Neck Pathology Flashcards
dens fracture defn and complications
fracture at base of dens
causes posterior displacement which leads to spinal cord injuries in 15% of patients
delayed healing or nonunion common d/t poor blood supply
cervical muscle strain defn and complications
exertion, overstretching, overuse injury –> tight muscles and tight paraspinals. most resolve spontaneously.
causes tension headaches d/t compression of greater occipital nerve by tight paraspinals
loss of lordosis due to paraspinal spasm and associated shortening
dens fracture causes and dx
most common upper cervical spine fracture
car accidents and falls
open mouth X-ray most sensitive, lateral for posterior displacement
dens fracture tx
surgery and bracing
cervical muscle strain causes and dx
most common cause of cervical muscle pain, caused by stress, awkward positions, repeatedly looking up and down, overstretching
physical exam - tightness/spasm, paraspinal tightness/spasm, loss of lordosis
cervical muscle strain tx
ice, NSAIDs, and bracing for acute. heat for subacute. PT and ergonomics for chronic.
atlantoaxial instability defn and complications
increased motility of atlantoaxial joint (arch and dens) d/t ligament laxity (usually transverse ligament)
posterior displacement of dens, may compress spinal cord (cervical myelopathy)
even relatively minor neck injuries can cause total displacement, paralysis or death - must catch early in high risk patients
atlantoaxial causes and dx
structural damage from trauma or chronic inflammation (e.g. rheumatoid arthritis)
connective tissue disorders (EDS, Down’s, Marfan’s…)
should be suspected in high risk patients and those with progressive neuro deficits
dx by X-ray (lateral)
risky activities: intubation, high impact exercises, neck manipulations…
atlantoaxial tx
surgery with rigid bracing while awaiting surgery
pain relief
***early detection
scoliosis defn and complications
lateral curvature of spine, mainly in thoracic and lumbar regions. C or S shape
scoliosis causes and dx
usually idiopathic, commonly onsets in early adolescents, 7x more likely to progress and require surgery in women
may onset in adults d/t bone injury or ddd
spinal asymmetry especially noticeable on bending, pain on affected side, higher ribcage and scapula on affected side, reactive muscle spasm
scoliosis tx
pain management
intervention needed at >10% deviation
in kids, brace at 20-30% and monitor progression until bones are fully developed (only prevents progression)
> 40% deviation, breathing impairment, rapid worsening –> surgical fixation
ddd defn and complications
aging/loss of flexibility of intervertebral disks - fewer proteoglycans and more collagen in the nucleus pulposa (center bit) –> excessive pressure on vertebral endplates
sclerosis of vertebral endplates –> osteophytes, tears in annulus fibrosis (bit surrounding he nucleus pulposa)
facets don’t align properly due to uneven pressure, ligament weakening, muscle spasm to make up for it
complications: radiculopathy, disk herniation
dermatomes relevant in cervical radiculopathy
C5, C6, C7: lateral parts of upper limbs (+C5 clavicles)
C6, C7, C8: hand
C6: Thumb
C7: index and middle finger
C8: ring and little finger
C8, T1: medial parts of upper limbs
ddd causes
aging, excess pressure or activity, leaning head, trauma
for lumbar- excess weight, sitting
ddd dx: clinical presentation, physical exam, imaging and how these differ from similar conditions
midline pain worsened with activity
if facet involvement, pain worse on extension
loss of lordosis
paraspinal spasm and tenderness - no tenderness directly over spine
normal to limited ROM
no special exam
plain films - narrowed disk space, osteophytes, endplate sclerosis
MRI - desiccated disks
ddd tx
NSAIDs
opioids if severe
if severe pain with any movement, consider spinal fusion
PT focused on releasing and strengthening paraspinals
cervical disk herniation defn and complications
nucleus pulposa breaks through annulus fibrosis
usually posteriolateral due to typical anterior head movements
complications: radiculopathy or myelopathy (spinal cord compression)
cervical disk herniation causes
…
cervical disk herniation dx: clinical presentation, physical exam, imaging and how these differ from similar conditions
midline and/or paraspinal tenderness paraspinal spasms loss of lordosis decreased ROM if no radiculopathy or myelopathy, normal neuro exam
cervical radiculopathy to upper extremities, along a specific myotome and causing muscle weakness and diminished reflexes
if myelopathy: weakness to upper extremities, weakness and/or spasticity/increased tone to lower extremities –> abnormal gait. hyperreflexia below level of compression.
if nerve root compression, positive spurling’s compression test (turn head and push down)
CT and MRI to confirm
cervical disk herniation tx
surgical
cervical radiculopathy defn and complications
compression or injury to spinal nerve roots, most commonly due to osteophytes or herniated disk
compression within spinal canal due to inflammation also possible
dorsal vs ventral involvement determines dermatome (paresthesias), myotome (weakness), or both
cervical radiculopathy causes
…
cervical radiculopathy dx: clinical presentation, physical exam, imaging and how these differ from similar conditions
paresthesias and/or weakness (w/ possible loss of reflexes)
paraspinal spasms
limited ROM d/t pain or abnormal sensation
local tenderness to paraspinals but not to affected extremities
Spurling’s compression test: turn head and push down to reproduce symptoms
EMG to determine degree and root level of involvement
imaging not always warranted except to determine cause
cervical radiculopathy tx
Tylenol, NSAIDs
neuropathic drugs (AEDs, antidepressants)
cervical traction (if not contraindicated) and stretching
heat and ice for spasm
epidural corticosteroids
if severe, consider surgery for underlying cause
sudden onset neck pain ddx
most common: muscle strain
common in hx of ddd: disk herniation
not uncommon in hx of recent trauma: dens fracture
can’t miss in high-risk pts: atlantoaxial instability with acute displacement
gradual onset neck pain without paresthesias ddx
most common:
muscle strain (d/t chronic factors e.g. ergonomics, stress)
ddd
possible: scoliosis
can’t miss in high-risk pts: atlantoaxial instability without acute displacement
gradual onset neck pain with paresthesias ddx
most likely:
ddd with radiculopathy
chronic muscle strain with paraspinal spasm around spinal nerve
