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rule and pathways > neck pain CPG > Flashcards

neck pain CPG Flashcards

1
Q

what are the recommend neck pain classifications

A
  1. neck pain with mobility deficits
  2. neck pain with headaches
  3. neck pain with radiating pain
  4. neck pain with movement coordination impairments
    - level B evidence
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2
Q

what are the basic treatment recommendations for neck pain with mobility deficits

A

acute
- B - thoracic manipulation, ROM exercise, scapular and UE strengthening
- C - cervical manipulation or mobilisation
subacute
- B - neck and shoulder endurance exercise
- C - thoracic/cervical manipulation or mobilization
Chronic
- B - thoracic and cervical manipulation mobilization, mixed exercise for cervical and scapular region, aerobic exercise, dry needling, last or traction
- C - behavioral modifications

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3
Q

what are the basic treatment recommendations for neck pain with coordination impairments

A

acute
- B - Education to return to normal activities, reassurance they will improve in 2-3 months, minimal use of soft color, multimodal treatment intervention
Chronic
- Mulitmodel exercise program and eduction

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4
Q

What are the basic treatment recommendations for neck pain with headaches

A 
acute
- B - instruction in active mobility 
- C - Self SNAG exercise C1-2
subacute
- B - cervivcal manipulation and mobilization
- C - C1-2 SNAG
Chronic
- B - manipulation and cervicothoracic exercise
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5
Q

basic treatment recommendations for neck pain with radiating pain

A

acute
- C - mobilizing and stabilizing exercise, short term collar use
chronic
- B - intermittent traction with exercise and joint mobs, education and ergonomics

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6
Q

Describe the prevalence of neck pain

A
  • neck pain is common with 10-20% of general population and 2-11% lasting a years, 25% with re-occurrence and work comp rates slightly higher
  • globally the prevalence is increasing
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7
Q

What are the risk factors for development of neck pain

A
  1. female sex and prior history of neck pain are the strongest indicators
  2. older age, high job demands, smoking history, low social/work support and prior history of low back pain
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8
Q

What is the difference between risk and prognosis

A
  • risk is the factors associated with new onset

- prognosis is the predicated course of the condition after onset

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9
Q

What are the risk factors for developing new onset of neck pain

A

Primary - females with prior history of neck pain

secondary - older age, high job demands, smoking, low social/work support, prior history of low back pain

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10
Q

What is the difference between natural course and clinical course of a pathology

A

natural - course of recovery with no treatment intervention

clinical - course of recovery with treatment

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11
Q

What is the prognosis for the clinical course of recovery following WAD

A

most improvement occurs in the first 6-8 weeks, but recovery commonly takes a one half to one year for pain and greater than a year for function

  • the greater the initial symptoms the more longer the recovery and the lower the recovery expectations
  • mild problems full recovery
  • moderate problems partial recovery
  • severe symptoms poor recovery
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12
Q

What is the prognosis for clinical recovery for idiopathic neck pain

A

6-12 weeks

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13
Q

what are the risk factors associated with poor recovery following WAD

A
  1. high pain intensity (greater than 6/10)
  2. high self reported disability (greater than 30%)
  3. high post traumatic stress
  4. strong catastrophic beliefs (20 or greater)
  5. cold hyperalgesia
    NOT predictive were angular deformity of neck, impact direction, seating position in the vehicle, awareness of the impending collision, having a head rest, stationary versus moving, older age
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14
Q

What was the key recommendation regarding the pathoanatomical features/differential diagnosis of neck pain

A
  • Direct pathoanatomic causes of mechanical neck pain are difficult to identify
  • Test for RED flags, assess for potential serious pathologies such as infection, cancer, cardiac involvement, arterial insufficiency, upper cervical instability, unexplained cranial nerve dysfunction or fracture
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15
Q

who do your test for arterial insufficiency of the cervical spine

A
  • pemberton’s sign - facial plethora and venous engorgement were due to the clavicles moving and compressing venous vasculature against the enlarged thyroid and not to a “cork effect.”
  • Valsalva maneuver
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16
Q

Describe the subjective symptom history of the early presentation of internal carotid disease

A

Rushton 2014

  • mid to upper cervical disease
  • pain around the ear and jaw (carotidynia)
  • head pain (fronto-temporal-parietal)
  • ptosis
  • lower cranial nerve disfunction
  • acute onset of pain “unlike an other”
17
Q

describe the subject symptom history of the early onset of vertebrobasilar disease

