OCS Chap 2 Cervical Flashcards
what percentage of asymptomatic people over 65 years will demo degenerative changes in the cervical spine w/ imaging
57%
what are the 3 articulations of the AA joint
2 planar-type synovial joints between infer surfaces of lateral masses of C1 and superior facets of C2 and 1 pivot-type synovial joint of median AA joint between the dens of C2 and anterior arch of C1
What is the nuchal lig purpose
provides a broad expanse for attachments and therefore, larger muscular mechanical advantage
what does the transverse lig do
functions to hold the dens firmly anterior to the vertebral canal and against the anterior arch of the atlas, preventing dens going into spinal cord
what does the alar lig do
limit rotation and C to the occiput
with WAD clinicians can expect three types of recovery
mild problems w/ rapid recovery, moderate problems w/ some but incomplete recovery, severe problems w/ no recovery
five factors shown strong predictors of chronicity w/ WAD
1 - high pain intensity
2- high self reported disability
3- high pain catastrophizing
4- high acute posttraumatic stress symptoms
5- cold hyperalgesia
need to rule out (red flags)
spinal fx, vascular pathology, lig stability, malignancy
vertebral artery pathology presents mostly like
unilateral and around the occiput
internal carotid artery presents mostly like
bilateral and around the occiput
vertebrobasilar artery dissection signs
- unsteadiness, ataxia
- dysphagia, dysarthria, aphasia
- lower limb weakness
- upper limb weakness
- nausea, vomiting
- facial palsy
- dizziness, loss of equilibrium
- loss of consciousness
internal carotid artery dissection signs
- ptosis
- upper limb weakness
- facial palsy
- lower limb weakness
- dysphagia, dysarthria, aphasia
- unsteadiness, ataxia
- nausea, vomiting
- loss of consciousness
symptoms consistent w/ lig instability
headaches, severe suboccipital or other mm spasms, and fear and anxiety associated with head motion
head and neck cancer most dx
in men over age 50
most common complaint is neck pain
what can refer to the neck
lung and diaphragm
thymus gland
cardiac symptoms - anterior neck
minimum detectable change (MDC) w/ NDI
5/50 for uncomplicated neck pain and up to 10/50 for cervical radiculopathy
headaches in the forehead region can indicate
myofascial dysfunction in the cranio-occipital region or sinusitis
headaches in the occipital region can be caused
by variety of causes such as eye strain, hypertension, or craniomandibular dysfunction
cervicogenic headaches present
classic ram’s horn presentation
upper cervical segments refer pain
upward to the cranium
lower cervical segments refer pain
posterior girdle and less so down the arm
nociceptive (physiologic) input
refers to pain produced primarily by nociceptive afferents
peripheral neuropathic
refers to pain derived from disease of the somatosensory system
central nociplastic
pain that is not the result of peripheral input and could be considered similar to the term central sensitization
emotional/affective dysregulation or pathology
mood disorder, anxiety, depression, etc
maladaptive cognitions
illogical or incorrect beliefs related to pain, such as pain catastrophizing or altered beliefs as to the nature of or solution to the problem
socioenvironmental context
broad category - culture, ethnicity, willingness to report, access to care
sensorimotor dysintegration
describes altered input or disagreement between 2 different sensory inputs
loss of combined ext and rot movements might hint at what
degenerative changes at a facet joint
loss of rotation motion of the cervical spine can be associated w/
cervical radiculopathy
loss of motion in all directions w/ empty end feel can indicate
highly irritable condition
neck pain w/ mobility deficits have pain likely where
central or unilateral cervical that may or may not refer to the shld girdle and upper quarter
presents w/ limitation in neck motion that reproduces symptoms
cervical rotation lateral flex does what and for which category
neck pain w/ mobility deficits assess first rib mobility and cervicothoacic junction mobility
expected exam findings for neck pain w/ mobility deficits
limited cervical ROM, neck pain at end ranges, restricted cerivcal/thoracic segmental mobility, intersegmental mobility testing reveals characteristic restrictions, neck and referred pain reproduce w/ provocation of the involved cervical or upper thoracic segments or cervical mm
