find with AROM with Mobility Deficits?
- Cervical ROM limitations and symptom provocation consistently reproduced at end range
- Symptom provocation with the addition of overpressure and/or combined motions
With the Movement and Provocation Examination, What will you typically find with PIVM with Mobility Deficits?
- Hypomobility of the Cerviothoracic spine with characteristic pattern of restriction
- Hypomobility of the involved segment(s) with local and/or somatic referred symptom reproduction
What is the Diagnostic Test-Item Cluster for pts. with Mobility Deficits?
- Younger individual (age < 50 years)
- Acute Neck Pain (duration < 12 weeks)
- Symptoms isolated to the neck
- Restricted cervical ROM
What is the Clinical Course and Prognosis for this condition?
- Acute Idiopathic neck pain has variable recovery with slowing of progress noted at 6-12 weeks from onset
- Chronic non-specific, atraumatic neck pain may be stable or fluctuating with periods of improvements and worsening
What are factors that may impact prognosis for this condition?
- Older Age
- Prior history of musculoskeletal disorder
- Prior health
- Regular exercise
- History of previous neck pain
- Sick leave
A patient with this condition, how would they present when they are in the Acute stage?
- Severity and Irritability are often high
- Pain at rest or with initial to mid-range spinal movements: before tissue stretch
- Pain control is often the intervention goal at this stage
A patient with this condition, how would they present when they are in the Subacute stage?
- Severity and Irritability are often moderate
- Pain experiences with mid-range motions that worsens with end-range spinal movements: at tissue resistance
- Movement control is often the intervention goal at this step
A patient with this condition, how would they present when they are in the Chronic stage?
- Severity and Irritability are often low
- Pain that worsens with sustained end-range spinal movements or positions overpressure: Overpressure into tissue resistance
- Functional optimization is often the intervention goal at this stage
With with condition, what are intervention recommendations in the Acute stage?
Education
- General exercise and patient education to stay active
Exercise
- Cervical ROM, stretching and isometric strengthening
- Supervised exercise, including interventions for cervicoscapulothoracic stretching and endurance training
Manual Therapy
- Thoracic manipulation
- Cervical mobilization and/or manipulation
With with condition, what are intervention recommendations in the Subacute stage?
Exercise
- Cervicoscapulothoracic endurance exercise
Manual Therapy
- Thoracic manipulation
- Cervical mobilization and/or manipulation
With with condition, what are intervention recommendations in the Chronic stage?
Education
- “Stay active” lifestyle approaches
Exercise
- Combined cervicoscapulothoracic exercise
- Mixed exercise for cervicoscapulothoracic regions including coordination, proprioception, postural training, aerobic conditioning, and cognitive effective elements
Manual Therapy
- Thoracic manipulation and cervical mobilization
- Biophysical agents
- Dry needling, TENS, low-level laser, pulsed or high powered ultrasound, intermittent mechanical traction, repetitive brain stimulation, and electrical muscle stimulation
With interventions, what is the Clinical Prediction Rule for those patients that will mostly likely respond to Thrust Manipulation of the Cervical spine?
If they are 3/4 in:
- Symptom duration less than 38 days
- A positive expectation that manipulation will help
- Side to side difference in cervical rotation ROM of 10° or greater
- Pain with posteroanterior spring testing of the middle cervical spine
When should we consider interprofessional or Intraprofessional referral and what are other treatment options?
Imaging
- In the absence of red flags and for those classified as low risk, imaging is not indicated
Medical Intervention
- Medications/Injections
–NSAIDs
–Facet joint injections
