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Neck Pain CPG Flashcards

1
Q

Risk Factors for New Onset Neck Pain

A

2 most common: female and prior hx of neck pain
Also: older age, high job demands, low social/work support, hx of smoking, and hx of low back pain

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2
Q

Factors affecting Prognosis

A
  1. High pain intensity >6/10
  2. High pain catastrophizing >20
  3. High self reported disability scores (aka NDI) >30%
  4. High post traumatic stress syndromes >33
  5. Cold hyperalgesia
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3
Q

Canadian C-Spine Rules

A

High Risk Factors:
1. Age > 65
2. Dangerous mechanism of injury
3. Paresthesias in upper extremities
Low Risk Factors:
1. Able to sit in emergency department
2. Simple rear end MVC
3. Ambulatory at any time
4. Delayed onset of neck pain
5. No midline cervical spine tenderness
if able to actively rotate head to 45 deg each way, then low risk and does not need x-ray

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4
Q

NEXUS for Imaging

A
  1. No posterior midline cervical tenderness
  2. No intoxication
  3. Normal level of cognition/alertness
  4. No focal neurologic deficit
  5. No painful distracting injuries
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5
Q

Best Imaging for Ruling out C-Spine Fracture

A

CT aside from if used for patient < 14 years of age due to radiation

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6
Q

Cervical Flexion Rotation Test

A

Definition: measurement of PROM of C1-C2
Positive IF: < 32 deg or at least 10 deg difference side to side

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7
Q

Neck Pain ICF Treatment Based Classification Categories

A
  1. Neck pain w/ mobility deficits
  2. Neck pain w/ movement coordination impairments
  3. Neck pain w/ headaches
  4. Neck pain w/ radiating pain
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8
Q

ICF: Neck pain w/ mobility deficits
Common Symptoms

A
  1. Central and/or unilateral neck
    pain
  2. Limitation in neck motion that
    consistently reproduces
    symptoms
  3. Associated (referred) shoulder
    girdle or upper extremity pain
    may be present
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9
Q

ICF: Neck Pain w/ mobility deficits
Exam Findings

A
  1. Limited cervical ROM, pain at end ranges actively and passively
  2. Restricted cervical and thoracic segmental mobility
  3. Neck and referred pain
    reproduced with provocation of
    the involved cervical or upper
    thoracic segments or cervical
    musculature
  4. Deficits in cervicoscapulothoracic strength and motor control
    may be present in individuals
    with subacute or chronic neck
    pain
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10
Q

ICF: Neck Pain w/ Mobility Deficits
ACUTE interventions

A
  1. Thoracic manipulation
  2. Cervical manipulation/mobilization
  3. Cervical ROM, stretching, isometric strengthening
  4. Advice to stay active plus HEP
  5. Supervised exercise
  6. General fitness training
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11
Q

ICF: Neck Pain w/ Mobility Deficits
SUBACUTE interventions

A
  1. Cervical mobilization/manipulation
  2. Thoracic manipulation
  3. Cervicoscapulothoracic endurance exercise
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12
Q

ICF: Neck Pain w/ Mobility Deficits
CHRONIC interventions

A
  1. Thoracic manipulation
  2. Cervical mobilization
  3. Combined cervicoscapulothoracic exercise plus mobilization
    or manipulation
  4. Mixed exercise for cervicoscapulothoracic regions—neuromuscular exercise: coordination,
    proprioception, and postural
    training; stretching; strengthening; endurance training; aerobic
    conditioning; and cognitive
    affective elements
  5. Supervised individualized
    exercises
  6. “Stay active” lifestyle
    approaches
  7. Dry needling, low-level laser,
    pulsed or high-power
    ultrasound, intermittent
    mechanical traction, repetitive
    brain stimulation, TENS,
    electrical muscle stimulation
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13
Q

ICF: Neck Pain w/ Movement Coordination Impairments (WAD)
Common Symptoms for ddx

A
  1. Mechanism of onset linked to
    trauma or whiplash
  2. Associated (referred) shoulder
    girdle or upper extremity pain
  3. Associated varied nonspecific
    concussive signs and symptoms
  4. Dizziness/nausea
  5. Headache, concentration, or
    memory difficulties; confusion;
    hypersensitivity to mechanical,
    thermal, acoustic, odor, or light
    stimuli; heightened affective
    distress
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14
Q

