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OCS Preparation > Neck Review > Flashcards

Neck Review Flashcards

1
Q

Neck pain has become less or more common over the years?

A

More common

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2
Q

How many percent of people with neck pain will likely develop chronic symptoms?

A

Approximately 30%

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3
Q

What are some of the risk factors to develop neck pain?

(2 items)

A
  1. Female sex
  2. Prior history of neck pain
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4
Q

What are some other some possible risk factors for new onset of neck pain?

(5 items)

A
  1. Older age
  2. High job demands
  3. Smoking history
  4. Low social or work support
  5. Prior history of low back pain
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5
Q

In what area of neck pain there is the most study in relation to clinical course? Why?

A

Traumatic neck pain

Because most neck pain is of insidious onset and it is hard to determine the start date of the occurrence. (WAD for instance)

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6
Q

What are the 3 outcomes for the clinical course of patients with WAD?

A

45% mild disability and post-traumatic stress (quick and complete resolution)

40% moderate disability and post-traumatic stress (some improvement, but incomplete recovery)

15% of individuals severe disability and post-traumatic stress (chronic problems without recovery)

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7
Q

What is the time-frame for the most progress in individuals with WAD?

A

6 to 12 weeks following the injury.

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8
Q

What are the main prognostic constructs to keep in mind for neck pain?

(Factors that might influence how well a patient recovers)

A
  1. High pain intensity
  2. High self-reported disability
  3. High pain catastrophizing
  4. High acute post-traumatic stress symptoms
  5. Cold hyperalgesia
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9
Q

How should pain be measured and what score indicates a poor prognosis?

A

VAS or NPRS
Scores greater than 6/10 indicate a poor prognosis

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10
Q

How is “high self-report disability” assessed in cases of neck pain? What is the cutoff score?

A

Neck Disability Index (NDI)
Greater than 30% indicates poor prognosis

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11
Q

How should “High pain catastrophizing” be assessed for neck pain?

A

Pain catastrophizing scale
Score of 20 or greater indicates poor prognosis

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12
Q

How should “High acute post-traumatic stress symptoms” be measured in neck pain and what is the cut-off score?

A

Impact of even scale revised
Score of 33 or greater indicates poor prognosis

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13
Q

How should “Cold hyperalgesia” be assessed with neck pain and what are the cut-off scores?

A

Cold presser test (hand in ice water/ice cube in the skin)
No cut-off scores present.

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14
Q

Does scoliosis or other change in ambulation affect neck pain prognosis?

A

It has not been shown to demonstrate significant change in prognosis.

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15
Q

Does impact direction and seating position in the vehicle influence the neck pain prognosis in traumatic neck pain?

A

It has not been shown to demonstrate significant change in prognosis.

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16
Q

Does awareness of an impending collision influence the neck pain prognosis in traumatic neck pain?

A

It has not been shown to demonstrate significant change in prognosis.

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17
Q

Does older age, having a head rest in place or being stationary vs moving influence the neck pain prognosis in traumatic neck pain?

A

It has not been shown to demonstrate significant change in prognosis.

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18
Q

Cook et al. have described a clinical prediction rule to help identify possibility of myelopathy, what are the 5 items in that CPR?

A
  1. Gait disturbance
  2. Positive Hoffman’s test
  3. Positive inverted supinator sign
  4. Positive Babinski test
  5. Age over 45 years
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19
Q

From the Cook et al. CPR - which involves the following items (1) Gait disturbance (2) Positive Hoffman’s test (3) Positive inverted supinator sign (4) Positive Babinski test (5) Age over 45 years -
having 3/5 of these tests demonstrates a high likelihood ratio. Approximately how much is that +LR?

A

+ LR of 30

20
Q

From the Cook et al. CPR - which involves the following items (1) Gait disturbance (2) Positive Hoffman’s test (3) Positive inverted supinator sign (4) Positive Babinski test (5) Age over 45 years -
having 4/5 of these tests demonstrates a high likelihood ratio. Approximately how much is that +LR?

A

Infinite likelihood ratio and a post-test probably of 99%

21
Q

Upper cervical ligamentous instability risk factors

A

Congenital collagenous issues (Down syndrome / Ehlers-Danlos Syndrome) Throat infection
Inflammatory arthritis conditions (Rheumatoid arthritis/Ankylosing spondylitis)

Recent, neck, or dental surgery

22
Q

Red flags for cervical instability

(4) Items

A

Signs and symptoms such as

  1. Needing to hold head up
  2. Feeling of instability
  3. Severely limited ROM
  4. Signs of cervical myelopathy
23
Q

Red flags for cerebrobasilar and carotid artery insufficiency.