deficits in strength and motor control
neck pain w/ movement coordination impairments (WAD) common symptoms
MOI w/ trauma or whiplash
referred shld girdle or UE pain
varied nonspecific concussive signs/symptoms
dizziness/nausea
HA, concentration, or memory difficulties, confusion, hypersen to mechanical/thermal/acoustic/ordor/ or light
expected exam findings for neck pain w/ coordination impairments (WAD)
+ cranial cervical flex
+ neck flexor mm endurance test
+ pressure algometry
strength/endurance deficits
neck pain w/ mid range motion that worsens at end range
point tenderness
sensorimotor impairment
neck and referred pain reproduce by provocation of the involved cervical segments
neck pain w/ HA (cervicogenic) common symptoms
noncontinuous, unilateral neck pain and associated (referred) HA
HA is precipitated or agg by neck movements or sustained positions/postures
neck pain w/ HA expected exam findings
+ cervical flex rotation test
HA reproduced w/ provocation of the involved upper cervical segments
limited cervical ROM
resistriced upper cervical segmental mobility
strength, endurance, and coordination deficits of the neck mm
neck pain w/ radiating pain (radicular) common symptoms
neck pain w/ radiating (narrow band of lancinating) pain in the involved extremity
UE dermatome paresthesia or numbness and myotomal mm weak
neck pain w/ radiating pain expected exam findings
neck and neck related radiating pain reproduced or relieved with radiculopathy testing,
+ ULNT, + spurlings, +cervical distraction, + cervical ROM
may have UE sensory, strength, or reflex deficits associated with the involve nerve roots
WAD 1 defined as
neck complaints, with stiffness or tenderness in the neck region and no physical signs of injury
WAD 2 defined as
neck complaints w/ stiffness or tenderness and some physical signs of injury such as point tenderness or trouble turning the head
WAD 3 defined as
neck complaints with stiffness or tenderness and neurological signs of injury such as changes to reflexes or weakness in the arms
WAD 4 defined as
neck complaints with an associated neck fx or dislocation
poor recovery from a WAD associated with
mod to high initial neck pain intensity and neck related disability, high posttraumatic stress symptoms, high pain catastrophizing, low self efficacy and cold hyperalgesia
craniocervical flexion (CCF) test
assess the activation and endurance of the deep neck flexor mm group
5 bouts w/ 10 sec holds and 10 sec rest between (BP cuff inflated to 20 then each hold increases BP cuff by 2 so 22 then 24 then 26 etc)
neck flexor mm endurance test
measures the time duration a pt is able to lift and hold the head and neck off the table against gravity
algometric assessment of pressure pain threshold (PPT)
good test for pt may present with pain to non painful stimuli (allodynia) or exaggerated pain perception to painful stimuli (hyperalgesia)
lower values indicate a mechanical hypersensitivity to pain
cervicogenic HA
PTs treat this HA - craniocervical movement dysfunctions - present with a typical ram’s horn symptom pattern, radiating from the occiput anteriorly and laterally to the temporal region
present unilaterally and are related to changes in movement of the craniocervical spine and/or TMJ
present with ROM deficits, painful segmental mobility of the upper 3 cervical segments, weakness or impaired coordination of the deep flexor mm
which HA do not respond well to PT
tension type HA, cluster HA, migraine HA
cluster HA
sharp, stabbing, sudden HA that occur at night and are associated with ANS signs like watering eyes
migraine HA
entire head, present with aura at onset and are debilitating
chiari malformation
present as neck pain w/ HA
caused by herniation of the cerebellar tonsils through foramen magnum
cervical flexion-rotation test
assess upper cervical joint mobility (specifically C1-2)
passively move the neck into full flex then rotate
if ROM >45 deg is noted make sure flex was not lost or neck side flex occured
positive is less than 32 deg rot or 10deg difference from side to side
cloward sign
medial scapular border - pain or symptoms of numbness or tingling
cluster findings for cervical radiculopathy
