Neck P! with Movement and Coordination Impairment (WAD) Flashcards
What is the proposed underlying cause of Whiplash Associated Disorder (WAD)? (7)
- Trauma often associated with a motor vehicle accident
- Central and Peripheral Nervous system sensitization are common (Nociplastic pain)
- Motor impairment
- Muscle strain and ligamentous sprain
- Fatty infiltration of the neck/extensors
- PTSD
- Concussion is possible
Differential diagnosis for WAD should include other impairment-based diagnoses. What are those different diagnosis?
- Neck pain with mobility deficit
- Neck pain with headache
- Neck pain with radiating pain
- Rotator cuff related shoulder
- Thoracic and/or rib pain with mobility deficit
What system, structure, pain mechanism (phenotype), and phase of healing are unique to WAD patients?
System
- Neuromuscular
Structure
- Ligaments, muscles, central/peripheral nervous system
Pain Mechanism
- Nociceptive (WAD I - WAD B){Minor injury},
- Nociplastic (WAD IIC),
- Nociplastic/Neuropathic (WADIII)
Phase of healing
- Muscle strain 2-4 weeks, ligament sprain 10-12 weeks
What are common subjective reports of patients with motor coordination impairments (WAD)?
(10) Get big picture
- History of trauma often involving MVA
- Neck pain with possible somatic referred pain in UE
- High pain and disability score
- Variable agg/ease factors and 24 hr pain behavior based on dominate pain mechanisms and Quebec classification
- Various nonspecific concussive S/S
- Dizziness/nausea
- Headache, concentration or memory difficulties
- Confusion
- Hypersensitivity to mechanical, thermal, acoustic, odor, light stimuli
- Heightened affective distress
What is the Pain Phenotype/Mechanism of pain for Movement Coordination impairments (WAD)
Nociceptive Pain
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD 0-1}
WAD 0
- No symptoms of neck pain
- No physical signs
WAD I
- Neck symptoms of pain, stiffness, or tenderness
- No physical signs
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD II}
WAD II
Neck Symptoms
- Pain, stiffness, or tenderness
Musculoskeletal signs
- Decreased ROM
- Point tenderness
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD III}
WAD III
Neck Symptoms
- Pain, stiffness, or tenderness
Musculoskeletal signs
- Decreased ROM
- Point tenderness
*Neurological
- Altered DTRs
- Weakness and sensory deficits
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD IV}
WAD IV
Fracture or Dislocation
Neck Symptoms
- Pain, stiffness, or tenderness
Musculoskeletal signs
- Decreased ROM
- Point tenderness
*Neurological
- Altered DTRs
- Weakness and sensory deficits
What are common findings for patients with movement coordination impairments (WAD) based on the Sterling Subclassification? {WAD II A}
WAD II A {Flexor Endurance is Poor}
Neck Pain
Motor Impairment
- Decreased ROM
- Altered recruitment patterns (CCFT)
Sensory Impairment
- Local Cervical Mechanical Hyperalgesia
What are common findings for patients with movement coordination impairments (WAD) based on the Sterling Subclassification? {WAD II B}
WAD II B
Neck Pain
Motor Impairment
- Decreased ROM
- Altered recruitment patterns (CCFT)
Sensory Impairment
- Local Cervical Mechanical Hyperalgesia
Psychological Impairment
- Elevated psychological distress
What are common findings for patients with movement coordination impairments (WAD) based on the Sterling Subclassification? {WAD II C}
WAD II C
Neck Pain
Motor Impairment
- Decreased ROM
- Altered recruitment patterns (CCFT)
- Increased joint positioning errors
Sensory Impairment
- Local Cervical Mechanical Hyperalgesia
Generalized sensory hypersensitivity (Mechanical, thermal, bilateral upper lomb neurodynamics testing
Sympathetic nervous system disturbances
Psychological Impairment
- Elevated psychological distress
- Elevated levels of acute post-traumatic stress
In the Objective Examination, what you looking for when doing AROM and PIVM with the patient?
We are looking at the patients ability to move and for Pain Provocation
In the Objective Examination, What will you typically find with AROM with WAD?
- ROM limitations and symptoms provocation will depend on individual patient presentation
- Neck P! with mid-range motion worsens with end-range positions
- May see altered muscle recruitment and aberrant motions
In the Objective Examination, What will you typically find with PIVM (Passive Intervertebral Motion) with WAD?
- Spasm and/or local and/or referred pain reproduction at the involved segments
- Possible hyper-or hypomobility throughout the cerviothoracic spine
