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354 > Neck pain disorders > Flashcards

Neck pain disorders Flashcards

1
Q

traumatic neck pain disorders

A

Whiplash associated disorders
Post traumatic headache

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2
Q

non traumatic neck pain disorders

A

cervicogenic headache

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3
Q

secondary headaches

A

PTH, WAD, cervicogenic

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4
Q

primary headaches

A

migraines, tension type, trigeminal autonomic cephalagia

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5
Q

Cervicogenic headache - criteria

A

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

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6
Q

Cervicogenic headache - symtoms

A
  • side-lock pain BUT can be bilateral
  • provoked by neck muscle palpation + head mvmt
    PAIN PRECEEDS HEADACHE
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7
Q

Cervicogenic headache - diary

A

time
type
duration
intensity + areas
triggers
signs and symptoms (vision, diziness..)

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8
Q

Cervicogenic headache - obj findings

A

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)

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9
Q

WAD - classification

A

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

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10
Q

WAD - aetiology

A

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

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11
Q

WAD - physical assessment

A

sensorimotor system:
- Cx spine proprioception
- balance
- occulomotor
- coordination

neurodynamic system:
- central sensitisation

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12
Q

WAD management

A

restoring whatever has deficit:
-pain
- mvmt
- neuromuscular
- sensorimotor
- neural mechanosensitivity
- fear avoidance, low self efficacy

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13
Q

Concussion - mechanism of injury

A

forces applied to brain at high magnitude (60-100G).
Brain is shaken around = damage.

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14
Q

Brain chemistry of consussion

A

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

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15
Q

Concussion presentation

A

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)

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16
Q

Concussion - exercise assessment and prescription

A

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)

17
Q

Concussion recovery

A

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

18
Q

Vestibular system - function

A

to sense the movement of head and its position in space to identify self motion.

19
Q

vestibular system - anatomy ear

A

outer - ear drum
middle - hearing bones
inner - canals and nerves (receive signals from middle ear.

20
Q

vestibular system - semi circular canals

A

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)

21
Q

vestibular system - otolith organs

A

utricle and saccule
sense linear direction - elevator
otoconia - Ca2+ crystals

22
Q

vestibular system -main 4 functions

A

gaze stability
postural stability
autonomic
orientation in space

23
Q

postural stability

A

uses vestibulo-spinal reflex
for postural adjustments
causes adjustments to keep the head and upright posture - prevent falls

tests: static balance, dynamic balance & gait

24
Q

gaze stability/dynamic vision

A

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

25
Q

vestibular dysfunction -subj assessment

A

ask to describe dizziness
- type
- duration
- onset
- pattern
- imbalance
other symptoms - visual, hearing, nausea

26
Q

vestibular dysfunction - obj assessment

A

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

27
Q

vestibular dysfunction - (peripheral) signs and symptoms

A

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

28
Q

Vestibular dysfunction - (central) signs and symptoms

A

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

29
Q

5D, 2N

A

nausea, nystagmus
diplopia, dysphagia, dysarthria, dysmetria, drop attack

30
Q

BPPV - def, signs and symptoms

A

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

31
Q

Dix-Hall pike - procedure, function

A

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

32
Q

Canalith repositioning manoeuvre/Eply - function, process

A

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

33
Q

Roll test

A

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.

34
Q

canalith repositioning manoeuver/BBQ roll

A

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.

35
Q

Vestibular rehab - obj ass findings

A

VOR (+ve head impulse test, reduced DVA, +/- symptoms)
balance (reduced mCSTIB/FGA score +/- symptoms)
motion sensitivity - MSQ

36
Q

Vestibular rehab - aim, 3 mechanisms

A

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.

37
Q

Vestibular rehab training - VOR

A

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

38
Q

Vestibular rehab training - balance

A

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

39
Q

vestibular rehab training - habituation

A

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

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