ICF: Neck Pain w/ Movement Coordination Impairments (WAD)
Exam Findings for ddx

A
  1. Positive cranial cervical flexion
    test
  2. Positive neck flexor muscle
    endurance test
  3. Positive pressure algometry
  4. Strength and endurance deficits
    of the neck muscles
  5. Neck pain with mid-range
    motion that worsens with
    end-range positions
  6. Point tenderness may include
    myofascial trigger points
  7. Sensorimotor impairment may
    include altered muscle
    activation patterns, proprioceptive deficit, postural balance or
    control
  8. Neck and referred pain
    reproduced by provocation of
    the involved cervical segments
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15
Q

ICF: Neck Pain w/ Movement Coordination Impairments
Acute if prognosis if for quick and early recovery

A
  1. Education: advice to remain
    active, act as usual
  2. Home exercise: pain-free
    cervical ROM and postural
    element
  3. Monitor for acceptable progress
  4. Minimize collar use
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16
Q

ICF: Neck Pain w/ Movement Coordination Impairments
Subacute if prognosis if for a prolonged recovery

A
  1. Education: activation and
    counseling
  2. Combined exercise: active
    cervical ROM and isometric
    low-load strengthening plus
    manual therapy (cervical
    mobilization or manipulation)
    plus physical agents: ice, heat,
    TENS
  3. Supervised exercise: active
    cervical ROM or stretching,
    strengthening, endurance,
    neuromuscular exercise
    including postural, coordination,
    and stabilization elements
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17
Q

ICF: Neck Pain w/ Movement Coordination Impairments
Chronic

A
  1. Education: prognosis,
    encouragement, reassurance,
    pain management
  2. Cervical mobilization plus
    individualized progressive
    exercise: low-load cervicoscapulothoracic strengthening,
    endurance, flexibility, functional
    training using cognitive
    behavioral therapy principles,
    vestibular rehabilitation,
    eye-head-neck coordination,
    and neuromuscular coordination
    elements
  3. TENS
18
Q

ICF: Neck Pain w/ Headache (cervicogenic)
Common Symptoms for ddx

A
  1. Noncontinuous, unilateral neck
    pain and associated (referred)
    headache
  2. Headache is precipitated or
    aggravated by neck movements
    or sustained positions/postures
19
Q

ICF: Neck Pain w/ Headache (cervicogenic)
Exam Findings for ddx

A
  1. Positive cervical flexion rotation test
  2. Headache reproduced with
    provocation of the involved
    upper cervical segments
  3. Limited cervical ROM
  4. Restricted upper cervical
    segmental mobility
  5. Strength, endurance, and
    coordination deficits of the neck
    muscles
20
Q

ICF: Neck Pain w/ Headache (cervicogenic)
ACUTE interventions

A

Exercise: C1-2 self-SNAG

21
Q

ICF: Neck Pain w/ Headache (cervicogenic)
SUBACUTE interventions

A
  1. Cervical manipulation and
    mobilization
  2. Exercise: C1-2 self-SNAG
22
Q

ICF: Neck Pain w/ Headache (cervicogenic)
CHRONIC interventions

A
  1. Cervical manipulation
  2. Cervical and thoracic
    manipulation
  3. Exercise for cervical and
    scapulothoracic region:
    strengthening and endurance
    exercise with neuromuscular
    training, including motor control
    and biofeedback elements
  4. Combined manual therapy
    (mobilization or manipulation)
    plus exercise (stretching,
    strengthening, and endurance
    training elements)
23
Q

ICF: Neck Pain w/ Radiating Pain (radicular)
Common symptoms for ddx

A
  1. Neck pain with radiating (narrow
    band of lancinating) pain in the
    involved extremity
  2. Upper extremity dermatomal
    paresthesia or numbness, and
    myotomal muscle weakness
24
Q

ICF: Neck Pain w/ Radiating Pain (radicular)
Exam findings for ddx

A
  1. Neck and neck-related radiating
    pain reproduced or relieved with
    radiculopathy testing: positive
    test cluster includes upper-limb
    nerve mobility, Spurling’s test,
    cervical distraction, cervical
    ROM
  2. May have upper extremity
    sensory, strength, or reflex
    deficits associated with the
    involved nerve roots
25
Q

ICF: Neck Pain w/ Radiating Pain (radicular)
ACUTE interventions

A
  1. Exercise: mobilizing and
    stabilizing elements
  2. Low-level laser
  3. Possible short-term collar use
26
Q