A

Rushton 2014

  • mid-upper cervical pain
  • occipital headaches
  • acute onset of pain “unlike any other”
18
Q

describe the early subjective symptom history of upper cervical instability

A

Rushton 2014

  • neck and head pain
  • feeling of instability
  • cervical muscle hyperactivity
  • constant support needed for head
  • worsening symptoms
19
Q

How does the late presentation of ICAD, VBAD and UCI

A
  • ICAD - transient retinal dysfunction (scintillating scotoma [premigrane visual aura], amaurosis fagux [temp vision loss]), TIA and CVA
  • VBAD - Hind brain dysfunction (dizziness, dipolpia, dysarthia, dysphagia, drop attacks, fascial numbness, ataxia, vomiting, horarseness, loss of short term memory, hyptonia, anihidrosis of face, hearing distrubance ,malaise, perioral dysthesia, photophobia, papillary changes, clumbsiness and agitation)
  • UCI - (B) foot drop and hand dysthesia; feeling of lump in throat, metallic taste in mouth; arm and leg weakness, lack of coordination bilaterally
20
Q

What age group has the greatest risk of ICAD and VBAD

A

ICAD - 35-54
VBAD - greater than 55
Vaughn 2015

21
Q

What risk factors for cervical arterieal dysfunction does Vaughn 2015 identify

A

Acute onset unilateral cervical spine pain
• Acute onset occipital, frontal, supraorbital or temporal headache
• Current history of migraine (particularly without an aura)
• Past history of migraine (particularly without an aura)
• Family history of migraine
• History of cervical spine trauma (including minor or ‘trivial’ trauma)
• Onset of pain related to sudden cervical spine movement
• Tinnitus (particularly ‘pulsating tinnitus’)
• History of hypertension and risk factors for cardiovascular disease
• Recent upper and/or lower respiratory infection (within the previous week)
• Upper and/or lower extremity neurological symptoms and ataxia

22
Q

what evaluative procedures are recommend to determine risk of cervical arterial dysfunction prior to manual therapy

A
  • pretest positions
  • Blood pressure
  • cranial nerve exam
  • eye exam
23
Q

what are the upper cervical instability tests

A
  1. sharp-purser - transverse lig, slide C2 forward with head nod and pushing on SP of C2
  2. alar ligament - side bending of the head shoulder have contraleral motion of C2 SP
  3. transverse lig
  4. tectorial membrane
  5. atlantoaxial membrane
  6. clunking
24
Q

What outcomes tools are recommended for neck pain by the 2017 CPG

A

NDI and PSFS

25
Q

Assessment of ROM in cervical spine has what level of evidence for demonstrating clinical improvement

A

level I

26
Q

what is the normal ROM for upper cervical ROM

A

39-45 healthly
20-28 neck pain
degree difference left compared to right - neck pain

27
Q

what tests are recommended for testing for cervical radciulopathy

A 
level of evidence II
Rule-in with
- spurlings
- neck distraction
- valsalva
- shoulder abduction test - resting the hand on the head reduces symptoms 
Rule-out with
- ULTT-1
28
Q

what is the CPG prososed model for exam, dx, and treatment planning with neck pain

A
  1. medical screening to determine if appropriate for PT or requires referral to another provider
  2. MSK eval to identify impairments to help classify patient
  3. classification into acute, subacute and chronic condition to help determine levels of irritability
  4. treatment
29
Q

During the acute phase of neck pain with mobility deficits what region has the best evidence for treating with manual therapy

A

thoracic spine manipulation in conjunction with cervical, scapular and shoulder exercise

30
Q

what stage of neck pain of mobility deficits is dry needling recommended

A

chronic

31
Q

in what stage of neck pain with mobility deficits is scapular exercises recommended

A

all

32
Q

what pathology typically makes up the neck pain with coordination deficits categories

A

WAD

33
Q

how do the treatment recommendations differ in patient with neck pain with coordination impairment as it relates to their risk for chronicity

A
  1. low risk - should improve in 2-3 months - education regarding injury and encourage to maintain prior levels of function and should do well with a home based program
  2. unclear risk - requires closer monitoring and impairment based treatment program
  3. high risk for chronicity - concerted multimodal treatment programs including psychological consults
34
Q

IN what stage of neck pain with headaches is shoulder gurdle exercise recommended

A

chronic

35
Q

Acute neck pain with headaches CPG treatment recommendations

A

patient directed active mobility exercise and self SNAG of C1-2

36
Q

what stage of neck pain with headaches is manipulation recommended

A

subacute or lower levels of irritability

rule and pathways (3 decks)

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