Neck pain disorders Flashcards
traumatic neck pain disorders
Whiplash associated disorders
Post traumatic headache
non traumatic neck pain disorders
cervicogenic headache
secondary headaches
PTH, WAD, cervicogenic
primary headaches
migraines, tension type, trigeminal autonomic cephalagia
Cervicogenic headache - criteria
non-traumatic
disorders of the Cx spine
- imaging of lesion of Cx or neck soft tissue.
- 2 of:
* temporal development with onset of Cx disorder/lesion
* improvement is parallel to that of Cx lesion/disorder
*decreased Cx ROM, headache way worse w provocative manoeuvres
* abolished by diagnostic blockade
- can’t be explained by other classifications
Cervicogenic headache - symtoms
- side-lock pain BUT can be bilateral
- provoked by neck muscle palpation + head mvmt
PAIN PRECEEDS HEADACHE
Cervicogenic headache - diary
time
type
duration
intensity + areas
triggers
signs and symptoms (vision, diziness..)
Cervicogenic headache - obj findings
limited ROM - active and passive
impaired neuromsk performance - head lift off, craniocervical flxn, axio-scap muscle function)
Headache reproduced with manual assessment (PAIVMs with 2/10 pain + stiffness)
WAD - classification
NON TRAUMAIC
- developed within 7days of event.
- associated w neck pain at time.
0- no complaint or physical signs
I- neck pain, stiffness or tenderness only. no physical signs
II - neck pain AND MSK signs (decreased ROM, point tenderness)
III- neck complaint AND neurological signs (impaired tendonreflexes, weakness or sensory deficit)
IV- neck complain AND fracture/dislocation
WAD - aetiology
structural changes:
- inflammatory changes + ischemia
- increase fatty infiltration
- decrease CSA of suboccipital muscles
- change from slow to fast muscle fibres
- mechanical disruption of joint surface and muscle
WAD - physical assessment
sensorimotor system:
- Cx spine proprioception
- balance
- occulomotor
- coordination
neurodynamic system:
- central sensitisation
WAD management
restoring whatever has deficit:
-pain
- mvmt
- neuromuscular
- sensorimotor
- neural mechanosensitivity
- fear avoidance, low self efficacy
Concussion - mechanism of injury
forces applied to brain at high magnitude (60-100G).
Brain is shaken around = damage.
Brain chemistry of consussion
K+ out, Ca2+ and Na2+ in.
overdrive of ion channels
energy crisis as brian is deprived of blood from inflammation, bv damage, limited space.. BUT ATP needed for ion channels = depressed brain function (drowsy/drunk effect).
impaire mitochondria function = more celllular dysfunction
structural changes to axons
Concussion presentation
somatic - headache
cognitive - feeling foggy, slowed rxn time
balance - gait instability
behavioural changes - moody, irritable, sad..
sleep/wake changes - drowsiness
symptoms can take up to 48h to show - hence importance of coming off field (death from re-injury = herniation)
Concussion - exercise assessment and prescription
assessment via incremental aerobic: buffalo concussion treadmill test.
acute exercise prescription improves recovery.
use pacing (work to max intensity, decrease to 80-90% and work there for 20min/day, 5-6/week)
Concussion recovery
return to normal ADL (school, work before exercise)
MUST BE SYMPTOM FREE and medically cleared for full contact return.
must tolerate aerobic exercise, have normal baance and cognitive functioning
Vestibular system - function
to sense the movement of head and its position in space to identify self motion.
vestibular system - anatomy ear
outer - ear drum
middle - hearing bones
inner - canals and nerves (receive signals from middle ear.
vestibular system - semi circular canals
latera, post, anterior
each have an ampulla at the end, connected to the 8th N to brain.
sense movement of head relative to body (moving head around)
vestibular system - otolith organs
utricle and saccule
sense linear direction - elevator
otoconia - Ca2+ crystals
vestibular system -main 4 functions
gaze stability
postural stability
autonomic
orientation in space
postural stability
uses vestibulo-spinal reflex
for postural adjustments
causes adjustments to keep the head and upright posture - prevent falls
tests: static balance, dynamic balance & gait
gaze stability/dynamic vision
uses the vestibulo-ocular reflex (otolith, semi O canals)
stabilises vision during head mvmts
tests: head impulse test, dynamic visual acuity (letters reading w head mvmt
vestibular dysfunction -subj assessment
ask to describe dizziness
- type
- duration
- onset
- pattern
- imbalance
other symptoms - visual, hearing, nausea
vestibular dysfunction - obj assessment
Cx ROM to see if they can move their head in the positions needed to test canals.
