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HOK 9 > Neck pain; Headache; Whiplash > Flashcards

Neck pain; Headache; Whiplash Flashcards

1
Q

Name 5 risk factors for neck pain.

A

Trauma

· Higher age

· Female

· Genetics

· Poor mental health

· High (work) stress

· Smoking

· Low work satisfaction

  • Strange working positions
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2
Q

Name 5 prognostic factors for neck pain.

A
  • Younger patients have better prognosis
  • Previous episodes of neck pain
  • Poor health
  • Psychological factors (anxiety, worry, frustration, negativity)
  • coping style
  • Work related complaints
  • Trauma related neck pain
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3
Q

Screening method - when do I refer to a GP/ when do I not refer?

A
  1. familiar pattern (‘a textbook example’) (not alarming: possibly physiotherapy)
  2. non-familiar pattern (alarming:GP)
  3. familiar pattern, one or more divergent symptoms
    (alarming: GP)
  4. familiar pattern, divergent development
    (alarming: GP)
  5. one or more red flags
    (alarming: GP)
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4
Q

What is the goal of the screening process?

A
  • is it worrisome / not worrisome
  • am I as a physio able to treat this patient?
  • -> for further physiotherapeutical process
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5
Q

Which structure/ rules should you consider when a patient had a trauma/ car accident?

A

Canadian spine rules

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6
Q

What is the objective of the Canadian spine rules?

A

They help to decide if radiography/GP is necessary

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7
Q

According to the Canadian spine rules, what do you do if the patient has a limited ROM (can only move up to 40°) in his neck in both directions after a trauma?

A

Radiography

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8
Q

Marta, 70 years old, had a frontal car crash with an other car. Keep / refer?

A

Refer, radiography is needed –> GP

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9
Q

Name 5 general red flags for patients with neck pain.

A
  • trauma
  • prolonged use of Corticosteroids
  • night pain
  • bowel problems/incontinence
  • weight loss (>5 kg/month)
  • hoarseness/ swallowing problems
  • non-mechanical pain
  • fever
  • structural misalignment
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10
Q

Which diagnostic groups does the KNGF neck pain guideline divide the patients into ?

A

Grade 1: neck pain with no ADL limitations
Grade 2: neck pain with ADL limitations
Grade 3: neck pain with neurological symptoms
Grade 4: serious pathology

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11
Q

Neck pain: After how much time is the course considered as ‘deviant’?

A

After more than 6 weeks, with no increase in activity level and increasing/persistent pain

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12
Q

Which treatment profiles for neck pain are mentioned in the KNGF guideline? Which treatment profile is used for which grade?

A

Treatment profile A –> Grade 1 +2
- informing & advising + motivate to stay active
Treatment profile B –> Grade 1+2
- informing, mobilizations + exercises
Treatment profile C –> Grade 1+2
-informing + exercising + focus on psycho-social factors
treatment profile D –> Grade 3
- informing (+about radiculopathies and movements) + exercising + mobilizations

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13
Q

Name 2 patterns of red flags for neck pain.

A

Example:

  • Cervical artery dysfunction: dizziness, nausea, weakness in limbs, double vision
  • Damage to cervical spinal cord: neurological symptoms in both arms and legs, loss of strength, sensory disorders, bowel & bladder dysfunction
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14
Q

Name 2 diagnostic tests for inclusion of grade 3 neck pain.

A
  • Spurling’s test
  • distraction test

–> best tests for inclusion radiculopathy: shoulder abduction test & distraction test

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15
Q

Name the diagnostic test for excluding grade 3 neck pain

A
  • ULTT
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16
Q

Which division did Waddell make for neck complaints?

A
  • specific neck complaints
  • radicular-type
  • other severe problems
  • non-specific neck complaints
  • at risk for developing chronicity
  • no risk of developing chronicity
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17
Q

Which 4 tests are included in the cluster of Wainner?

A

Cluster of Wainner

  • Active neck rotation (test is positive under 60°)
  • Spurling’s test
  • Distraction test
  • ULTT a (upper limb tension test A)
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18
Q

When the shoulder abduction test relieves the symptoms, what is this ‘sign’ called?

A
  • shoulder abduction relief sign

* Bakody’s sign

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19
Q

What can be the problem (with focus on the joint and muscles)causing non-specific neck complaints?

A
  • atherogenic
  • myogenic
  • movement function disorder/ hypomobility
  • motor control impairment/ muscular instability
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20
Q

In screening you distinguish between regular neck pain and…. (name 5 conditions)

A
  • facet joint Osteoarthritis
  • whiplash
  • work-related complaints
  • cervicogenic headache
  • radicular-type
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21
Q

What are 4 specific neck complaints according to Binder?

A
  • metastases
  • radiculopahty
  • stenosis
  • spondylolisthesis
22
Q

What is the best way of imaging for fractures and herniations in the cervical spine?

A
  • CT –> fractures

* MRI –> cervical disc herniation

23
Q

Anatomy cervical spine:

out of which ligaments is the lig. cruciatum composed?

A
  • lig. transversum atlantis

* lig. fasciculi longitudinale

24
Q

What is the name of the joint between C1 and the dens of C2?

A

Art. atlanto- ondotoideum

25
Q

Name the security tests:

A
  • Sharp purser test
  • short cervical flexion test
  • lateral shift test
26
Q

What are the main differences between Atlas and Axis?

