Neck pain; Headache; Whiplash Flashcards
Name 5 risk factors for neck pain.
Trauma
· Higher age
· Female
· Genetics
· Poor mental health
· High (work) stress
· Smoking
· Low work satisfaction
- Strange working positions
Name 5 prognostic factors for neck pain.
- 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
Screening method - when do I refer to a GP/ when do I not refer?
- familiar pattern (‘a textbook example’) (not alarming: possibly physiotherapy)
- non-familiar pattern (alarming:GP)
- familiar pattern, one or more divergent symptoms
(alarming: GP) - familiar pattern, divergent development
(alarming: GP) - one or more red flags
(alarming: GP)
What is the goal of the screening process?
- is it worrisome / not worrisome
- am I as a physio able to treat this patient?
- -> for further physiotherapeutical process
Which structure/ rules should you consider when a patient had a trauma/ car accident?
Canadian spine rules
What is the objective of the Canadian spine rules?
They help to decide if radiography/GP is necessary
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?
Radiography
Marta, 70 years old, had a frontal car crash with an other car. Keep / refer?
Refer, radiography is needed –> GP
Name 5 general red flags for patients with neck pain.
- trauma
- prolonged use of Corticosteroids
- night pain
- bowel problems/incontinence
- weight loss (>5 kg/month)
- hoarseness/ swallowing problems
- non-mechanical pain
- fever
- structural misalignment
Which diagnostic groups does the KNGF neck pain guideline divide the patients into ?
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
Neck pain: After how much time is the course considered as ‘deviant’?
After more than 6 weeks, with no increase in activity level and increasing/persistent pain
Which treatment profiles for neck pain are mentioned in the KNGF guideline? Which treatment profile is used for which grade?
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
Name 2 patterns of red flags for neck pain.
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
Name 2 diagnostic tests for inclusion of grade 3 neck pain.
- Spurling’s test
- distraction test
–> best tests for inclusion radiculopathy: shoulder abduction test & distraction test
Name the diagnostic test for excluding grade 3 neck pain
- ULTT
Which division did Waddell make for neck complaints?
- specific neck complaints
- radicular-type
- other severe problems
- non-specific neck complaints
- at risk for developing chronicity
- no risk of developing chronicity
Which 4 tests are included in the cluster of Wainner?
Cluster of Wainner
- Active neck rotation (test is positive under 60°)
- Spurling’s test
- Distraction test
- ULTT a (upper limb tension test A)
When the shoulder abduction test relieves the symptoms, what is this ‘sign’ called?
- shoulder abduction relief sign
* Bakody’s sign
What can be the problem (with focus on the joint and muscles)causing non-specific neck complaints?
- atherogenic
- myogenic
- movement function disorder/ hypomobility
- motor control impairment/ muscular instability
In screening you distinguish between regular neck pain and…. (name 5 conditions)
- facet joint Osteoarthritis
- whiplash
- work-related complaints
- cervicogenic headache
- radicular-type
What are 4 specific neck complaints according to Binder?
- metastases
- radiculopahty
- stenosis
- spondylolisthesis
What is the best way of imaging for fractures and herniations in the cervical spine?
- CT –> fractures
* MRI –> cervical disc herniation
Anatomy cervical spine:
out of which ligaments is the lig. cruciatum composed?
- lig. transversum atlantis
* lig. fasciculi longitudinale
What is the name of the joint between C1 and the dens of C2?
Art. atlanto- ondotoideum
Name the security tests:
- Sharp purser test
- short cervical flexion test
- lateral shift test
What are the main differences between Atlas and Axis?
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.
What are security tests for?
Testing for lig. transversum atlantis strain.
What is the function of the ligg. alaria?
Guiding rotation (if rotation of the head to the right, the left alar ligament is stretched = inhibition)
If the head is rotated to the right, the left lig. alare is stretched, which movement will relax it?
Lateral flexion to the same side (to the right)
What is the joint called between C1 and C2? What is the main characteristic?
Art. Atlanto-axialis
- both joint surfaces are convex
When a person does lateral flexion to the right, how does the movement look like for the atlas and the axis?
- Atlas moves to the right
- Axis moves to the left
What is the ROM division of flexion - extension in C0-C2?
- 45° to each side
29° of movement between C0-C1
16° of movment between C1-C2
Name 5 symptoms of cervical arterial dysfunction.
- nausea
- vomiting
- dizziness
- balance problems
- headache
- neck pain
Which artery can cause cervical arterial dysfunction
Arteria vertebralis
Name 3 risk factors for cardiovascular disease.
High blood pressure ▫ Obesity ▫ Atherosclerosis ▫ Intervention/check-up by an internist/cardiologist etc. ▫ Use of Beta blockers
Name 3 primary headaches.
- Migraine
- TTH
- Cluster headache
What is a primary headache and what is a secondary headache?
primary headache = unknown cause
secondary headache = known cause
Where does the medication dependent headache belong to in the IHS classification?
secondary headaches
Name a few characteristics about cervicogenic headache.
- 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
Which tests can be executed to determine if the headache is cervicogenic?
- High cervical rotation test
* CCFT (cranio-cervical flexion test)
Which movements happen during a a car accident resulting in whiplash?
neutral position –> hyper flexion –> hyper extension
Name 3 causes for whiplash
Traffic accidents
sports
work accidents
Name 6 symptoms of a whiplash.
- Deafness
- limited mobility in neck
- Ringing ears
- Headache
- neck pain
- Memory loss
- Difficulty swallowing
- Pain in the jaw joint (temporomandibular joint)
What does WAD stand for?
Whiplash Associated disorders
What is a Grade 2 in the WAD scale?
Neck complaints and complaints of postural and locomotor system
What is the Risk assessment score for? Which components are tested?
Risk of developing chronicity in neck pain after whiplash. Tested are: cervical active ROM Neck/Head VAS Number of non-pain symptoms
What are risk factors for developing chronicity after a whiplash? Name some.
- 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
When do we talk about late post whiplash syndrome?
when complaints get chronic / are still there after 6-12 months
When is the recovery of whiplash defined as delayed?
no improvement of activities and functions within 4 weeks
Explain the 5 phases of treatment for patients with whiplash.
• 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.
Diagnostic process for whiplash: which examinations can be useful?
- testing balance
- standing on one leg
- tightrope walk test
- posture
- muscle tension
- VAS
- Neck diability index (NDI)
- IPQK
- 4DSQ