limited ipsilateral cervical rotation less than 60 deg, positive ULNT A (median), positive spurlings, positive neck distraction test
ULNT A is the most sensitive so
could be used to rule out cervical radiculopathy when neg
valsalva test for cervical radiculopathy
pt bears down w/o exhaling to increase intrathecal pressure and elicit upper quarter symptoms
dont overload the cardiovascular symptom
intervention for neck pain w/ mobility deficits ACUTE
t-spine manipulation
c-spine manipulation/mobilization
cervical ROM, stretching, and isometric strengthening
advice to stay active plus HEP
supervised exercise
general fitness
intervention for neck pain w/ mobility deficits SUBACUTE
c-spine mobilization or manipulation
t-spine manipulation
cervicoscapulothoracic endurance exercise
intervention for neck pain w/ mobility deficits CHRONIC
t-spine manipulation
c-spine mobilization
combine cervicoscapulothoracic exercise plus mobilization or manipulation
mixed exercise
supervised individualized exercises
stay active
dry needling, low-level laser, pulsed or higher power US, intermittent mechanical traction, repetitive brain stimulation, TENS, electrical mm stimulation
intervention for neck pain w/ movement coordination impairments (WAD) ACUTE (if prognosis is for a quick and early recovery)
edu: advice to remain active
home exercise: pain free cervical ROM and postural element
monitor for acceptable progress
minimize collar use
intervention for neck pain w/ movement coordination impairments (WAD) SUBACUTE (if prognosis is for a prolonged recovery trajectory)
edu: activation and counseling
combined exercise: active cervical ROM and iso low-load strengthening plus manual therapy (cervical mob or manipulation), plus physical agents (ice, heat, TENS)
supervised exercise: active cervical ROM or stretching, strengthening, endurance, neuromuscular exercise including postural, coordination, and stabilization elements
intervention for neck pain w/ movement coordination impairments (WAD) CHRONIC
edu: prognosis, encouragement, reassurance, pain management
cervical mobilization plus individualized progressive exercise: low load cervicoscapulothoracic strengthening, endurance, flex, functional training using cognitive behavioral therapy principles, vestibular rehab, eye-head-neck coordination elements
TENS
intervention for neck pain w/ HA ACUTE
exercise: C1-2 self SNAG
intervention for neck pain w/ HA SUBACUTE
cervical manipulation/mobilization
exercise: C1-2 self SNAG
intervention for neck pain w/ HA CHRONIC
cervical manipulation
cervical/thoracic manipulation
exercise for cervical and scapulothoracic region: strengthening and endurance exercise w/ neuromuscular training, including motor control and biofeedback elements
combine manual therapy plus exercise
intervention for neck pain w/ radiating pain ACUTE
exercise mobilizing and stabilizing elements
low level laser
possible short term collar use
mobilizations are generally performed
in 2-3 bouts of 30 sec depending on patient response
intervention for neck pain w/ radiating pain CHRONIC
combine exercise and manual therapy (mobilization and manipulation)
education counseling to encourage participation in occupational and exercise activity
intermittent traction
cervical upglide
first motion is contralateral rotation until resistance then ipsilateral side flexion
cervical downglide
first motion is ipsilateral side flexion then contralateral rotation
patients who report HA symptoms in a seated activity w/ forward head posture
OA joint mobility
forward head posture tend to rest in OA ext and subsequently have limited OA flex
patients w/ deteriorating cervical discs that have extruding nuclear material may likely fall
cervical radiculopathy subgroup
non degenerative causes of cervical myelopathy
syringomyelia or tumor
cervical myelopathy occurs more frequently
over the age of 55, males, Asian descent
also present in 90% of individuals in their 7th decade of life
most sensitive test for cervical myelopathy
supinator sign
as most test have mod to high specificity but low sensitivity
cluster of 5 variables to dx cervical myelopathy
age over 45
positive Babinski
positive inverted supinator sign
positive Hoffmann
gait dysfunction
(if no positive findings then sensitivity of .94 w/ neg likelihood ratio of 0.18)
(if 3 or more positive likelihood ratio was 30.9 indicating a high probability for the condition to be present)