A

Atlas: large processi transversi, very small processus spinosus, does not have a vertebral body,
upper joint surface - concave, lower joint surface - convex
Axis: Dens (for rotation of C1), big processus spinosus, weak processi transversi, fascies articularis anterior & posterior (articulation with C1) , fovea articularis superior & inferior.

27
Q

What are security tests for?

A

Testing for lig. transversum atlantis strain.

28
Q

What is the function of the ligg. alaria?

A 
Guiding rotation
(if rotation of the head to the right, the left alar ligament is stretched = inhibition)
29
Q

If the head is rotated to the right, the left lig. alare is stretched, which movement will relax it?

A

Lateral flexion to the same side (to the right)

30
Q

What is the joint called between C1 and C2? What is the main characteristic?

A

Art. Atlanto-axialis

- both joint surfaces are convex

31
Q

When a person does lateral flexion to the right, how does the movement look like for the atlas and the axis?

A
  • Atlas moves to the right

- Axis moves to the left

32
Q

What is the ROM division of flexion - extension in C0-C2?

A
  • 45° to each side
    29° of movement between C0-C1
    16° of movment between C1-C2
33
Q

Name 5 symptoms of cervical arterial dysfunction.

A
  • nausea
  • vomiting
  • dizziness
  • balance problems
  • headache
  • neck pain
34
Q

Which artery can cause cervical arterial dysfunction

A

Arteria vertebralis

35
Q

Name 3 risk factors for cardiovascular disease.

A 
High blood pressure
▫	Obesity
▫	Atherosclerosis
▫	Intervention/check-up by an internist/cardiologist etc.
▫	Use of Beta blockers
36
Q

Name 3 primary headaches.

A
  • Migraine
  • TTH
  • Cluster headache
37
Q

What is a primary headache and what is a secondary headache?

A

primary headache = unknown cause

secondary headache = known cause

38
Q

Where does the medication dependent headache belong to in the IHS classification?

A

secondary headaches

39
Q

Name a few characteristics about cervicogenic headache.

A
  • Unilateral “side locked”
  • Starts occipital
  • Not pulsating
  • Can be provoked
  • (Often) cerv. mov. limitation
  • Possible arm/shoulder pain (ipsilateral)
  • Possibly instability of high cervical spine
  • Hours up to weeks
  • 14-18% of all chronic headaches
  • Referral
40
Q

Which tests can be executed to determine if the headache is cervicogenic?

A
  • High cervical rotation test

* CCFT (cranio-cervical flexion test)

41
Q

Which movements happen during a a car accident resulting in whiplash?

A

neutral position –> hyper flexion –> hyper extension

42
Q

Name 3 causes for whiplash

A

Traffic accidents
sports
work accidents

43
Q

Name 6 symptoms of a whiplash.

A
  • Deafness
  • limited mobility in neck
  • Ringing ears
  • Headache
  • neck pain
  • Memory loss
  • Difficulty swallowing
  • Pain in the jaw joint (temporomandibular joint)
44
Q

What does WAD stand for?

A

Whiplash Associated disorders

45
Q

What is a Grade 2 in the WAD scale?

A

Neck complaints and complaints of postural and locomotor system

46
Q

What is the Risk assessment score for? Which components are tested?

A 
Risk of developing chronicity in neck pain after whiplash.
Tested are:
cervical active ROM
Neck/Head VAS
Number of non-pain symptoms
47
Q

What are risk factors for developing chronicity after a whiplash? Name some.

A
  • coping style
  • psychosocial factors
    (* influence external/ internal )
    • High baseline pain intensity (>5.5/10)
    • Headache from the start
    • Low level of education,
    • No seatbelt
    • Low back pain from the beginning
    • High Neck Disability Index score (> 14.5/50)
    • Neck pain before accident
    • Neck pain from the start (regardless of the intensity)
    • Catastrophising
    • Female
    • WAD grade 2 or 3
    • WAD grade 3 only
48
Q

When do we talk about late post whiplash syndrome?

A

when complaints get chronic / are still there after 6-12 months

49
Q

When is the recovery of whiplash defined as delayed?

A

no improvement of activities and functions within 4 weeks

50
Q

Explain the 5 phases of treatment for patients with whiplash.

A

• Phase 1 (- 4 days)
Reducing pain (possibly pain medication)
Reducing load bearing
Increasing knowledge and understanding
• Phase 2 (4 days - 3 weeks)
Improving function
Building up the load bearing step by step
Increasing knowledge and understanding
• Phase 3 (3 - 6 weeks)
Pain should no longer be central!
Expanding activities and participation up to a normal level
Stimulating an adequate way of handling the complaints
• Phase 4 (6 weeks - 3 months)
Continuation of phase 3
Stimulating participation at work
• Phases 5 - 6 (> 3 months)
Concluded when treatment goals have been achieved or no further recovery is expected.
In case of prolonged complaints, the chance of full recovery goes down.

51
Q

Diagnostic process for whiplash: which examinations can be useful?

A
  • testing balance
  • standing on one leg
  • tightrope walk test
  • posture
  • muscle tension
  • VAS
  • Neck diability index (NDI)
  • IPQK
  • 4DSQ

HOK 9 (6 decks)

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