Part B - Thoracic & Cervical Flashcards
known factors associated with neck pain
previous history neck pain female gender increasing age up to ~50 headache back pain
dizziness possibly cervical in origin
transient dizziness neck pain neck pain associated with dizziness limited cervical movement headache/upper limb symptoms nausea
dizziness that is non-cervical in origin
constant dizziness/vertigo feelings of being pushed to one side speech problems swallowing problems severe headache sight problems hearing problems blackouts/falls upper motor neuron signs and symptoms
symptoms associated with VBI
dizziness drop attacks diplopia dysarthria dysphagia nausea nystagmus
safeguards with cervical arterial dysfunction
always use progression of forces - test safety of movement and degree of force before progressing to end-range, overpressures or mobilization
lateral deviation of cervical spine (wry neck)
head and upper cervical spine is visibly and unmistakably shifted to one side
onset of deviation occurred with neck pain
patient is unable to correct deviation voluntarily
if patient is able to correct deviation they cannot maintain correction
_____ lateral deviation exists when the vertebra above has laterally flexed to the right in relation to the vertebra below, carrying the head with it
right
_____ lateral deviation exists when the vertebra above has laterally flexed to the left in relation to the vertebra below, carrying the head with it
left
differences in cervical anatomy when compared to lumbar
absence of intervertebral discs at occiput-C1 and C1-2
atypical vertebral bodies atlas and axis
uncinate processes forming uncovertebral joints (Luschka)
foramen transversarium in transverse process of C1-6 through which vertebral arteries pass
upper cervical
occiput - C2
mid and lower cervical
C2 - T1
cervical retraction
maximal upper cervical flexion and mid-range lower cervical extension
cervical protrusion
maximal upper cervical extension and mid-range lower cervical flexion
uncovertebral joints are best developed at what cervical levels?
C2-4
uncovertebral joints are least developed at what cervical levels?
C5-7
arthrosis of zygapophyseal and uncovertebral joints occurs most severely and frequently at what cervical levels?
upper and middle cervical levels
spondylosis of intervertebral disc occurs most severely and frequently at what cervical levels?
lower cervical levels (especially C5-7)
are sagittal plane movements or lateral movements explored first in the case of wry neck?
lateral movements
only the patient resolves their problem with self-management strategies in what syndrome?
postural
only the patient is able to provide the appropriate loading strategies with sufficient regularity to enable a remodeling of the structural impairment in what syndrome?
dysfunction
clues in history as to need for flexion principle in cervical derangement
anterior or antero-lateral symptoms
pain/problems with swallowing
pain on neck flexion
indications for use of the lateral principle in cervical derangement
negative response to sagittal plane movements
acute wry neck (much less common)
which side is explored first in a cervical derangement with lateral component, but no lateral deviation?
lateral procedures usually involve movements of the neck and head towards the side of pain
what is the only condition in which the deliberate provocation of distal symptoms can be permitted during the application of treatment?
adherent nerve root
what cervical movement is performed first when treating an ANR?
flexion
what test can be used to monitor improvements in cervical ANR?
ROM of the ULLT position
possible red flag indicators of serious pathology in headaches
progressive worsening of headache
recent severe onset ("thunderclap")
onset of headache after exertion
nausea and vomiting
history of major trauma
visual changes
preceding sore throat/respiratory infection
problems with speech/swallowingpossible clues to mechanical nature of cervicogenic headache
intermittent symptoms
symptoms associated with consistent activity
symptoms produced with sustained activity in one posture
what are the most commonest reductive forces for headaches caused by derangement?
upper cervical flexion (retraction or a combination of retraction and flexion)
what is the most commonest remodelling force for headaches caused by dysfunction?
upper cervical flexion and rotation (less common)
whiplash associated disorders (WAD) classification = 0
presentation in clinic?
no neck pain
no mechanical signs
whiplash associated disorders (WAD) classification = 1
presentation in clinic?
neck pain (stiffness or tenderness only) no mechanical signs
whiplash associated disorders (WAD) classification = 2
presentation in clinic?
neck pain and mechanical signs
whiplash associated disorders (WAD) classification = 3
presentation in clinic?
neck pain
mechanical signs and neurological signs
whiplash associated disorders (WAD) classification = 4
presentation in clinic?
neck pain and fracture or dislocation