ICF: Neck Pain w/ Radiating Pain (radicular)
CHRONIC interventions

A
  1. Combined exercise: stretching
    and strengthening elements plus
    manual therapy for cervical and
    thoracic region: mobilization or
    manipulation
  2. Education counseling to
    encourage participation in
    occupational and exercise
    activity
  3. Intermittent traction
27
Q

CPR for Manipulation

A
  1. Symptom duration < 38 days
  2. Positive expectation that manipulation will help
  3. side to side difference in cervical range of motion > 10 deg
  4. Pain w/ P/A spring testing of cervical spine
28
Q

Cervicogenic Headache: what nerves converge at same place and what symptoms can they create that might accompany a cervicogenic headache?

A

C1-C3 and trigeminal afferent nerves all converge at same nucleus - so afferent signals coming from any of these can be interpreted by brain differently AKA can have TMJ pain, headache, or fullness in ear accompanied

29
Q

Cervicogenic Headache Diagnosis

A
  1. unilateral
  2. Aggravated w/ neck movements or sustained postures
  3. limited cervical ROM
  4. Pain w/ spring testing of C1/2
  5. Positive cervical flexion rotation test
  6. Strength/endurance deficits
30
Q

Cervicogenic Headache: Treatment

A

see Neck pain w/ headache cards

31
Q

Tension-Type Headache diagnosis

A
  1. Increased pericranial tenderness (facial and cervical muscles that increase in tenderness aka trigger points?)
  2. Bilateral
  3. Pressing/tightening
  4. Lasts minutes to days
  5. Does not get worse with physical activity
  6. Sensitivity to light or sound can be present, but only one at a time
  7. No nausea typically
32
Q

Tension-Type Headache: Treatment

A
  1. Aspirin/acetaminophen for acute headaches
  2. Acupuncture for prophylaxis
  3. Manual therapy
  4. Dry needling has shown significant findings but still needs more research
    10 occurrences needed for diagnosis
33
Q

Migraine Diagnosis

A
  1. Can occur with or without an aura
  2. Prodromal symptoms can occur prior to headache including:
    - fatigue, difficulty concentrating, sensitivity to light and sound, blurred vision, palor, nausea, yawning
  3. Lasts 4-72 hours
  4. Unilateral
  5. Pulsating quality, recurrent
  6. Aggravated w/ physical activity
  7. Moderate to severe pain
  8. Nausea and/or photophobia or phono-phobia
    with aura can have the prodromal symptoms and are connected w/ decrease in blood flow to brain
    need to have had 4 to diagnose
34
Q

Migraine Treatment

A
  1. PT = modulating symptoms
  2. Referral to specialist for migraines
35
Q

Cluster Headache Diagnosis

A
  1. Unilateral, severe to very severe pain
  2. Orbital, supraorbital, temporal
  3. Lasts 15-180 minutes
  4. Occurring from once every other day to 8x a day
  5. Ipsilateral nasal congestion, myosis, ptosis, restlessness, conjectival injection, rhinorrhea, eye lid edema, lacrimation, forehead and facial sweating
  6. Patients are unable to lie down typically
  7. Men>women
  8. Age 20-40
36
Q

Cluster Headache Treatment

A
  1. Oxygen + nasal triptan (AKA refer)
  2. symptom management
37
Q

CPR Cervical Myelopathy

A
  1. Gait disturbance
  2. Positive Babinski
  3. Positive inverted supinator test
  4. Positive Hoffman’s
  5. Age > 45
38
Q

CPR for cervical radiculopathy

A
  1. Positive spurlings A
  2. Positive ULTT A
  3. Positive distraction test
  4. Less than 60 deg cervical rotation on involved side
39
Q

CPR for cervical closed fracture

A
  1. Single
  2. Age < 55
  3. MOI involving trauma
  4. Acute condition
  5. Involved ER visit
40
Q

CPR for mechanical traction for neck pain

A
  1. Patient reported peripheralization with lower c-spine C4-C7 mobility testing
  2. positive shoulder abduction test
  3. Age > 55 years
  4. Positive ULTT A
  5. Positive distraction test
41
Q

CPR for thoracic manipulation for neck pain

A
  1. Looking up does not increase symptoms.
  2. No pain distal to shoulder
  3. Symptoms < 30 days
  4. FABQ-PA < 12
  5. Diminished upper thoracic spine kyphosis
  6. Cervical spine extension < 30 deg

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