A

Watch for cardiovascular symptoms such as:

  1. HTN
  2. HX of TIA
  3. Clotting disorders
  4. And systemic issues that might cause damage to arteries: DM or prolonged steroid use
  5. Signs of TIA or CVA
24
Q

What do the 5 Ds and 3 Ns stand for?

A

Ds: Dizziness, Diplopia, Disarthria, Drop attacks, Disphagia

Ns: Nausea, Nistagmus, and Numbness (face)

25
Q

What are some systemic issues (constitutional signs) which could be serious pathology for the spine and neck?

A

Fever, elevated blood pressure and fatigue

26
Q

What are the 4 classifications for the treatment based classification.

A

Neck pain with mobility deficits

Neck pain with movement coordination impairments

Neck pain with radiating pain

Neck pain with headaches

27
Q

What is the most studied outcome measure for neck problems?

A

Neck disability index (NDI)

28
Q

What are the cut-off scores for the NDI?

A

0-8% - No disability (0-4 points)

10-28% - Mild disability (5-14 points)

30 - 48% - Moderate disability (15-24 points)

50-64% - Severe disability (25 to 34 points)

70-100% - Complete disability (35-50 points)

29
Q

What are the MDC and MCID for the NDI?

A

5 points (10%)

30
Q

What were the 5 classification from the 2004 CPG for neck pain?

A

Mobilization/Manipulation

Exercise and conditioning

Centralization and traction

Pain control

Headache

31
Q

For neck pain what is considered acute in the staging phase of the CPG?

A

Less than 6 weeks.

32
Q

What time-frame is considered sub-acute for the neck CPG?

A

6-12 weeks

33
Q

For how long does pain have to be present at the neck to be considered chronic?

A

12 weeks or greater.

34
Q

What are common symptoms for neck pain with mobility deficits?

(Things the patient reports)

A

Central and/or unilateral neck pain

Limitation in neck motion that consistently reproduce symptoms

Associated or referred shoulder girdle of UE pain

35
Q

What are common examination finds for neck pain with mobility deficits?

A

Limited cervical range of motion

Neck pain reproduced at end range of active/passive ROM

Restricted cervical and thoracic segmental mobility

Neck and referred pain reproduced with provocation of the involved cervical or upper thoracic segment or cervical musculature

36
Q

What are common examination findings for subacute and chronic neck pain with mobility deficits?

A

Deficits in cervical, scapular and thoracic strength and motor control.

37
Q

What are common treatments for neck pain with mobility deficits?

(In all phases)

A

Level B

Thoracic manipulation

Supervised neck ROM, stretching and isometric exercises

Scapulothoracic upper extremity stretching and strengthening

Cervical manipulation/mobilization (Level C)

38
Q

What are recommended treatments for neck pain with mobility deficits subacute phase?

A

Level B

Neck and shoulder girdle endurance exercises

Thoracic manipulation and cervical manipulation (level C)

39
Q

What are recommended treatments for neck pain with mobility deficits chronic phase?

A

Multi-modal approach:

Thoracic manipulation, cervical manipulation/mobilization

Mixed exercises for cervical and scapulothoracic region including neuromuscular training, stretching, strengthening, endurance, aerobic conditioning

Cognitive effective strategies

Modalities (Dry needling, laser or intermittent traction)

40
Q

CPR for cervical spine manipulation from 2012.

4 items

A

Symptoms duration less than 38 days

Positive expectation towards manipulation

Cervical ROM difference in cervical rotation of 10º or more

Pain or PA spring testing of the middle cervical spine

3/4 specific and sensitive to identify positive results.

41
Q

What are common symptoms for neck pain with headaches?

Things the patient feels

A

Non-continuous unilateral neck pain

With associated or referred headache

A headache that is precipitated or aggravated by neck movements or sustained postures/positions

42
Q

What are common exam findings for neck pain with headaches?

A

Positive flexion rotation test

Headaches reproduced with provocation of the involved upper spine segment test

Limited cervical range of motion

Restricted upper cervical mobility

Strength, endurance and coordination deficits of the cervical muscles (positive cranial cervical flexion test)

43
Q

Cervical flexion rotation test: what are the cut-off scores?

A

Positive test

Less than 32º

or

10º difference side to side in visually estimated ROM

44
Q

What are common treatments for neck pain with headaches?

Acute:

A

Supervised active mobility exercise

C1-C2 Self SNAG (Leve C)

44
Q

What are common treatments for neck pain with headaches?

Acute:

A

Supervised ROM

Self SNAG (level C)

45
Q

What are common treatments for neck pain with headaches?

Sub-acute:

A

Cervical manipulation/mobilization

C1-2 self snag

46
Q

What are common treatments for neck pain with headaches?

Chronic:

A

B level

Combination of cervical or cervico-thoracic manipulation/mobilization

and

Shoulder girdle and neck strengthening, as well as stretching and endurance exercise

OCS Preparation (7 decks)

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