oculomotor function - smooth pursuit, saccades
positional testing
dynamic visual acuity + head impulse test
balance and gait analysis
vestibular dysfunction - (peripheral) signs and symptoms
signs:
- nystagmus - fixed direction, horizontal, decreased fixation
- normal eye mvmt
- can walk
symptoms:
- sudden onset
- true vertigo
- episodic
- can have tinnitus/hearing loss
- head mvmt -provoked
Vestibular dysfunction - (central) signs and symptoms
signs:
- nystagmus - changing direction, vertical, increased fixation
- eye mvmts can be abnormal
- can lose walking ability
symptoms:
-gradual OR sudden onset
- vertigo/imbalance/light headache
- continual OR >50% of day
- less likely to have hearing loss
- 5D, 2N
5D, 2N
nausea, nystagmus
diplopia, dysphagia, dysarthria, dysmetria, drop attack
BPPV - def, signs and symptoms
benign paroxysmal positional vertigo
def: when otoconia from otoliths break off and lodges in canals.
frequency increases with age, head injury, inner ear infection.
signs:
- all normal except hall dix pike OR roll test
symptoms:
- intermittent vertigo
- sudden onset
- days- months
- no hearing/visual loss
Dix-Hall pike - procedure, function
test to diagnose BPPV
in long sitting, rotate head 45˚, sitting to supine quickly holding their head, extend head 20˚, observe nystagmus, wait until symptoms come on and see how long it takes to leave.
must be nystagmus for +ve test.
can be nauseous, dizzy - stay in position and eyes open.
test, tx, retest.
nystagmus direction:
- down in eye = anterior canal
- up in eye = post canal
Canalith repositioning manoeuvre/Eply - function, process
BPPV post canal.
check the suspected negative side first, then the positive one.
used to remove otoconia crystals from canals
80% effective in 1 tx for free floating ones.
go down in hall pike dix position, BUT do slowly, turn head 90˚ to side clearing, gently help roll on to side (eyes looking at floor), slowly sit up
(eyes open whole time)
RETEST
keep head neutral for 20mins
Roll test
testing BPPV - horizontal canal
supine, head flxn 20-30, quick turn to side to look for horizontal nystagmus and to other side.
+ve diagnosis = horizontal eye mvmt in head mvmt to both directions (one more than other).
duration + intensity of nystagmus and symptoms determine which side is affected.
canalith repositioning manoeuver/BBQ roll
BPPV tx - horizontal canal
supine w head turned to affected side, move to neutral, to other side, move onto stomach, back to supine (going in same direction). can do 3/4 and stand/sit up if able.
hold each for 30-60secs.
Vestibular rehab - obj ass findings
VOR (+ve head impulse test, reduced DVA, +/- symptoms)
balance (reduced mCSTIB/FGA score +/- symptoms)
motion sensitivity - MSQ
Vestibular rehab - aim, 3 mechanisms
aim for compensation of vestibular system.
3 mechanisms involved:
- adaptation - long term plastic changes in neural response to head mvmt.
- substitution - alternatice strategy to ahcive smt that was done by now damaged sys.
- habituation - repeated exposure to provocative stimulus to reduce response to it in long term.
Vestibular rehab training - VOR
gaze stability - adaptation
-VOR x 1 = head is moving, object still
- VOR x 2 both head and object moving (sports)
progressions: speed, duration, background, freq, target size/distance, position, envrmt/task specific
Vestibular rehab training - balance
static balance, dynamic balance, functional activities.
progress:
static - BOS, manipulation of somatosensory/visual cues, head motion.
dynamic - speed, direction, distance, BOS, head motion
function - envrmt, specific task related to goal
vestibular rehab training - habituation
exercise prescribed based on MSQ
- pick 4 activities and do them at an achievable intensity (don’t over do)
- symptoms should be 3/5 no more
